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Case work interviewing methods in a child guidance setting : an analysis based on records of privately… Glover, Ernest Geoffrey 1951

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CASE WORK INTERVIEWING METHODS IN A CHILD GUIDANCE SETTING An Analysis Based on Records of P r i v a t e l y Referred Cases f o r l°l4.8 - 19i>0 i n The Gui l d Guidance C l i n i c at Vancouver by ERNEST GEOFFREY GLOVER Thesis submitted i n p a r t i a l f u l f i l m e n t of the requirements f o r the Degree of MASTER OF SOCIAL WORK i n the School of S o c i a l Work. 1951 The U n i v e r s i t y of B r i t i s h Columbia ABSTRACT This study concerns i t s e l f with the s o c i a l worker's contribution to the services of the P r o v i n c i a l C h i l d Guidance C l i n i c i n Vancouver. The focus i s on the interviewing methods of the worker as a f a c t o r i n treatment. The analysis i s derived from case records of l l j l p a t i e n t s admitted f o r service i n 1°U8 and ~L9k9 , as w e l l as from one case record admitted f o r service i n 193>0 which i l l u s t r a t e d the worker's methods i n interviewing. A preliminary review v:;t.s made of the evolution of s o c i a l case work interviewing over the l a s t 20 years and 13 methods v;are derived. The i n t e g r a t i o n of s o c i a l case work and mental health services i s drawn from l i t e r a t u r e on s o c i a l case work and c h i l d guidance published i n the United States. The nature of interviewing by s o c i a l workers at the c l i n i c i s seen i n r e l a t i o n to the c l i n i c ' s program of diagnosis and t r e a t -ment. The examination of records.for a two year period indicate®' that diagnosis v.w.s a large part of the c l i n i c a l program. About 38 percent of l l j l cases discontinued t h e i r contact with the c l i n i c immediately a f t e r the diagnostic conference. About 89 percent of interviewing c a r r i e d out by s o c i a l workers was on a short-term b a s i s and the proportion of treatment interviewing on an advanced intensive scale was f i v e percent. The study of selected cases indicatesthat the s o c i a l worker could contribute more to the services i n the area of intensive case Y/ork interviewing. L i m i t a t i o n s on h i s capacity to do so may have been imposed by imperfect p h y s i c a l f a c i l i t i e s . Mothers received I4I percent of the interviews i n l l j l cases as compared with 31 percent with the c h i l d and nine percent with f a t h e r s , ^here i s a need f o r greater i n t e r p r e t a t i o n to f a t h e r s of t h e i r importance to the c h i l d ' s emotional development. ihe type of case work interviewing being done with some adults seems, to i n -dicate that future development i n the program might w e l l include them w i t h i n i t s focus. A suggestion i s made that more purpose and d i r e c t i o n may be given to treatment i f workers are more conscious of t h e i r s k i l l s . Ihe agency would be able to meet i t s r e s p o n s i b i l i t i e s to community more su c c e s s f u l l y i f increased appropriations were made. TABLE OF CONTENTS Chapter 1 . Evolution of Case Work IntervieYsdng Methods 1 S o c i a l Case Work and Interviewing 1 Evolution of Interviewing 3 "Insights"and "Actions" k P sychoanalytic.Knowledge 5 Relationship Therapy 5 Passive Technique 6 Attitude Therapy 6 Thirteen Methods Derived 8 Chapter 2 . Case Work Interviewing i n C h i l d Guidance 16 Integration of S o c i a l Work and C h i l d Guidance 16 Vancouver C l i n i c 16 Problems Referred 18 Diagnostic Process 20 32 32 3k 35 36 37 38 38 39 ko la U2 U6 k9 51 Chapter 5. Interviewing as Treatment 56 Contribution of s o c i a l case work interviewing to the C h i l d Guidance C l i n i c 56 Methods of interviewing 60 Broad purposes of treatment interviewing 63 Recommendation 61| Bibliography 65 Chapter 3. Case Worker's Methods Encouragement to Talk Moving with the c l i e n t Information given • Guiding Motivating Aiding expression of f e e l i n g Acceptance of f e e l i n g P e r s o n a l i t y strength in «j C l a r i f y i n g Holding to frame of reference Rechannelling Interpreting Setting Lirr>i{s. Chapter J+. Methods As a Factor i n Treatment Methods as e a r l y treatment D e f i n i t i o n of the helping s i t u a t i o n Acceptabce of s e l f Working through emotional c o n f l i c t C l a r i f i c a t i o n of fundamental issues Signs of p e r s o n a l i t y growth TABLES Page Table 1 - Interviews Held with C h i l d , Father, and Others 19 Table 2 - Frequency of Interviews i n Each Case bhown By Problem or Service Grouping 21 Table 3 - Cases Showing Number of Interviews Held A f t e r Diagnostic Conference by Problem or Service Grouping 23 ^able k - Cases Shoring Number of Interviews Held Before Diagnostic Conference by Problem or Service Grouping 2k Table $ - Cases Showing Number of Interviews with Parent of G h i l d by In t e l l i g e n c e Quotient 28 Table 6 - Cases ^howing Number of Interviews with the C h i l d by I n t e l l i g e n c e Quotient 29 Table 7 - Interviews Held at C l i n i c , Home, Outside the C l i n i c and Home, by Telephone 30 • 1 . CHAPTER 1 . EVOLUTION OF CASE WORK INTERVIEWING METHODS The interview in social case work has emerged as a special means of help to individuals in conflict with their social environ-ment. It stands beside environmental manipulation as another method employed by the social case worker in bringing the individual and his environment into harmony. This accomplishment i s often the result of both approaches, the treatment of the personality through skilled interviewing as well as the lessening of external pressures by environ-mental manipulation. One technique does not take the place of the other and the fact that interviewing i s under consideration here does not mean that i t is felt to be more important. Both techniques are integral parts of social case work, each has particular value, and often one cannot be effective without the other. Interviewing involves a close and subtle relationship between human beings, and s k i l l in conducting this relationship i s increased by a case worker's specialized knowledge of human behaviour, and his training in how to influence that behaviour. The fact that attention concentrated on the development of skills in interviewing should not suggest the removal of the human element from the process. On the contrary i t i s felt that there can be no substitute for the warm friend-liness and real interest in other individuals which has for so long been the case worker's approach. An informed person does not have to be an unfriendly one. The worker-client relationship in the interview i s often an intensification of the usual positive and negative feelings between (^GARRETT, Annette, Interviewing. Its Principles and Methods. Family Service Association of America, New York, N.Y., 19U2, p. b. • 2. e persons. The positive feelings are b u i l t around the helping situation i n which a client may talk with someone who does not judge him or c r i t i c i z e , nor impose his advice or controlj his interest i s simply in helping the client with his d i f f i c u l t y . In these circumstances and with a lack of real knowledge about the interviewer the client often tends to idealize him. The opposite situation may also arise independently of the interviewer's character. Because of the client's own anxieties, insecurity, and deprivations the worker may be endowed with negative characteristics. The worker i n these situations i s required to control the nature and intensity of this feeling i f possible,in the interests of treatment. Interviewing i n social case work i s more than a conversation between two people. Unlike the census taker who only wants an answer to his questions, the case work interviewer seeks information about the problem to be solved and sufficient understanding of the person and his d i f f i c u l t y to give effective help. Infonnation may also be handed out, as for example to parents of the children brought to a child guidance c l i n i c . As an interview becomes less a means of meeting special heeds and more a way of helping the individual to make fundamental changes i n attitudes, i t may be classified as treatment interviewing. In this sense i t becomes clear that interviewing may become very much a s k i l l . The functions of the agency determine the type of help an interviewer can give as well as the sort of information he needs i n order to help. He may want to obtain the kind of information needed to give medical aid, guidance or r e l i e f , to assist i n child-placing or employment. He i s guided i n each instance by the needs of the case, and those factors which may l i m i t his a b i l i t y to help,such as the agency (^GARRETT, Annette, Interviewing, Its Principles and Methods, Family Service Association of America, New York, N.Y., 19U2, p. 19. function, h i s personal c a p a c i t i e s as w e l l as those of h i s c l i e n t . The development of interviewing has been c l o s e l y l i n k e d to the development of case work, and i t i s p o s s i b l e to see i n the evolution of s o c i a l case work the growth of the p r i n c i p l e s and methods of the interview. One of the f i r s t major changes i n s o c i a l case work was that from philanthropy to a profession based on a body of s c i e n t i f i c knowledge While the interview became more of a p r o f e s s i o n a l s k i l l , i t continued, as d i d case work, to bear the traces of the e a r l i e r movement under c h a r i t y organizations. S o c i a l case work, with i t s beginning i n the c h a r i t y movements i n England and the United States, had concentrated on the economic needs of the underprivileged, and had attempted to give help through the en-vironment. Interviewing had taken place i n "house v i s i t a t i o n s " , an i n v e s t i g a t i o n i n t o e l i g i b i l i t y f o r material r e l i e f . Behind the c h a r i t y movement there had been a philosophy l i k e that expressed by George B. Buelle. ... we are bound always to respect the d i g n i t y with which he (the i n d i v i d u a l ) i s invested as a self-governing being. However e f f i c i e n t our service may be i t i s a service of help. I t must not encroach upon the.freedom or r e s p o n s i b i l i t y of our brother whom we would help.'W Here was the idea of service f o r others, the fundamental. d i g n i t y of the i n d i v i d u a l and h i s r i g h t to s e l f determination. There i s not much difference between t h i s passage and one w r i t t e n i n 1939 by Gordon H a m i l t o n . " C a s e work ... respects h i s ( i n d i v i d u a l ' s ) r i g h t (^GARRETT, Annette, Interviewing, I t s P r i n c i p l e s and Methods, Family Service A s s o c i a t i o n of America, New York, N.Y., 19U2, p. 26. (WBUZELLE, George B., I n d i v i d u a l i t y i n the Work of Charity, Proceedings of the National Conference of lbb6, p. Ib7, 188. (^HAMILTON, Gordon, S o c i a l Work Year Book f o r 1939, p. U08, U09. t o s o l v e h i s own p r o b l e m s w i t h w h a t e v e r h e l p t h e w o r k e r c a n g i v e h i m ; c a s e w o r k s e e k s t o r e l e a s e c a p a c i t i e s i n t h e p e r s o n a n d u t i l i z e r e -s o u r c e s i n t h e e n v i r o n m e n t . . . e f f e c t i v e change depends o n t h e c l i e n t ' s w i l l i n g n e s s t o change-." We r e c o g n i z e i n t h e s e c o n c e p t s some f u n d a m e n t a l s o f i n t e r v i e w i n g , t h e i d e a o f s e r v i c e t o a n i n d i v i d u a l who i s f r e e t o c h o o s e how he u s e s i t , b u t r e g a r d l e s s o f how he u s e s t h e s e r v i c e , he i s a c c e p t e d a s a human b e i n g w i t h c e r t a i n r i g h t s a n d p r i v i l e g e s . A n o t h e r b a s i c change i n t h e d i r e c t i o n o f c a s e w o r k h e l p was s e e n i n t h e s h i f t o f i n t e r e s t a t t h e b e g i n n i n g o f t h e c e n t u r y away f r o m e x t e r n a l p r o b l e m s t o w a r d t h e i n c l u s i o n o f p e r s o n a l i t y d i f f i c u l t i e s , a t t e m p t s t o s t r e n g t h e n i n d i v i d u a l s t o s e l f - h e l p . Then, i n 1 9 2 2 , M a r y R i c h m o n d , one o f t h e b e s t known c o n t r i b u t o r s t o t h e g r o w t h o f a p r o -f e s s i o n a l s e r v i c e , n o t e d t h a t a l l c a s e w o r k h a d two f e a t u r e s i n common, w h a t she c a l l e d " I n s i g h t s " a n d " A c t i o n s " . I n s i g h t s w e r e t h e f e a t u r e s y i e l d i n g u n d e r s t a n d i n g o f i n d i v i d u a l i t y and t h o s e y i e l d i n g k n o w l e d g e off t h e i n f l u e n c e o f s o c i a l e n v i r o n m e n t . A c t i o n s w e r e t h o s e f e a t u r e s m a r k i n g t h e i n f l u e n c e o f m i n d u p o n m i n d i n w h a t i s t o d a y c a l l e d t h e w o r k e r - c l i e n t r e l a t i o n s h i p . I n d i r e c t a c t i o n s were t h o s e i n f l u e n c e s e x e r t e d t h r o u g h t h e s o c i a l e n v i r o n m e n t . R i c h m o n d t h e n made two d i v i s i o n s , c o n s i s t i n g o f t h e k n o w l e d g e a w o r k e r h a d a b o u t p e o p l e i n r e l a t i o n t o t h e i r e n v i r o n m e n t , and w h a t t h e w o r k e r d i d w i t h t h a t k n o w l e d g e ; t h a t i s , t h e o r y a s compared w i t h p r a c t i c e . A f u r t h e r i n d i c a t i o n o f t h e t r e n d away f r o m e x t e r n a l p r o b l e m s a l o n e ^ t o w a r d a c o n c e n t r a t i o n o n p e r s o n a l i t y d i f f i c u l t i e s c a u s i n g e x t e r n a l p r o b l e m s , w a s t h e e m p h a s i s o n h i s t o r y t a k i n g i n t h e 1 9 2 0 ' s . T h i s w a s p a r t o f t h e t h i n k i n g w h i c h s t r e s s e d t h e c o n c e p t o f m u l t i p l e c a u s a t i o n , ( 6 ) G L E N N , M a r y W i l l c o x , The G r o w t h o f S o c i a l Case Work i n t h e U n i t e d  S t a t e s , f r o m R e a d i n g s i n S o c i a l Case W o r k , 1 9 2 0 - 3 8 , e d i t e d b y F e r n L o w r y , p u b l i s h e d f o r t h e New Y o r k S c h o o l o f S o c i a l W o r k , C o l u m b i a U n i v e r s i t y P r e s s , New Y o r k , 1 9 3 9 , p . 1 8 7 - 8 8 . 5. and workers f e l t that i f they could get enough information about the f a c t o r s involved i n a problem they would also have the means of solving i t . S o c i a l work was therefore ready to make use of the new psychoanalytic knowledge which had gained the a t t e n t i o n of profess-i o n a l people toward the end of the decade. I t was e s p e c i a l l y u s e f u l since requests f o r help often involved p e r s o n a l i t y adjustment and inter-personal r e l a t i o n s h i p s . Within the interview case workers learned to l i s t e n , to detect and understand clues the c l i e n t gave to his^conscious f e e l i n g s . They noted the a s s o c i a t i o n of one i d e a with respect to another. They became aware of the parental surrogate r o l e which the worker often took on i n the mind of the c l i e n t , and con-s c i o u s l y u t i l i z e d t h i s r o l e i n treatment.. Worker's were helped to recognize b e t t e r the reasons f o r the c l i e n t ' s resistance to treatment and to gain s k i l l i n meeting a t t i t u d e s that blocked progress. Two phases of developments taking place were the s p e c i a l i n t e r e s t i n the study of interviewing techniques and the worker's s k i l l , and the care-f u l study of a c l i e n t ' s emotional response i n h i s r e l a t i o n s h i p s . In the next few years there arose terms apparently designating new functions i n case work interviewing, " r e l a t i o n s h i p therapy", "attitude therapy" and the "passive technique". Relationship therapy^?) grew out of the circumstances bringing worker and c l i e n t together. In the process of the c l i e n t ' s s o l u t i o n to h i s problem, the worker came to represent to the c l i e n t another person who had been i n close r e l a t i o n s h i p to him i n the past. He tended to re-enact ^ t h o u t r e a l i z i n g i t , h i s o r i g i n a l f a m i l y r e l a t i o n s h i p s . In working out h i s problems with the case worker he tended to work through (7) v 1' Originated i n P h i l a d e l p h i a under leadership of the s t a f f of the Pennsylvania School of S o c i a l Work. French, L o i s Meredith, P s y c h i a t r i c S o c i a l Work, The'Qmmohvrealth Fund, New York. 6. some of the patterns of f e e l i n g which were h i s ways of adjusting to d i f f i c u l t i e s i n the f a m i l y s i t u a t i o n . Relationship of c l i e n t and worker was therefore regarded not only i n terms of external need and service but also as a cause of basic changes i n the nature of the c l i e n t ' s socio-emotional r e l a t i o n s h i p s . At one time the passive technique was generally applied i n case work to a l l c l i e n t s . At i t s best t h i s method was employed when a c l i e n t showed a capacity f o r accepting h i s own emotional problem and wished to face d i r e c t l y the d i f f i c u l t i e s r e l a t e d to other persons. The worker assumed a r o l e described as "passive", the c l i e n t t a l k i n g f r e e l y , b r i n g i n g up any information concerning h i s past experience which was s i g n i f i c a n t to him. He reacted as he f e l t , the worker r e -f r a i n i n g from praise or blame, d i r e c t advice and judgmental a t t i t u d e s . The c l i e n t could express resentment, h o s t i l i t y or any other strong, f e e l i n g s without being subjected to the emotional responses which such expression u s u a l l y evoked from others. The c l i e n t was often able to face d i f f i c u l t i e s i n h i s s o c i a l r e l a t i o n s h i p s , to understand the part h i s own emotional reactions played i n preventing h i s adjustment and through expression of them to work toward a more e f f e c t i v e handling, of them. However, there was l i t t l e awareness of which c l i e n t s could, and which could not^be helped i n t h i s way, and the technique l e d to the concept that no help was given unless a c l i e n t v e r b a l i z e d the need. Attitude therapy was i n i t i a t e d by Dr. David Levy at the I n s t i t u t e of C h i l d Guidance i n New York c i t y . I t was an attempt to influence the emotional a t t i t u d e s of parents so as to b r i n g about a change i n the c h i l d ' s emotional environment. The main task of t r e a t -ment devolved on the s o c i a l worker who had to work out means of helping the mother i n order to ensure a b e t t e r adjustment f o r the c h i l d . How-ever, the mother's'own problems often had to be dealt with before progress 7. could be made i n t r e a t i n g the c h i l d w i t h i n the c l i n i c a l s e t t i n g . As a r e s u l t , the former d i v i s i o n of labour which l e f t treatment to the p s y c h i a t r i s t and environmental manipulation to the s o c i a l worker,was broken down. The l a t t e r also had to develop treatment s k i l l s to meet emotional needs. In t h i s l a t e r stage of development a t t i t u d e therapy was applicable only to those i n d i v i d u a l s who i n d i c a t e d a desire to change and were able to p a r t i c i p a t e . I t was not applied where d i r e c t suggestions brought r e s u l t s or where a simple change i n environment brought a successful adjustment. Out of t h i s development grew the f i r s t general concept of case work as i n d i v i d u a l therapy through a treatment r e l a t i o n s h i p . In the l a r g e r f i e l d of s o c i a l work interviewing was showing f u r t h e r adaptations of p s y c h i a t r i c methods. Bertha Reynolds wrote -The case worker helps the c l i e n t to meet s o c i a l demands understandingly, counsels him so as to stimulate h i s maximum e f f o r t on h i s own behalf, f i l l s i n where h i s knowledge i s l a c k i n g and opportunities are meagre and where courage would f a i l without a r e l a t i o n s h i p of con-fidence with an understanding p r o f e s s i o n a l person. S o c i a l case work helps the c l i e n t to see the r e a l i t y of s o c i a l demands more c l e a r l y , and to choose among them with b e t t e r understanding of what he i s doing. Another important addition to case work interviewing was that represented by J e s s i e T a f t ' s statement concerning the greater merits of a treatment plan i n i t i a t e d by the c l i e n t rather than the worker. She said -One must accept one's f i n a l l i m i t a t i o n s and the r i g h t of the other, perhaps h i s necessity, to refuse help, to take help on h i s own terms, not as a t h e r a p i s t , f r i e n d s or society might choose ... knowledge and s k i l l a v a i l nothing unless they are accepted and used by the other. ( 9 ) (8)REYNOLDS, Bertha C , An Experiment i n Short-Contact Interviewing. North Hampton, Smith College, School of S o c i a l Work, 1932, p. 11 . (9)TAFT, J e s s i e , The Dynamics of Therapy i n a Controlled Relationship, New York, MacMillan, 1933, p. 3-5. 8 The Pennsylvania School of S o c i a l Work contributed by drawing attention to the rendering of a service i n response only to the c l i e n t ' s request, m o b i l i z i n g the c l i e n t ' s w i l l and energies around the problem he presented to the agency. This technique corresponded to one described by workers outside t h e i r group simply as "beginning where the c l i e n t i s " . ^ ^ ) Present day case work interviewing is,then, a combination of the p r i n c i p l e s and methods of case workers of e a r l i e r days. The methods were defined and redefined i n p r a c t i c e and d e f i n i t e i n t e r -viewing methods have emerged as s k i l l s to help a c l i e n t through t r e a t -ment. The methods to be discussed here are not n e c e s s a r i l y the only s k i l l s used by workers, and i t i s l i k e l y that t h i s l i s t may be incom-p l e t e . However, the methods are those which seem to have come Yout of the development of case work, most of which are seen i n a p p l i c a t i o n as some of the s k i l l s of the s o c i a l case worker i n a c l i n i c a l s e t t i n g . ( H ) Such techniques as were observed may conceivably reach f u r t h e r d e f i n -i t i o n and e l a b o r a t i o n ' s experience here and i n other places adds to present knowledge. Methods which seem to have emerged i n a study of the h i s t o r y of s o c i a l case work interviewing are i d e n t i f i e d ( 1 2 ) as the encourage-ment, to t a l k , moving with the c l i e n t , g i v i n g information, guiding, motivating, aiding expression of f e e l i n g , accepting f e e l i n g , person-a l i t y strengthening, c l a r i f y i n g , holding to the frame of reference, re e n a m e l l i n g , i n t e r p r e t i n g , s e t t i n g l i m i t s . ( 1 0 ) GARRETT, Annette, Interviewing. I t s P r i n c i p l e s and Methods, Family Service Association of America, New York, N.Y., 19U2, p. 3o. ( 1 1 ) This study i s based on work done by case work interviewers at the P r o v i n c i a l C h i l d Guidance C l i n i c i n Vancouver. want of b e t t e r terms, methods are i d e n t i f i e d d e s c r i p t i v e l y . 9 S o c i a l workers learned e a r l y i n the evolution of case work interviewing to l i s t e n s e n s i t i v e l y to the c l i e n t ' s request f o r help and to make a d e f i n i t e statement of t h e i r own desire to help within the l i m i t s of t h e i r q u a l i f i c a t i o n s . In the beginning they helped a c l i e n t to deal with the problem about which he came o r i g i n a l l y to the agency, making c l e a r to him what help the worker could o f f e r , what she could not o f f e r , and the conditions under which help was given. Before the influence of p s y c h i a t r i c thinking was f e l t i n s o c i a l work a c l i e n t v/as encouraged to t a l k i n order to make ava i l a b l e the information needed to help him. With the adaptation of p s y c h i a t r i c thinking however, at t e n t i o n was focused on the p e r s o n a l i t y of the c l i e n t as an avenue of help and the encouragement to t a l k assumed wider meaning. I t was used throughout the treatment process i n a form of question varying from general to s p e c i f i c , by gestures of encouragement or by remaining s i l e n t . A general opening gave the c l i e n t freedom to t a l k of what seemed to him most important, u s u a l l y pointing the way to h i s more fundamental attitudes and f e e l i n g s as we l l as giving information about himself i n a t o t a l s i t u a t i o n . Related to t h i s method was the worker's capacity to move  with the c l i e n t i n treatment. A general question was worded i n such a way that the c l i e n t could take up the discu s s i o n i n h i s own way or turn the question o f f unanswered i f he wished. (13) The c l i e n t ' s view of h i s immediate needs was made use of, and the. p a r t i c i p a t i o n gained by t h i s method was often a strengthening influence since the c l i e n t had a chance to take the i n i t i a t i v e i n discussion. At the beginning of treatment the c l i e n t i n d i c a t e d where discussions should begin by t a l k i n g of a s p e c i f i c problem. When t h i s had been dealt with (13) The c l i e n t might choose not to take up discussion around a general-question i f he were too anxious, about the area i t seemed to i n d i c a t e , i f he wanted to deal with a t o p i c quite unrelated, or i f he d i d not understand how the question pertained to discussion. 10 he often l e d the discussion i n t o more fundamental causes of h i s d i f f i -c u l t y or other areas of tension, u n t i l the c h i e f area of disturbance had been uncovered and dealt with. This method placed a burden on c l i e n t s who had d i f f i c u l t y i n v e r b a l i z i n g t h e i r desire f o r help. The t r a i n e d worker was able to read the true meaning of a c l i e n t ' s e n t i r e system of expression i n -cluding speech, mannerisms and b o d i l y tensions. Her s e n s i t i v i t y to these signs helped her to decide when i t was best to do something f o r the c l i e n t and when she should encourage the c l i e n t to act f o r himself. Workers f e l t that the c l i e n t had the r i g h t to determine the course of h i s own l i f e , to p a r t i c i p a t e i n treatment or not, as he wished. The P h i l a d e l p h i a School f e l t case workers d i d not have the r i g h t to make a diagnosis while f a c i n g the c l i e n t i n an interview because of the l i k e l i h o o d of b i a s entering i n t o the evaluation. Workers of the dynamic point of view gave diagnosis and evaluation a d e f i n i t e place i n t h e i r interviews, agreeing that new information could change the i n i t i a l diagnosis as they moved through treatment. Giving information to the c l i e n t could take on d e f i n i t e value f o r treatment when i t was given i n r e l a t i o n to h i s needs and f e e l i n g s ; information about himself, h i s problem, the treatment process, and resources outside the agency. In c h i l d guidance c l i n i c s the worker's capacity f o r transmitting with s e n s i t i v i t y the i n f o r -mation about a c h i l d ' s behaviour t o the parent .was of primary importance. The effectiveness of work with parents depended to a great extent on giv i n g information when the c l i e n t was ready f o r i t ^ and i n a form that could be used by him. Guiding during the interview was used by workers i n the 1920's to keep the c l i e n t on the subject of the immediate need. The method was f u r t h e r defined a decade l a t e r as workers moved away from 11. the use of the passive technique toward more active worker p a r t i c i p a t i o n i n the interview, contributing the worker's knowledge and experience i n add i t i o n to h i s p a r t i c i p a t i o n i n the r e l a t i o n s h i p . Motivating described a p a r t i c u l a r act i n treatment by the worker, not only encouraging the c l i e n t to continue and p a r t i c i p a t e , but also i n d i c a t i n g to him the d i r e c t i o n treatment and p e r s o n a l i t y growth could take. This was an i n t e r p r e t a t i o n of the process of t r e a t -ment based on what had been achieved and what r e a l i s t i c a l l y could be expected to take place i n p e r s o n a l i t y growth. By aiding theexpression of f e e l i n g to an accepting person workers sought to give r e l i e f from tension when i t was h e l p f u l to the treatment process. This method^W was u s e f u l where a c l i e n t was troubled by f e e l i n g s of anxiety, inadequacy and defeat. I t was noted that an anxious c l i e n t who expressed h i s f e e l i n g to someone able to understand h i s anxiety but who could remain calm, increased the c l i e n t ' s confidence once the pressure of f e e l i n g had been r e l i e v e d . I n advanced stages of treatment a c l i e n t could be helped to " r e - f e e l " emotional experiences of the past by discussing them i n the interview with, or without understanding of t h e i r r e a l meaning. With the i n t e r -viewer's support ;the c l i e n t might be helped to see p a i n f u l memories of the past i n t h e i r true meaning. Even i f the c l i e n t d i d not achieve understanding of himself, r e - f e e l i n g i n the presence of strong emotional support helped to overcome o l d f e a r s . The separate act of accepting f e e l i n g which was e i t h e r p o s i t i v e or negative^was d i f f e r e n t than the measures taken to a i d expression of ( l ^ T h e r e s u l t s of t h i s method were c a l l e d c a t h a r s i s i n p s y c h i a t r i c terminology. (^HOLLIS, Florence, S o c i a l Case Work i n P r a c t i s e . Family Welfare Association of America, New York, 1939, p. 302. 12. feeling. Worker's noted in the later 1930's^as the importance of feelings were continual!y emphasized in case work interviewing, that the client seemed to make definite progress in treatment after having expressed positive or negative feeling in relation to the problem. His expression, did not bring down on him the interviewer's criticism, blame or praisej he could be himself safely. The permissiveness of the worker seemed to direct the attention of the client toward his feeling and he was often able to understand i t in a state uncomplicated by the need to satisfy another person. The method was of value where the worker helped a client who had failed to make f u l l use of indirect and socially acceptable methods of expression. The client was helped to express verbally his socially unacceptable feelings, relieving the pressures of impulses built up by repression, and the worker indicated by attitude and words that i t was a l l right to do so in this setting. Personality strengthening had been used intuitively by workers since case work began, and more scientifically as the effects were studied in later years. This method was the act of drawing the client's attention to a particular personality strength. The worker might refer to successful experiences for which the client was himself responsible or to personality attributes which were actually present or latent in him. Expressions of confidence and encouragement were always based on reality. A corollary of this technique was the accept-ance of the client's personality weaknesses. The method differed from the over-all supportive process known to case work and described by Lucille Austin as a supporting of strengths, a dynamic rather than a static process including ... "reassurance, permissive attitudes that relieve.guilt, and a protective relationship along with work in the 13. environment and use of s o c i a l services when ind i c a t e d . " (1^) Clarifying(17) . was the worker's v e r b a l i z a t i o n of a c l i e n t ' s discussion i n order to b r i n g out c l e a r l y h i s r e a l meaning, The worker might then r e l a t e the a t t i t u d e , f e e l i n g or opinion to r e a l i t y f a c t o r s , depending on the c l i e n t ' s capacity to accept the f a c t s . Often, the mere v e r b a l i z a t i o n of the c l i e n t ' s true meaning was s u f f i c i e n t to help him achieve i n s i g h t i n t o u n r e a l i s t i c b e l i e f s and a t t i t u d e s . He was l e f t f r e e to accept the interviewer * s v e r b a l i z a t i o n or not, depending upon h i s own state of readiness. Holding to the frame of reference was a method which con-sidered the discussion i n d i r e c t r e l a t i o n to the current problem, helping to mobilize energy i n the immediate area of need. As t r e a t -ment progressed the c l i e n t ' s own d e f i n i t i o n of h i s need might change as tensions were suc c e s s f u l l y worked through, and new ones were con-sidered. The new area of tension became the new frame of reference during discussions. This method was f i r s t emphasized by the Pennsyl-vania School of S o c i a l Work, and was l a t e r adopted by workers i n other centres.(1^) Rechannelling was a l a t e r d e f i n i t i o n of the steps taken to help the c l i e n t f i n d acceptable o u t l e t s f o r p a r t i c u l a r repressed im-pulses. When a c l i e n t had i d e n t i f i e d these impulses, accepted them and i n d i c a t e d a desire to express them i n more s o c i a l l y acceptable ways, the best means of accomplishing t h i s was discussed and encouraged by the worker. ( l 6)AUSTIN, L u c i l l e N. , Trends i n D i f f e r e n t i a l Treatment i n Case Work. Proceedings of the National Conference of S o c i a l Work, I9I4.8, p. 271. U7)lt d i f f e r e d from c a l l i n g a t t e n t i o n to a frame of reference since t h i s l a t t e r was a r e f e r r a l to the core of the problem while c l a r i f i c a t i o n could be applied to any part of discussion which was unclear. (1^)This technique has been c a l l e d focusing by some workers, but with confusion as to whether the frame of reference was the problem o r i g i n a l l y b r i n g ing the c l i e n t to the agency, or another taking the place of one s u c c e s s f u l l y d e a l t with. l l i . The worker r a r e l y i n t e r p r e t e d r e l a t i o n s h i p s , a t t i t u d e s , and b e l i e f s handicapping a c l i e n t because she could not be c e r t a i n that the c l i e n t was ready to see i n t o the deeper recesses of h i s per-s o n a l i t y . I t was more common i n advanced treatment to make te n t a t i v e statements i n a step by step c l a r i f i c a t i o n so that ideas could be taken up or r e j e c t e d by the c l i e n t who could not bear them. In c e r t a i n s i t u a t i o n s the worker found i t necessary to set l i m i t s i n the treatment process. Workers i n some settings made use of t h i s technique i n d e f i n i n g sharply the area of help a v a i l a b l e i n the agency. This was the concept of strengthening the w i l l and meeting r e a l i t y by accepting the l i m i t s of agency f u n c t i o n . (-^) The group of workers c a l l i n g themselves the Dynamic School also made use of t h i s method i n noting how the c l i e n t used the l i m i t s around the time and place of the interview, how he reacted to giving required information f o r the s o c i a l h i s t o r y , and h i s acceptance of such l i m i t a t i o n s as are imposed i n a r e l a t i o n s h i p with a p r o f e s s i o n a l person. Besides f a c t o r s named above c h i l d r e n i n the interviewing s i t u a t i o n were l i m i t e d i n the amount of damage they could do to equipment, and the violence they could express on the worker's person. The method was of value with c h i l d r e n whose needs i n t r a i n i n g were i n t h i s area. Immature adults who had never learned to use l i m i t s and those with s p e c i a l problems i n r e l a t i o n to authority were also able to b e n e f i t from l i m i t s set w i t h i n a treatment r e l a t i o n s h i p . An attempt has been made to define some of the more common interviewing methods emerging from several decades of case work p r a c t i e e . The f a c t that p a r t i c u l a r methods have been singled out should not (19)The Phi l a d e l p h i a School was the f i r s t to draw attention to the possible use of agency fu n c t i o n i n t h i s way. 15. suggest that they are ever i s o l a t e d completely i n the dynamics of the interview. On the contrary, methodology i s only one of the means by which the case work interview achieves i t s purpose. Methods alone are recognized as i n e f f e c t i v e u n t i l they are applied by the worker who i s by nature warm, sympathetic and sincere. The aim of de f i n i n g methods i s to help give a be t t e r s e r v i c e . The f o l l o w i n g chapter i s a study . of the ways i n which the case «ork interviewer contributes to services given by the C h i l d Guidance C l i n i c of Vancouver. 16, CHAPTER 2. CASE WORK INTERVIEWING IN CHILD GUIDANCE A primary i n t e r e s t of s o c i a l case workers has been t h e i r effectiveness i n giving help, and they have constantly re-examined methods i n order to give a b e t t e r service. The act of applying p s y c h i a t r i c thinking to s o c i a l case work was one attempt to increase capacity to help the i n d i v i d u a l i n s o c i a l d i f f i c u l t y . Another attempt was the study of process recording of interviews i n order to gain b e t t e r i n s i g h t i n t o the way help was a c t u a l l y given. Workers became very conscious i n the 1920's of the meaning a r e l a t i o n s h i p could have f o r a c l i e n t and t r i e d to improve the measures w i t h i n the interview which might influence him. With the passing years^new knowledge and experience has been added to old ;and improvements i n the worker's ways of helping have -contributed to the development of a young profession. Pioneers i n the mental health movement recognized e a r l y that s o c i a l workers had a d e f i n i t e c o n t r i b u t i o n to make to C h i l d Guidance^and i n the 1930's c l i n i c s t a f f s i n many centres were expanded by the addition of s o c i a l case workers. The new personnel brought a new point of view i n t h e i r knowledge of human behaviour and r e l a t i o n s h i p s between people and t h e i r s o c i a l environment. Their c o n t r i b u t i o n was modified to some extent i n the process of i n t e g r a t i o n i n t o the health program, but the s o c i a l worker also influenced the f i e l d of C h i l d Guidance by i&s own unique approach to pu b l i c service. Like mental hygiene c l i n i c s i n other parts of the continent, the C h i l d Guidance C l i n i c of Vancouver i n 19^8 and 19U9 was both a s o c i a l and a health agency. I t s s e l e c t i o n of pat i e n t s , i t s diagnostic thinking and treatment goals helped to i d e n t i f y the c l i n i c as a health 17. resource. At the same time the c l i n i c achieved an i d e n t i f i c a t i o n with the s o c i a l agencies of the community through the generic t r a i n i n g of a l l p s y c h i a t r i c s o c i a l workers i n the c l i n i c . When the P r o v i n c i a l C h i l d Guidance C l i n i c was opened i n 1932 at Vancouver, c l i n i c s i n other places were t r y i n g to d i s t i n g u i s h the functions of the p s y c h i a t r i s t and the p s y c h i a t r i c s o c i a l worker. There ware s t i l l some who h e l d r i g i d l y to the concept of work with the c h i l d and the parent as separate functions. S o c i a l workers, whose duty i t had once been.to i n t e r p r e t to the parents how to deal with behaviour i n the c h i l d , found that they were of necessity g i v i n g the parents treatment f o r t h e i r own problems before they were able to help them to make changes i n t h e i r a t t i t u d e s toward the c h i l d . I t was a common occurrence f o r workers i n most c l i n i c s to make constant r e f e r r a l to the p s y c h i a t r i s t f o r consultation on t r e a t -ment f o r parents. Consultation took up a very great part of the p s y c h i a t r i s t ' s time, and h i s fu n c t i o n soon was defined around diagnosis and consultation alone. This was work of primary importance f o r which only the p s y c h i a t r i s t was tra i n e d . I t was recognized however, that the s o c i a l worker i n most instances could take over i n d i v i d u a l treatment w i t h i n the c l i n i c as long as the knowledge and experience of the more s p e c i a l i z e d person was a v a i l a b l e through consultation. In the years 19U8 and 19U9}a study of l i d . p r i v a t e cases showed that the burden of treatment was c a r r i e d almost e n t i r e l y by s o c i a l workers; the propor-t i o n of these cases c a r r i e d by p s y c h i a t r i s t s was n e g l i g i b l e . ^ P r i v a t e cases were those r e f e r r e d to the c l i n i c by parents, p r i v a t e physicians, speech t h e r a p i s t s , schools and so on, being d i f f e r e n t i a t e d from those cases r e f e r r e d by s o c i a l or health agencies. Diagnostic service alone was given to cases r e f e r r e d by s o c i a l agencies or by medical and health agencies. The agency submitting the case f o r diagnosis pre-18. pared a s o c i a l h i s t o r y and a p s y c h i a t r i c and psycho-social study was made of problems contained wi t h i n these areas. Possible solutions to problems were then presented by the c l i n i c team. In some instances treatment was undertaken on a cooperative b a s i s with r e f e r r i n g agencies, and p a t i e n t s could be seen by p s y c h i a t r i s t s , or by c l i n i c s o c i a l workers and psychologist under the d i r e c t i o n of the p s y c h i a t r i s t . ( 2 0 ) The s o c i a l worker assumed r e s p o n s i b i l i t i e s d i f f e r i n g a good deal from those of workers i n s o c i a l welfare agencies. While the worker i n a children's a i d so c i e t y might deal with emotional d i s t u r -bances secondary to chronic i l l n e s s , m a r i t a l discord, f i n a n c i a l d i f f i c u l t i e s and c h i l d problems of not too serious a nature, the p s y c h i a t r i c work^through h i s a s s o c i a t i o n with medical personnel>became more s p e c i a l i z e d . With the support i n diagnosis and consultation of a c l i n i c a l team co n s i s t i n g of p s y c h i a t r i s t s , psychologists, and nursing s t a f f , the p s y c h i a t r i c s o c i a l worker was able to undertake treatment of more complicated emotional problems than generally handled i n welfare agencies. The study of pr i v a t e cases f o r the two year period of 19U8 and 19k9 revealed that reasons f o r r e f e r r a l could be grouped i n f i v e d i v i s i o n s . The l a r g e s t group of cases (h$ per cent) was r e f e r r e d because of d i f f i c u l t i e s i n s o c i a l adjustment at school, at home or i n the community. This d i v i s i o n was broken down i n t o general and s p e c i f i c school d i s a b i l i t i e s , as w e l l as s o c i a l l y unacceptable behaviour such as temper tantrums, b u l l y i n g , destructiveness, bragging or showing o f f , l y i n g , s t e a l i n g , truancy, and precocious sex a c t i v i t y . The second group, r e f e r r e d because of p e r s o n a l i t y reactions ( 2 9 per cent) included seclusiveness, t i m i d i t y , sensitiveness, f e a r s , excessive imagination Annual Report of Welfare Branch of the Department of Health and Welfare, King's P r i n t e r , V i c t o r i a , 1 9 U 8 , p. 1 2 8 . 19. and f a n c i f u l l y i n g , stubbornness, r e s t l e s s n e s s , s e l f i s h n e s s , over-a c t i v i t y and unpopularity with other c h i l d r e n . The t h i r d was c l a s s i f i e d as habit formations (6 per cent) and included sleeping and eating d i f f i c u l t i e s , speech disturbances, n a i l b i t i n g , masturbation, prolonged bed wetting and s o i l i n g . The f o u r t h d i v i s i o n was c l a s s i f i e d as spastic d i s a b i l i t y (7 per cent) and the f i f t h as r e f e r r a l f o r psychometric t e s t i n g f o r aptitude t e s t s , vocational guidance or mental evaluation' (13 per cent). The s o c i a l work interviewer at the c h i l d guidance c l i n i c however, devoted only 31 per cent of f u l l scale interviews held i n p r i v a t e cases (19U8-19U9) to work with the c h i l d r e n brought to c l i n i c and la per cent with the mothers. Table 1 INTERVIEWS HELD WITH CHILD, MOTHER, FATHER, AND OTHERS Person Interviewed i 2 3 k 5 6 7 8 9 LO Over 10 Total Total Number Interviews C h i l d ia 23 12 k k 2 1 2 1 -i h 9k 352 Mother 28 22 2h 19 10. 5 6 2 h 2 2 12k U60 Father 36 12 k ,3 -' l 56 90 OtherW 15 k k - 1 l -. - - - 1 26 85 T o t a l 120 61 hk 26 15 9 7 Ii 5 2 7 300 T o t a l Number Interviews 120 122 132 9k 75 5ii k9 32 kS 20 2kh 987 (•^Number of = times a person was interviewed. Teacher, doctor, f r i e n d , other p r o f e s s i o n a l persons. In those instances i n which a mother's personal problems i n t e r f e r e d with the treatment of the c h i l d however, a v a r i e t y of other types of problems would be added t o the l i s t above which would generally 2 0 . include the same group of adult problems r e f e r r e d to a c h i l d r e n ' s a i d s o c i e t y i n addition to serious p e r s o n a l i t y d i f f i c u l t i e s . The s o c i a l worker i n the c l i n i c a l s e t t i n g has been able to use medicine's more formalized system of diagnostic study and treatment with f l e x i b i l i t y , b r i n g i ng from the welfare agency 5 the i d e a that case evaluation was a continuous process which might change as f u r t h e r i n f o r -mation was brought to bear on a problem. And f u r t h e r , the diagnostic process continued even a f t e r formal treatment had begun since new i n f o r -mation was bound to be uncovered which would influence evaluation. Treat-ment was more of a dynamic^han a s t a t i c process, and rather than be-ginning at some d e f i n i t e p o i n t a f t e r the diagnostic conference, treatment was a c t u a l l y under way as soon as the c l i e n t sensed the influence of the worker i n a face to face contact. At the same time the system of diag-n o s t i c study and treatment was a d e f i n i t e a s s e i ^ i n that i t allowed the whole c l i n i c a l team to share r e s p o n s i b i l i t y f o r diagnosis, to give the " worker carrying out treatment the b e n e f i t of d i f f e r e n t p r o f e s s i o n a l points of view. The f a c t that the f i r s t interviews were aimed at gaining enough information f o r a diagnostic conference also tended to give d i r e c t i o n to interviewing. 21. Table 2 FREQUENCY OF INTERVIEWS IN EACH CASE SHOWN BY PROBLEM OR SERVICE GROUPING Problem or Service Grouping Weekly More Than Once Weekly Less Than Once Vfeekly Incomplete Information Total D i f f i c u l t y i n S o c i a l Adjustment-1 26 10 Ik Ik 6k Personality Reactions 17 15 1 8 kl Habit Disorders 5 1 1 1 - 8 D i s a b i l i t y (Spastics) 2 3 1 k 10 Psychometric Testing 1 1 Ik 2 18 T o t a l 51 30 31 29 i i a l l n c l u d i n g d i f f i c u l t i e s i n school adjustment and s o c i a l l y unacceptable behaviour. In order to i n d i c a t e frequency interviews had to occur w i t h i n one of the patterns named at l e a s t f i v e times consecutively. Where there was a mixture,that p a t t e r n appearing f o r the longest time or most often was taken. During.the face to face interview which u s u a l l y took place on the average of once a week, a worker helped the c l i e n t to b r i n g out information pertinent to the problem. On the b a s i s of her d i r e c t observation of the c l i e n t ' s mannerisms, a t t i t u d e s and f e e l i n g s around the information brought out, along with such information as might come from other sources, persons or documents the c l i e n t had made available an interviewer would make a t e n t a t i v e evaluation. Such thinking as the worker might do about the case would be added to by the case work supervisor, and other c l i n i c a l personnel would be a v a i l a b l e f o r con-s u l t a t i o n i f a s p e c i a l i z e d point of view was needed. 22. The diagnostic process under c l i n i c a l organization included preparation of a s o c i a l h i s t o r y , the p h y s i c a l examination, psychological and p s y c h i a t r i c examinations and the diagnostic conference. The s o c i a l h i s t o r y drawn up by the worker was an attempt to present a v i v i d p i c t u r e of the c h i l d l i v i n g with h i s parents or f o s t e r parents, i n h i s home, school and community. As the worker prepared the s o c i a l h i s t o r y over several i n t e r -views the more s u p e r f i c i a l aspects of treatment interviewing were often supplied, e s p e c i a l l y with adults. (21) The i n i t i a l p e r i o d took on sp e c i a l meaning i n view of the worker's c a r e f u l use of r e l a t i o n s h i p i n treatment. She made a conscious e f f o r t to set up a good r e l a t i o n s h i p with the c l i e n t by demonstrating her desire to help. E a r l y c l a r i f i -c a t i o n and motivating was undertaken i n order to give^as soon as p o s s i b l e 5 a conception of the help a v a i l a b l e and how i t might best be used. Where f e a s i b l e the c l i e n t was encouraged to t a l k from the out-set i n order to b r i n g out f a c t s , to gain a f u l l e r expression of funda-mental att i t u d e s and f e e l i n g s around the problem as w e l l as to help the worker gauge the depth of the i n d i v i d u a l ' s p e r s o n a l i t y disturbance. Information was sometimes given the c l i e n t to meet immediate needs i n the s i t u a t i o n ; t h i s often took the form of p r a c t i c a l suggestions f o r dealing with a c h i l d ' s unacceptable behaviour. While the interviewer noted c a r e f u l l y the order and development the c l i e n t gave to the d i s -cussion, she encouraged p a r t i c i p a t i o n and i n i t i a t i v e i f the c l i e n t could b e n e f i t by i t . When expressions of negative f e e l i n g were made the worker i n d i c a t e d acceptance. P e r s o n a l i t y strengthening was given i n (21) With a c h i l d the beginning interviews were b u i l t around getting to know him and f a m i l i a r i z i n g him with the worker, the agency and t h e i r ways of doing things, although treatment might also be given. 23 r e l a t i o n to need, but on the more s u p e r f i c i a l l e v e l s , and without the sharpness of focus on fundamental issues which would l a t e r be added by the diagnostic conference. Table 3 GASES SHOWING NUMBER OF INTERVIEWS HELD AFTER DIAGNOSTIC CONFERENCE BY PROBLEM OR SERVICE GROUPING Problem or Service Grouping 0 1 to 5 6 to 10 11 .to 15 Over 15 T o t a l D i f f i c u l t y i n S o c i a l Adjustment 20 35 5 1 3 6h P e r s o n a l i t y Reaction 12 25 2 1 i 1 ia Habit Disorders 2 h 1 1 j 8 D i s a b i l i t y (Spastics) h • 6 - - - 10 Psychometric Testing 16 2 - - - 18 T o t a l 5U 72 8 3 h l l j l The importance of t h i s e a r l y p e r i o d i n interviewing was c l e a r i n the study of the p r i v a t e cases f o r 19k8 and 19h9 which i n d i c a t e d that 38 per cent of the l l j l cases discontinued t h e i r contact with the c l i n i c immediately a f t e r diagnostic conference. Reasons f o r discontinuing were often r e l a t e d s p e c i f i c a l l y t o the nature of the problem. Some c l i e n t s decided e a r l y that they were unable to make good use of the service given by the c l i n i c . They were helped to t h i s d ecision by the worker's c l a r i f i c a t i o n of discussion and holding to the frame of reference. Others found that i n t h i s short contact the worker was able to give e x a c t l y the information needed to handle the problem, or was able to 2k. help him to s u f f i c i e n t understanding or acceptance of f a c t o r s which could not be changed. A number of parents i n d i c a t e d that they came to the c l i n i c f o r help at a time of momentary weakness i n handling t h e i r a f f a i r s . With the opportunity to t a l k out emotional tensions to an accepting person they were b e t t e r able to see t h e i r problem i n perspective and to handle i t without f u r t h e r help. Thirteen per cent of t h i s group were r e f e r r e d f o r d i s a b i l i t i e s or psychometric testing^and discontinued e i t h e r because they had ob-tained the information sought (mental evaluation, vocational t e s t i n g ) , could not get the kind of help they desired, or were not able to b e n e f i t further from c l i n i c a l s ervices. Table k CASES SHOWING NUMBER OF INTERVIEWS HELD BEFORE DIAGNOSTIC CONFERENCE BY PROBLEM OR SERVICE GROUPING Problem or Service Grouping 1 to 5 6 to 10 More Than 10 T o t a l D i f f i c u l t y i n So c i a l Adjustment U6 16 2 6k P e r s o n a l i t y Reactions 31 10 - i a Habit Disorders 6 2 - 8 D i s a b i l i t y (Spastics) k 6 - 10 Psychometric Testing 17 1 - 18 T o t a l 101+ 35 2 i i a I t i s important to note the size of the group of cases which received short-term treatment or l e s s . Of the 87 cases seen a f t e r diagnostic conference 7U d i d not proceed beyond f i v e interviews altogether a f t e r conference. Only 15 of l l a cases (11 per cent) continued 25. to over f i v e interviews, and seven cases (5 per cent) to over 10 i n t e r -views a f t e r conference^<0 i n t h i s group of cases i t might be said that treatment was generally of a more s u p e r f i c i a l nature.^3) xhe heavy incidence of cases i n the groups r e f e r r e d f o r " d i f f i c u l t y i n s o c i a l ad-justment" and "personality reactions" (^U) suggested that minor adjustments were responsible f o r discontinuing treatment. These groups included 60 of the 72 cases which proceeded to f i v e f u l l interviews a f t e r the confer-ence. Of the 5Ii cases which discontinued immediately a f t e r conference, 59 per cent were i n t h i s same category, again suggesting that the worker e i t h e r gave j u s t the information needed to take care of the problem, helped the c l i e n t accept conditions which could not be changed or made i t -apparent that the c l i n i c was unable to help the c l i e n t f u r t h e r . I t i s c l e a r then that a very important part of the work done at the c h i l d guidance c l i n i c i n Vancouver was done by the s o c i a l worker during interviews and the diagnostic conference. The f a c t that so many cases were closed i n a r e l a t i v e l y short time a f t e r the diagnostic confer-ence suggested that pre-conference treatment had been given more purpose and d i r e c t i o n . The authority c a r r i e d by several professions working (22) ' F u l l interviews only were taken i n t o account, not mere contacts or casual conversations. The c r i t e r i a of an interview required that there should be some evidence i n the record of the worker's methods as they are described i n Chapter One, that there should be a reasonable opportunity f o r emotional i n t e r a c t i o n between the interviewer and the interviewed. (23} v -'•'Length of treatment does not n e c e s s a r i l y mean that most intensive work was done since the r e a l gauge of depth of treatment i s the seriousness of the problem, the strength and capacity of the c l i e n t . A strong p e r s o n a l i t y would take more intensive treatment i n a r e l a t i v e l y shorter perio d of time than a weaker one. ( ^ " D i f f i c u l t y -j_ n S O c i a l adjustment" included school adjustment and s o c i a l l y unacceptable behaviour. These were s i t u a t i o n s i n which some minor adjustment i n the environment might conceivably dissol v e the problem. This might involve changes i n p h y s i c a l conditions or a t t i -tudes ot teachers and parents i n the c h i l d ' s emotional environment. "Personality reactions" were a s p e c i f i c complaint of the parent on r e f e r r a l , and the f a c t . t h a t so many cases were discontinued a f t e r a. short contact suggested that the parent had been helped to regulate the causative f a c t o r s of the c h i l d ' s behaviour. 26, as a team on each case^plus the thoroughness of t h e i r process., was l i k e l y a strong influence i n the m o b i l i z a t i o n of a c l i e n t ' s energies around h i s problem. By the time a c l i e n t had discussed h i s problem with a s o c i a l worker and had experienced something of treatment i n t e r -viewing he was i n a good frame of mind to be impressed and influenced by other formalities,which were a part of diagnosis. The p h y s i c a l examination was necessary i n recognizing cases i n which the disturbance was due to organic l e s i o n within the central nervous system. In some cases the p h y s i c a l examination added i n under-standing behaviour and might di s c l o s e defects such as dental c a r i e s , b i r t h marks and other d i s f i g u r i n g features having a possible damaging psychological e f f e c t on the c h i l d . The psychological examination v/as concerned with the evaluation of the c h i l d ' s innate a b i l i t i e s , educa-t i o n a l achievements and s p e c i a l aptitudes. The psychologist was able to p r e d i c t w i t h i n c e r t a i n limit s ' , the maximum school achievement to be expected of a p a r t i c u l a r c h i l d , and the c h i l d ' s chance f o r success i n some vocations. Having discovered any special d i s a b i l i t i e s , the psycho-l o g i s t could recommend s p e c i a l t u t o r i n g and treatment to overcome them. A program of remedial reading was a v a i l a b l e f o r a l i m i t e d number of the c h i l d r e n found to be i n need of i t . In the p s y c h i a t r i c examination,the p s y c h i a t r i s t through h i s special'training^was i n a p o s i t i o n to view the i n t e r - r e l a t i o n s h i p of the p h y s i c a l and the mental. His s p e c i f i c contribution i n understanding the c h i l d was the discovery and e l u c i d a t i o n of the c h i l d ' s inner motives as these might be revealed by h i s behaviour i n a c l i n i c interview. The p s y c h i a t r i s t might also interview both parents although i n many instance only the mother came to c l i n i c with the p a t i e n t . At the conference which was held a f t e r the completion of the four procedures o u t l i n e d above the p s y c h i a t r i s t acted as chairman. The 27 other three members of the c l i n i c team were present on a p r i v a t e case and tiie aim of the conference was to define reasonable treatment ob-j e c t i v e s and the prospects of a t t a i n i n g them. This involved a decision to use d i r e c t therapy, treatment of one or both parents, manipulation of the environment or a l l three. I f remedial reading was prescribed the psychologist took charge. In the two year p e r i o d f o r 19U8 and 19k9 ; an average of four s o c i a l workers conducted a t o t a l of 987 f u l l scale interviews with pat i e n t s , parents and other persons d i r e c t l y concerned i n the case. During these years 7 .0 interviews per case were held, with the average number of cases opened and assigned to each worker at 3 5 . 3 . The average number of interviews per worker was 2U6.8 f o r the two year period. These f i g u r e s do not i n d i c a t e the t o t a l amount of work done by s o c i a l interviewers since the cases considered d i d not include that part of case loads assigned p r e v i o u s l y to 19U8, nor which had been assigned w i t h i n the two year period ;but were not closed by January of 1951. The type of work most r e l a t e d to "a t t i t u d e therapy" i n child. guidance development was s t i l l a very important part of the s o c i a l worker's job. The mother i n a c h i l d ' s emotional environment.was by f a r the person r e c e i v i n g most of the worker's atten t i o n . Mothers gained 41 \yC per cent of the 987 interviews w i t h the worker as compared to nine . per cent f o r fathers. More interviews were recorded with mothers than with c h i l d r e n , and t h e i r contact was often maintained with consistency beyond a t o t a l of ten interviews. This i n d i c a t e d that interviewing with mothers was often a lengthy treatment process and of a r e l a t i v e l y complicated nature. The la c k of p a r t i c i p a t i o n of f a t h e r s i n treatment shown by these f i g u r e s re-enforced the general b e l i e f that i n t h i s community fathers hold t h e i r spouses responsible f o r the reari n g of 28 t h e i r c h i l d r e n . Only one father i n the II4I cases considered, took part to the extent of s i x f u l l interviews. Only three were seen to a t o t a l * four interviews. Table 5 CASES SHOWING NUMBER OF INTERVIEWS WITH PARENT OF CHILD BY INTELLIGENCE QUOTIENT Int e l l i g e n c e Quotient 0 ' 1 to 5 6 to 10 Over 10 T o t a l Near Genius lUO and over 1 1 — — 2 Very Superior 120 to 139 3 8 2 - 13 Superior 110 to 119 2 13 k 2k Average 90 to 109 2 25 9 ~- 36 Low Average 80 to 89 1 13 2 2 18 Below Average 70 to 80 - 1 - 6 Below 70 29 8 - k2 T o t a l 11; 9k 27 6 l l l l The i n t e l l i g e n c e of a c h i l d was a determining f a c t o r i n the amount of interviewing done. Children of average i n t e l l i g e n c e and better ;were interviewed more often than those of l e s s than average i n t e l l i g e n c e . On the other hand, the parents of l e s s than average c h i l d r e n received more of the worker's time. The f i g u r e s suggested that the work of an interviewer was l i m i t e d with the c h i l d of l e s s than average i n t e l l i g e n c e , and i n these cases the worker devoted more time to work with the parent. 29 Table 6 CASES SHOWING NUMBER OF INTERVIEWS WITH THE CHILD BY INTELLIGENCE QUOTIENT Int e l l i g e n c e Quotient 0 1 to 5 6 to 10 Over 10 T o t a l Near Genius lliO and over 1 1 • _ _ 2 Very Superior 120 to 139 2 10 1 - 13 Superior 110 to 119 5 15 1 3 2k Average 90 to 109 10 23 1 2 36 Lovr Average 80 to 89 6 10 2 - 18 Below Average 70 to 80 k 2 — — 6 Below 70 16 25 1 - k2 T o t a l kk 86 6 5 i i a The amount of long-term interviewing done i n the home was not much l e s s than that c a r r i e d on within the c l i n i c . While interviewers made a pr a c t i c e of paying at l e a s t one c a l l to the home i n order to see the patient w i t h i n h i s natural environment, t h i s was u s u a l l y accomplished i n one or two interviews. I t i s c l e a r that interviewing continued with consistency i n homes^and i t may be that p h y s i c a l f a c i l i t i e s at the clinic^ w h i c h are recognized as d e l i m i t i n g , had some influence on the si t u a t i o n of an interview. 30. Table 7 INTERVIEWS HELD AT CLINIC, HOME, OUTSIDE THE CLINIC AND HOME, BY TELEPHONE: Means of Contact u: 1 2 3 h 5 6 7 8 9 10 Over 10 T o t a l T o t a l Number Interviews C l i n i c 36 22 18 12 8 U Ii 2 U 2 U 116 U78 Home 3U 21 17 10 h U 3 2 l - 3 99 359 Other (School, car Office) 25 8 k —» 2 l _ _ 1*0 69 Telephone(2) 25 10 5 h 1 16 81 Total 120 61 Uh 26 15 9 7 u 5 2 7 300 T o t a l Number Interviews 120 122 132 9h 75 5U U9 32 ii5 :20 2iiU 987 Number of times a person was interviewed. Telephone Interviews meaning records where evidence i s given that some of worker's methods described i n Chapter One were employed. Interviews i n si t u a t i o n s other than the face to face contact at the c l i n i c or i n " a home, were r e l a t i v e l y few i n number. These i n -cluded interviews taking place at schools, cars, other o f f i c e s and by telephone. The shortness of these contacts would b r i n g most work done within the category of gathering information f o r s o c i a l h i s t o r y , and giving information and i n t e r p r e t a t i o n about the c l i e n t and c l i n i c operations. This would be c a r r i e d out i n order to modify c e r t a i n at t i t u d e s i n the c h i l d ' s emotional environment. Work which was done through a telephone interview would be of a supplementary nature with the mother, part of the attempt to influence others around the c h i l d , or r e l a t e d to gathering information to be used i n the case. 31. In the P r o v i n c i a l C h i l d Guidance C l i n i c at Vancouver the c l i n i c a l team assumed r e s p o n s i b i l i t y f o r treatment and i n a majority of cases r e l i e d upon the s o c i a l worker to c a r r y i t out. The s o c i a l worker was equipped to do t h i s by v i r t u e of h i s t r a i n i n g i n under-standing and i n f l u e n c i n g human behaviour. Through h i s o r i e n t a t i o n i n case work he was -able to influence the r e l a t i o n s h i p s between a c h i l d and h i s family, school associates, playmates and community groups. In the c l i n i c a l s e t t i n g the worker's capacity to influence human behaviour was formalized somewhat by the program b u i l t around diagnosis and treatment. Although s t a t i s t i c s have shown that a large part of interviewing was on a short-term b a s i s , the worker was able to give treatment through the medium of the interview,from the be-ginning of a case. Treatment was given a d e f i n i t e o r i e n t a t i o n to fundamental f a c t o r s by the diagnostic conference, and work with c l i e n t s could then continue with greater i n t e n s i t y from that p o i n t . The con-ference and diagnostic s k i l l of other members of the c l i n i c team, and the worker's close attention i n frequent interviews^were seen as a d e f i n i t e influence i n m o b i l i z i n g the e f f o r t of the c l i e n t around h i s problem. Problems were of a s p e c i a l i z e d nature and the amount of interviewing time spent ?/ith each was noted. The person of the mother of the c h i l d took on special meaning f o r the treatment process as d i d also the home of the c l i e n t . The i n t e l l i g e n c e of the c h i l d was seen as an influence on the worker's a c t i v i t y i n interviewing. Through short-term and long-term treatment, and i n whatever context an interview occurred, the methods of the worker could be a d e f i n i t e help to the c l i e n t i n meeting h i s problem. Methods were seen as u s e f u l throughout treatment e i t h e r i n s u p e r f i c i a l adjustment or i n fundamental d i f f i c u l t i e s . The next chapter i s a study of some of these methods i n a p p l i c a t i o n . 32. CHAPTER 3 CASE WORKER'S METHODS In Chapter Two i t was seen that an import ant f a c t o r i n treatment was the influence exerted by the s o c i a l worlcer i n face to face interviews. This influence was exerted not only through h i s personal impact on the c l i e n t , but also through interviewing techniques consciously applied. His methods were u t i l i z e d i n de-f i n i t e r e l a t i o n to the c l i e n t ' s immediate and long-term needs. Four records were selected from among the pri v a t e cases at the C h i l d Guidance C l i n i c , and were studied with a view to poi n t i n g out that methods defined i n Chapter One were fundamental to treatment interviewing. D i f f e r e n t workers might c a l l the same method by d i f f e r e n t names; others might use a method without consciously i d e n t i -f y i n g i t . Some methods were often used i n association with others; many of them overlapped and were i n t e r - r e l a t e d i n the complexity of the interviewing s i t u a t i o n . Some methods appeared i n nearly a l l typ e's of interviewing, i n treatment of greater i n t e n s i t y and i n that on more s u p e r f i c i a l l e v e l s . Of the 13 methods i d e n t i f i e d i n Chapter One, only rechannelling and i n t e r p r e t i n g were not found i n a l l four records at some point. The encouragement to t a l k was common with an adult, and with a c h i l d took the form of encouragement to express himself i n play. In some interviews the worker d i d not make any record of t h i s method, whereas i n others i t was found i n some form as many as six times, apparently depending on the f u l l n e s s of recording. A l l workers i n the four cases chosen, r e g i s t e r e d "encouragement to t a l k " at l e a s t once, and i t was found on an average of 12 times i n each case. I t was not at any d e f i n i t e stage i n the progression of the case, but 33. appeared throughout. Since the c l i e n t had somewhere within h i s experience most of the information needed i n diagnosis and treatment he was encouraged to express himself. Gathering information f o r a s o c i a l h i s t o r y and the diagnostic conference was a f a c t o r i n getting the c l i e n t i n t o the habit of t a l k i n g about himself and h i s problem. Although such means as the p e r s o n a l i t y of the worker, h i s tone of v o i c e , and natural warmth were of s i g n i f i c a n c e , these were not often w r i t t e n i n t o the record. Two workers expressed t h i s interviewing device i n d i f f e r e n t ways. For example i n Case "A" the ivorker stated the c l i n i c ' s f u n ction to Mrs. White. In each interviewing s i t u a t i o n the c l i e n t was encouraged to express himself f u l l y while s t a t i n g h i s problem to the worker. ...I explained how Judy might give some of the needed i n f o r -mation through p l a y interviewing although information about her e a r l i e r childhood would also be important. Did she see how she h e r s e l f might f i t i n t o a plan f o r treatment? Mrs. White s a i d she would have to make some changes h e r s e l f . I wondered what she meant by t h i s . . . Here the worker showed simply by a d i r e c t question how the c l i e n t was l e d further i n t o t a l k i n g about h e r s e l f i n r e l a t i o n to her problem. The same worker i l l u s t r a t e d the same method beginning another interview with questions l i k e " H O T ; have things gone t h i s week?" or "Well, where are we today?" or simply by waiting f o r the c l i e n t to take the i n i t i a t i v e . An example of how l i t t l e was sometimes required i n t h i s way was shown i n the following excerpt i n which the c l i e n t said ..."My mother-in-law d i d some very unusual things. I t was not u n t i l l a s t year that I found out she was a s h o p l i f t e r . " "Oh?" Mrs. White went on to say that she had always wondered why her husband's mother had too many watches, r i n g s , e t c . When the c l i e n t understood be t t e r the way the process worked i n the l a t e r stages of treatment, the worker t r i e d to give the c l i e n t 3U. more r e s p o n s i b i l i t y i n the process. The worker i n the fo l l o w i n g i l l u s t -r a t i o n showed how the device was used i n the l a t e r stages of the case. When I again i n v i t e d her to begin where she wanted she thought she would t a l k about her marriage. The c l i e n t was not sure where to s t a r t , and I recognized the d i f f i c u l t y i n having to decide where to s t a r t , but pointed out the value of t h i s . She h e r s e l f could best l e a d us to the area of importance to her. She began by speaking of how disappointed she had been by Ed,' how d i f f e r e n t he was than she expected. In t h i s example the worker by-passed the c l i e n t ' s temporary blocking by recognizing the d i f f i c u l t y she was having and lending h i s emotional support to her e f f o r t . Another worker i l l u s t r a t e d "the encouragement to t a l k " with a c h i l d of seven years, on entering the p l a y room f o r the f i r s t time. ...Worker explained f u r t h e r that as she and I got to know each other that she could t a l k to me about anything she wanted and that any things we said together were j u s t between us. She could t e l l me about the things she l i k e d and d i d not l i k e . I added that I had worked with l o t s of l i t t l e g i r l s and boys who had problems l i k e hers and hoped that I could help her. Jean said that she d i d not want to t a l k and worker said she d i d not need to i f she didn't want to e i t h e r t h i s time or at l a t e r times. As we played t o -gether and got to know each other a b i t better, that perhaps Jean would f e e l l i k e t a l k i n g . Worker wanted her to know she could t a l k whenever she wanted. The worker encouraged her to " t a l k " i n another way as the c h i l d asked "Can I pla y with anything I l i k e i n here?" saying that she c e r t a i n l y could. Play i s a natural medium of expression f o r a c h i l d i n which she may i n d i c a t e her a t t i t u d e s and f e e l i n g s about h e r s e l f , people and things around her. The worker's capacity to move with the c l i e n t i n treatment was seen i n r e l a t i o n to information brought out. At the beginning of the case i n every instance a worker gave the c l i e n t the opportunity to say why he had come f o r help. This served the purpose not only of con-centrating the e f f o r t s of the c l i e n t around the problem, but also of O 35. i n d i c a t i n g what were h i s attitudes-and f e e l i n g s about i t . Time a f t e r time records i n d i c a t e d that the very f i r s t utterance of the c l i e n t had s p e c i a l meaning f o r the problem. Worker "C" i n the f i r s t contact with h i s c l i e n t gave the opportunity to i n d i c a t e "where he was" i n terms of h i s problem. B i l l came to the o f f i c e as arranged and soon a f t e r the interview began, opened the subject of home and h i s . problem through h i s answer to the worker's question of how things were going along. Systematically through the treatment process t h i s worker gave the c l i e n t s i m i l a r openings at the s t a r t of each interview. Worker "A" i n d i c a t e d another way of s t a r t i n g where the c l i e n t was by taking note of her p h y s i c a l appearance. He recorded -She was frowning and looking uncomfortable. I wondered how her headache was t h i s week. She responded to t h i s and went on to discuss the f a c t that she had been to her doctor f o r her eye examination i n connection with her headaches. I t had been explained to her by her doctor that the headaches might w e l l be connected with the emo-t i o n a l s t r a i n she was under. I recognized her discomfort v e r b a l l y and i n v i t e d her to t a l k about i t s r e l a t i o n to her d i f f i c u l t i e s . She then spoke with some concern about her job s i t u a t i o n . . . Since the C h i l d Guidance C l i n i c was i n a medical s e t t i n g and s o c i a l workers were part of a team made up of three other pro-f e s s i o n s , each t r a i n e d and s p e c i a l i z i n g i n t h e i r profession, some sp e c i a l i z e d i n information around problems.given to c l i e n t s . A l l records examined gave t h i s kind of help. In "C"'s case i t took t h i s form i n the t h i r d and f i f t h interviews. There was considerable discussion around the problem of h i s s i s t e r , about the way we l e a r n . Y/orker went on to discuss the family, p a r t i c u l a r l y the mother's and father's influence through the f e e l i n g s of love and hate which were found i n the f a m i l y . Normal f a m i l y development was d i s -cussed with worker pointing out the meaning of attachement of c h i l d r e n to the opposite parent and how t h i s was worked through. In the f i f t h interview he recorded again that B i l l . . . " b r o u g h t out some 36, of the inadequacies i n h i s home and the vrorker t a l k e d a b i t about the process of growth and l e a r n i n g which l e d people to be what they are." At the c l i n i c some of the information given to a c l i e n t concerned psychological t e s t i n g and other f a c t s coming out of the diagnostic conference. Information was -usually given i n the c l i e n t ' s own language, and worker "A" began i n t h i s way. I o u t l i n e d b r i e f l y what Judy's t e s t i n g performance seemed to i n d i c a t e . . . By the W.B. I.Q. she had placed low i n the superior group. I explained wh at the general groupings were, and that the psychologist f e l t her performance had been handicapped by her state of emotional tension and confusion.... Sometimes the c l i e n t asked f o r information d i r e c t l y . "Mrs. White asked i f she had done wrong i n 'getting mad1 at Judy. I s a i d that a c h i l d has to get an i d e a of what r e a l human reactions are l i k e from someone.... There was a difference i n 'getting mad1 at the c h i l d and 'getting mad' at what the c h i l d d i d . . . A l l c h i l d r e n want to be loved, and the withdrawal of love i s the very hardest thing f o r them to bear...." At c e r t a i n points i n treatment interviewing i t was necessary to guide the discussion. This method was d i s t i n c t from holding to the frame of reference which always r e l a t e d discussion to the current problem. At times i t took the form of a s p e c i f i c question, and at others involved the i n t r o d u c t i o n of a new t o p i c by the worker. The worker i n Case "A" made use of d i r e c t questions i n order to bring out more information. Mrs. White was r e l a t i n g an incident about her daughter and husband, i n which she s a i d " i f Judy made too much noise or l e f t something out of place he was always ' f l y i n g o f f the handle'." The worker i n t e r j e c t e d "What did he do at these times?", apparently seeking more information about the c h i l d . "He would pick up anything that was handy, a s t i c k or something and h i t her. Sometimes he grabbed her by the neck and choked her." The worker then asked how Judy had received t h i s rough treatment, 37. and the parent went on to b r i n g out more information. In Case "C" the worker guided B i l l i n a more general way. Yforker discussed f u r t h e r with him the f a c t that while he understood B i l l ' s concern, perhaps t h i s was not r e a l l y achieving what he wanted and some other way of doing i t might be looked f o r . As i t was, i t d i d look as i f the only r e s u l t was to increase the f r i c t i o n i n the home. Worker said he r e a l i z e d t h i s d i d not make B i l l f e e l any l e s s concerned about things, but perhaps they could think over some other way i n which things might be handled. The same worker at a l a t e r point guided more d e f i n i t e l y , and wrote that he ..."introduced i n t o t h i s interview the question of mother having l e f t home." The worker's act of motivating appeared c l e a r l y i n the following examples i n Cases "C" and "A". In the s i x t h interview with B i l l the worker recorded t h a t he would get over many of h i s d i f f i c u l t i e s through understanding them and through h i s development outside h i s home. His growth would c ontinue as he understood more and was able to e s t a b l i s h h i s own s e l f apart from tensions and problems i n the home. He placed before the c l i e n t a p i c t u r e of what he could expect to gain from the treatment process, encouraging him to c a r r y on i n order t o understand himself b e t t e r . The other worker i n Case "A" also expressed t h i s method c l e a r l y . I o u t l i n e d that a program of t h i s kind would mean coming once a week f o r a couple of months, or f o r as long as.:; she f e l t she wanted that kind of help. I knew i t was not easy to go back and face p a i n f u l memories, but we would discuss only such things as she brought up and wanted to t a l k about. I t was a strong thing to do t h i s , not a weak thing... I t was noticeable here, that although there was some element of strengthening at a p a r t i c u l a r time, that the worker was t r y i n g to give the c l i e n t a conception of the process, encouraging her to make us of i t . 38. Aiding expression of f e e l i n g was often seen i n records followed c l o s e l y by the worker's i n d i c a t i o n of acceptance of the f e e l i n g brought out. These were a c t u a l l y two d i s t i n c t acts on the part of the worker and d i d not n e c e s s a i r l y have to come together. Spontaneous expressions of f e e l i n g by a c l i e n t could occur apart from a worker's encouragement i n t h i s way. A good example of the worker's acceptance of the expression of negative f e e l i n g i s given i n the recording of worker "A". He encouraged the c l i e n t f i r s t to express her f e e l i n g i n recognizing that anyone who had been through her experience would n a t u r a l l y have a l o t of deep f e e l i n g about i t . Mrs. White then s a i d i n an agitated way that marriage was supposed to be a £0-!?0 a f f a i r , with companionship and l o t s of give and take, but hers had been a l l one-sided... 'She got t i r e d of being nagged and nagged at, sneered and screamed and y e l l e d a t.' She paused here f o r a second, saying that I should not get the i d e a that there had not been some good times together however. The worker made no comment here, but apparently made some sign of the acceptance of her expression of f e e l i n g , and she went on to say that nothing had ever been good enough f o r Ed or h i s mother... She r e c a l l e d how Ed's mother had attacked her once during a quarrel, both of them scratching and p u l l i n g h a i r . The T/orker recognized her f e e l i n g and accepted i t , by saying at t h i s p oint... " I t must have been a r e a l shock to her to be f o r c e d i n t o something,like t h i s with the mother of her husband." She went on to t a l k about other scenes of violence around the home, eventually coming to the point of tears. Y/orker "C" also demonstrated an acceptance of f e e l i n g i n h i s recording when the c l i e n t reacted spontaneously to the t o p i c . He introduced i n t o t h i s interview the question of mother having l e f t the home "...and B i l l i n d i c a t e d a good deal of f e e l i n g i n t h i s regard. He pointed out that the fat h e r r a r e l y took the mother out and even i f 39. he offered, no one of them l i k e d to go with him because no one could enjoy i t . His outlook and habits were described as 'peculiar'... He followed t h i s however with a comment showing he was now able to see things more from h i s f a t h e r ' s point of view. He p a r t i c u l a r l y noticed now that mother was saying provocative things to the f a t h e r , making sa r c a s t i c remarks that were almost c e r t a i n to start something." The same p r i n c i p l e of acceptance was i n d i c a t e d i n the p l a y sessions with Jean by worker "B", who recorded that she had to leave the p l a y room f o r a few minutes to speak to the c h i l d ' s mother. In the p l a y session that followed Jean became q u i t e aggressive, p i c k i n g up d o l l s and banging them together... Worker commented that maybe Jean was a l i t t l e angry at worker f o r l e a v i n g her, and that worker knew she had been disappointed. Pe r s o n a l i t y strengthening appeared as a s p e c i f i c method on the part of the worker and may be considered one element i n the case work p r i n c i p l e known as supportive therapy, which was a combination of a l l the things a worker, d i d f o r a c l i e n t i n addition to the sup-por t i v e nature of r e l a t i o n s h i p . There was a d i s t i n c t i o n between strengthening and motivating, the former being an attempt to strengthen the c l i e n t i n r e l a t i o n to a s p e c i f i c need at a p a r t i c u l a r time. Motivation, while also strengthening by encouraging p a r t i c i p a t i o n , had as i t s s p e c i f i c aim the c l i e n t ' s growth and advance wit h i n the treatment process. The worker i n Case "C" i l l u s t r a t e d strengthening by making a s p e c i f i c e f f o r t to support i n r e l a t i o n to a p a r t i c u l a r need. B i l l stated that he d i d not f e e l able to c a r r y on conversation with strangers as other boys d i d . . . He discussed things that other boys d i d that he could not do, such as j u s t p i c k i n g up a conversation with a g i r l i n a c l a s s with no p a r t i c u l a r reason i n mind. Worker generalized t h i s f e e l i n g as being something which could be overcome through experience. B i l l admitted that when he was a c t u a l l y i n such a p o s i t i o n he got Uo. along much bett e r than he expected, most of the worry was before hand or a f t e r . Worker pointed out that from what he had seen of B i l l , he knew that despite t h i s f e e l i n g he was able to carry on i n a very s o c i a l and mature way with strangers without any sign of t h i s inner s e c u r i t y being shown. C l a r i f y i n g was seen a l l the way through the treatment process i n interviewing. I t was the worker's v e r b a l i z a t i o n of a c l i e n t ' s d i s -cussion i n order to br i n g out more c l e a r l y the r e a l meaning. In the four cases c l a r i f i c a t i o n appeared a t o t a l of 32 times or on an average of over eight times per case. This technique i n the i n i t i a l stages often l e d i n t o the d e f i n i t i o n of the helping s i t u a t i o n . In record "D" i t appeared, when the c l i e n t stated that Dr. L., had t o l d her that the c l i n i c was f o r 'Ifelfare Cases'. The worker took t h i s oppor-t u n i t y to explain that c h i l d r e n from f a m i l i e s of every f i n a n c i a l status were examined at the c l i n i c , as w e l l as ch i l d r e n from s o c i a l agencies. This l e d the c l i e n t to ask what happened at the c l i n i c and the worker explained the need f o r a developmental h i s t o r y and the procedure f o r the examination. With Jean of Case "B" the worker seized the oppor-t u n i t y to c l a r i f y f o r the c h i l d the meaning of the pla y s i t u a t i o n . She asked Jean i f mother had t o l d her why she was coming and' Jean r e p l i e d that she had; that i t was because she wasn't getting on w e l l at school. Yforker agreed and sa i d that her mother had come to us because she wanted to help Jean so that she would be happy a l l the time. Her mummy wanted help too so that she would know how to help Jean... Another worker showed the same technique i n the t h i r d i n t e r - • view with 1$ year o l d B i l l . He thought that h i s s i s t e r 'got away with murder' i n the home. He had openly c r i t i c i z e d h i s mother i n t h i s regard and while he recognized t h i s was not h i s function, he stated he was worried and could not j u s t stand by and l e t i t go on a l l the time. Worker asked what the e f f e c t of h i s i n t e r v e n t i o n was and B i l l admitted that h i s mother d i d not l i k e t h i s and h i s s i s t e r was r e s e n t f u l of h i s t r y i n g to t e l l her. Worker wondered i f h i s continual discussion of t h i s had had any r e s u l t s and B i l l admitted that i t had not. 111. In the fourth interview t h i s worker went on to the discussion of the previous interview regarding the sister-mother r e l a t i o n s h i p and suggested that they t a l k about h i s dad along s i m i l a r l i n e s to see i f they could f i n d some things that might i n d i c a t e why he was the sort of man he was... "This v/as discussed from the point of view of persons needing to defend, themselves who have a weak spot which they cannot admit to themselves or to others." Worker "A" used t h i s method at the end of an interview i n which he wrote "The hour was now up, and I summarized what I thought had been discussed today, the f a c t t h a t she had been b i t t e r l y d i s -appointed and humiliated i n marriage, and that i t was only natural f o r her f e e l i n g s about her own marriage to carry over to the whole idea of family l i v i n g . " The worker i n Case "B" on the other hand used t h i s method i n helping the c h i l d to recognize the true meaning of her r e l a t i o n -ship t o the worker. When the c h i l d o f f e r e d her candy the worker said i t was "nice of her to want to share them with her, but she would not need candy t o remember Jean by as she would remember her anyway and would save a s p e c i a l time f o r her i n case she could come (to c l i n i c ) and wanted to." The method c a l l e d holding to a frame of reference showed how the worker brought the c l i e n t ' s thinking and f e e l i n g more sharply i n r e l a t i o n t o the current d i f f i c u l t y . I t was found i n these records a t o t a l of 20 times, an average of f i v e times per case. A l l cases r e g i s t e r e d t h i s technique at l e a s t once and one worker made usaof i t nine times through 15> interviews, ^ e worker's attempts at focusing often were found together with c l a r i f i c a t i o n , one example being i n the primary stage of interviewing during which the helping s i t u a t i o n was defined. 1|2. W i t h -the 15 y e a r o l d b o y o f Case " C " t h e v r o r k e r s k i l f u l l y p i c k e d up t h e t h r e a d o f t h e d i s c u s s i o n i n t h e f i r s t i n t e r v i e w t o s h a r p e n f o c u s and t o h e l p t h e c l i e n t t o m o b i l i z e h i s f e e l i n g and t h i n k i n g a r o u n d s o m e t h i n g s p e c i f i c . B i l l s a i d -. . . he b e l i e v e d t h a t h i s o u t l o o k a n d i n t e r e s t s w e r e e n t i r e l y d i f f e r e n t a n d i r r e c o n c i l a b l e w i t h t h o s e o f t h e o t h e r members o f t h e f a m i l y . W o r k e r p o i n t e d o u t t o B i l l t h a t f e e l i n g t h i s w a y mus t c r e a t e a g o o d d e a l o f f e e l i n g w i t h i n h i m s e l f a n d make i t h a r d f o r h i m t o b e a t e a s e . L a t e r i n d i s c u s s i n g t h e p l a n f o r w e e k l y i n t e r v i e w s w i t h B i l l w o r k e r s u g g e s t e d t h a t t h e s e f e e l i n g s a n d t h e way t h a t t h e y c o u l d be h a n d l e d w o u l d n e e d t o be d i s c u s s e d i n more d e t a i l , a n d t h i s w o u l d h e l p . B i l l seemed q u i t e p l e a s e d and a l s o seemed t o r e a l i z e t h a t t h i s , was t h e b a s i s o f much o f h i s e m o t i o n a l d i s t u r b a n c e . The same w o r k e r , who a p p e a r e d v e r y s k i l l f u l i n t h i s w a y , i n t h e s e c o n d i n t e r v i e w h e l p e d t h e b o y f u r t h e r t o t h i n k i n t e r m s o f h i s f r a m e o f r e f e r e n c e . . . . B i l l w a s t h i n k i n g o f t a k i n g a c o u r s e w h i c h w o u l d a l l o w h i m t o go t h r o u g h u n i v e r s i t y w i t h a minimum o f t h i s s u b j e c t ( m a t h e m a t i c s ) . He t a l k e d o f a p r e f e r e n c e f o r s u c h t h i n g s a s s o c i a l w o r k i n w h i c h he w o u l d b e w o r k i n g w i t h p e o p l e . He . d i d n o t t h i n k he w o u l d make a good t e a c h e r . L a t e r w o r k e r r e f e r r e d t o t h i s , p o i n t i n g o u t t h a t p e o p l e who w a n t e d t o w o r k w i t h o t h e r s s h o u l d f i r s t have a g o o d u n d e r s t a n d i n g o f t h e m s e l v e s a n d p e r h a p s t h a t was s o m e t h i n g t h e y c o u l d w o r k t o w a r d s i n t h e i r i n t e r v i e w s . I n t h e f o u r t h i n t e r v i e w t h i s w o r k e r a g a i n p i c k e d up t h e d i s c u s s i o n " o f t h e p r o c e s s o f g r o w t h a n d l e a r n i n g e v o l v i n g f r o m a q u e s t i o n b y B i l l o f how p e o p l e h a d i m m e d i a t e l i k e s a n d d i s l i k e s f o r c e r t a i n o t h e r s . " When t h e c l i e n t s t a t e d t h a t " h e w a n t e d t o h a n d l e h i s own s i t u a t i o n b y s e e k i n g h i s own o u t l e t s a n d b y d e v e l o p i n g h i s l i f e a p a r t f r o m t h e f a m i l y s i t u a t i o n " , t h e w o r k e r p o i n t e d o u t t h a t i t s t i l l meant t h a t c o n t a c t w i t h h i s f a m i l y was b o t h i n e v i t a b l e a n d d e s i r a b l e f r o m h i s p o i n t o f v i e w . H i s f u r t h e r u n d e r s t a n d i n g o f t h e s i t u a t i o n and t h e r e a s o n s f o r i t w o u l d h e l p h i m t o d e a l w i t h t h i s i n t h e b e s t w a y p o s s i b l e . " R e c h a n n e l l i n g was a m e t h o d u s e d more i n f r e q u e n t l y , w h e r e t r e a t -ment l e d i n t o a r e a s o f r e l a t i v e l y g r e a t e r e m o t i o n a l d e p t h . " R e - f e e l i n g " 1*3. by the c l i e n t seemed to be a preliminary step i n the single example found i n the four records. Mrs. White r e c a l l e d ... scenes of violence around the home during which her husband, i n f i t s of rage over things of no consequence^ picked up the nearest thing to him and smashed i t against the w a l l . 'He t r e a t e d the dog b e t t e r than he tr e a t e d her. although once i n a while he beat the dog too.' Mrs. White 1s eyes were flooded with tears at t h i s point, and she seemed to be" struggling t o h o l d them back. I sa i d i t was a l l r i g h t to cry here and that her f e e l i n g was understood ... She apologized a f t e r having d r i e d her eyes a few minutes l a t e r with 'It's been a long time since I ever d i d that.' I remarked,that there was nothing wrong with expressing oneself t h i s way, and the f a c t that she had brought her f e e l i n g out i n t h i s way showed that she was f a c i n g p a i n f u l memories and i n a way r e l i v i n g them. I t was important to see these things i n r e l a t i o n to the r e s t of her l i f e . Was she able to go on with t h i s ? What meaning d i d these experiences have f o r her now? ...... Mrs. White then t a l k e d f o r a while about her marriage i n general, ending with 'I guess I r e a l l y am b i t t e r . ' With the support of the worker the c l i e n t v e r b a l i z e d and re-experienced h o s t i l i t y ; she was able to see vnth more understanding the whole pi c t u r e of her married l i f e a f t e r i d e n t i f y i n g her own f e e l i n g i n the l a s t sentence of the i l l u s t r a t i o n above. The worker's actual act of rechannelling impulses occurred a week or so l a t e r when he helped Mrs. White to concentrate released impulses i n changing her job s i t u a t i o n . Worker "B" i l l u s t r a t e d i n t e r p r e t a t i o n of t h i s method on a more s u p e r f i c i a l l e v e l when she recorded. "Jean s a i d that she would be the teacher and worker could be the l i t t l e g i r l j ' the worker sa i d "Like you at school", and Jean laughed and said , "Yes, you can be me." Here the c h i l d wished to enact the part of an adult i n an aut h o r i t a t i v e p o s i t i o n , and the worker brought her f e e l i n g about i t i n t o a l i t t l e sharper focus by i n t e r p r e t i n g i n a way 'You want to g et even f o r the way you've been ordered around,' In the f i f t h interview with B i l l worker "C" recorded -B i l l agreed with worker's suggestion that he had f i l l e d i n f o r the husband i n many respects, such as taking h i s mother to shows. She discussed questions with him instead of t a l k i n g over problems with h i s f a t h e r . I t was noted that t h i s example occurred i n the l a t e r stages of t r e a t -ment, at a point a f t e r the r e l a t i o n s h i p between worker and c l i e n t had been soundly established. The boy was able to take t h i s worker's d i r e c t suggestion without resentment. At times during treatment i t was noted that the interviewer f e l t i t was necessary to set l i m i t s f o r the c l i e n t i n some way. I t was most common i n p l a y interviewing with c h i l d r e n , and i n defining the l i m i t s of agency function with respect to adults. Worker "B" recorded "A few minutes before her interview time was up vrorker t o l d Jean we would only have time f o r one more p i c t u r e . However, Jean wanted to p l a y on. Worker stated that i f she wanted to t r y the paints f o r a few minutes today, the next time she could s t a r t with the p a i n t s . Jean was at f i r s t quite annoyed .but f i n a l l y decided that she would do t h i s . " An adult, Mrs. White, asked her worker i f he would prevent her husband from meeting ^udy at school. The worker asked i f her husband was permitted to do t h i s under the conditions of t h e i r l e g a l separation, and when the c l i e n t admitted that he was, the worker con-ceded t h a t he would be unable to do what she requested. He then went on to discuss immediate p o s i t i v e ways i n which he could help. I t was evident while studying worker's methods i n these four records that none could be considered apart from i t s contactj methods were interdependent. The worker's act of encouraging the c l i e n t to t a l k was necessary before he could b r i n g i n t o the d i s c u s s i o n needed information, give adequate Expression to f e e l i n g s and a t t i t u d e s , or i n d i c a t e the character of h i s need. S i m i l a r l y , the c l i e n t often had to be helped to express himself v e r b a l l y i n order to experience emotionally. His attitudes had to be brought out into the open where they might be modified by the worker's c l a r i f i c a t i o n and rechannelling. Some methods seemed characteristically to appear i n the primary stages of treatment while others were not seen u n t i l a relation-ship of confidence and trust had been set up. The worker's acceptance of a client's fundamental attitudes and feelings for example, was not u t i l i z e d as a method u n t i l the client was sure he could be trusted with these confidences, or u n t i l the true nature of the process and i t s use to himself had been made clear. A method appearing early i n treatment often was seen i n different use for a different purpose by the vrorker later on i n treat-ment. Motivating, for example i n primary stages was used i n the "White" case, f i r s t to point out the general direction treatment might take. In the later stages of treatment the same worker used the method to point out a more definite direction by emphasizing the strength that had been shown by the client i n facing painful memories, and i n encour-aging further development along the same li n e . The fact that the same method could be used by different vrorkers i n different situations suggested that there were many factors operating within the interviewing situation besides the methods them-selves. Here was a reminder that the human element may not be l e f t out of the picture; treatment interviewing i s a dynamic whole of which methods are only a part. Chapter Four i s a study of the stages of treatment emerging i n relation to the worker's methods. 1*6. CHAPTER k METHODS AS A FACTOR IN TREATMENT At the C h i l d Guidance C l i n i c a s o c i a l worker at intake determined i f the problem of the c l i e n t was generally w i t h i n the function of the agency. I f i t was, the c l i e n t met with another worker to c l a r i f y t h i s f u r t h e r and often the i n i t i a l c l i n i c a l services i n diagnosis and treatment were begun at that time. D i f f i c u l t i e s of a s u p e r f i c i a l nature were helped with l e s s fundamental methods of t r e a t -ment and i n a r e l a t i v e l y short p e r i o d of time. I t was seen i n Chapter Two that the majority of p r i v a t e cases admitted f o r treatment at the c l i n i c i n 1°U8 and l°u° received l e s s intensive interviewing and en-vironmental work (69 per cent). .When the diagnostic conference had d e f i n i t e l y e s t a b l i s h e d the area of d i f f i c u l t y measures were taken wit h i n a few months to dissolve i t . Eighty-nine (25) per cent of the l l j l cases examined had l e s s than six f u l l interviews a f t e r the diagnostic conference, apparently discontinuing because a s a t i s f a c t o r y service had been given or because the c l i e n t wished no f u r t h e r s e r v i c e . With the other 11 per cent longer treatment goals were set out and e f f o r t s made to work toward them. Eventually these cases were closed and comments at the end of a record very often i n d i c a t e d that a successful adjustment had beai made. The s o c i a l worker, sharing r e s p o n s i b i l i t y d i r e c t l y - w i t h a case work supervisor and the diagnostic team, undertook to meet the emotional needs of the c h i l d , and where necessary, the emotional needs of those persons exerting an influence upon him. (25) Of the 89 per cent, 20 per cent were c l a s s i f i e d as s p a s t i c d i s a b i l i t y or r e f e r r e d f o r psychometric t e s t i n g only. U7. This chapter w i l l i l l u s t r a t e how the worker was able to contribute directly to the movement of the client through the treatment process. He made his contribution by deliberate and thoughtful appli-cation i n relation to the client's need. Treatment seemed to f a l l into several definable stages within a case record, two of the cases i n -dicating more clearly than others how the worker's methods were related to growth within the process. The stages may be described i n their general order of appearance during treatment as the definition of the helping situation, working through emotional conflict, acceptance of self i n relation to the problem, c l a r i f i c a t i o n of fundamental issues, i n i t i a t i o n of positive action, insight, expressions of personal adequacy or social impulse. 7/hen a client came to the c l i n i c i t was necessary for the vrorker to know what kind of help was expected i n order to determine i f the agency was organized to administer that kind of help. The worker spent as much time as was necessary to give the client aware-ness of the nature of help available and the client could accept i t or not as he pleased. He refused the offer of help i f he f e l t i t could not satisfy his need or i f agency methods of meeting his needs were not to his l i k i n g . The definition of the helping situation therefore was necessary before a client could make use of agency resources with purpose. In the records examined this process was worked through usually within the f i r s t few interviews. Only one worker seemed to deal with a l l aspects of this process i n one interview, and i t was found that i t was necessary to repeat the same information later as the client brought up further questions. The definition of the helping situation usually took on definite form. The client expressed the desire for help i n her own words and the vrorker responded by indicating a desire to help. The 1*8. client was encouraged to say what kind of service she was expecting from the c l i n i c , and the worker discussed this i n relation to the help that was actually available. These steps helped to mobilize the energy of the client i n a specific area,- and were re-enforced by an early demonstration of help by the worker, as for example i n giving information to meet an immediate need or aiding and accepting the client's expression of feeling. Reassurance concerning the confidentiality of the situation was carefully made and one worker indicated the direction treatment might take. The degree to which the client moved into the helping situation, accepting i t and agreeing to make use of i t , also depended on the formation of a relationship of trust and con-fidence with the interviewer. By the time information had been gathered for the diagnostic conference and early demonstrations of the worker's treatment s k i l l s had been made, the client was more comfortable i n the situation and was free to move into the next stage. The examining process at the c l i n i c and the worker's discussion of diagnosis helped to give this movement more direction. Two of the four records merely stated that this stage had been recognized and dealt with. Worker "B" explained that children from every financial group were examined as well as children from social agencies when Mrs. Brown informed her a doctor had said the c l i n i c was for welfare, cases. The client asked what happened atthe c l i n i c and the worker explained the need for a developmental history and the procedure for examination. Worker "A" went into greater detail. Mrs. White had come to us now on the advice of Dr. M., because la t e l y Judy had been lying about her home work, and stealing.. . I outlined how we might be of help to her, pointing out that she could arrange for the c l i n i c to examine Judy. There were psychiatrists, psychologists, psychiatric social workers and nursing staff here who would be able to determine how disturbed Judy was. I 1*9. explained that I was a s o c i a l worker who worked along with other c l i n i c a l personnel, and would be able to i n t e r p r e t the diagnosis of the c l i n i c team to her as w e l l as work out possible plans f o r treatment. The worker here defined the helping s i t u a t i o n . He went on from the point recorded above to i n d i c a t e what might l i e ahead i n the process. ...This would mean that we would have to have as much i n f o r -mation as possible about Judy from those who knew her best -i t would a l s o be h e l p f u l to contact her teacher at school i f t h i s was a l l r i g h t with her. With what information she her-s e l f gave me. and by t a l k i n g with Judy we would t r y to get to the root of her troubles and do something about them. I ex-plained generally how Judy might give some of the needed information through p l a y interviewing and how Mrs. White could add to t h i s . The worker encouraged the c l i e n t to verb a l i z e her problem and of f e r e d help by stating what ?ras a v a i l a b l e f o r use at the c l i n i c . He c l a r i f i e d h i s own r o l e i n the process as w e l l as i n d i c a t i n g the general form treatment might take. He also pointed out the parent's r e s p o n s i b i l i t y i n g i v i n g information as w e l l as the part the c h i l d would t a k e , ^he idea of both of them working along with the c l i n i c team was expressed. He attempted to ensure the c l i e n t ' s p a r t i c i p a t i o n by asking "Did she see how she h e r s e l f might f i t i n t o a plan f o r treatment?" In the discussion that followed, he picked up other points and gave f u r t h e r information needed to present a c l e a r conception of the process. In t h i s f i r s t stage i t was noted that the worker made use of methods i d e n t i f i e d as the encouragement to t a l k , g i v i n g information, motivating, c l a r i f y i n g , and holding to the frame of reference. The next area of treatment consisted of some combination of the elements c a l l e d acceptance of s e l f i n r e l a t i o n to the problem, working through emotional c o n f l i c t , and c l a r i f i c a t i o n of fundamental issues. In the two cases which i l l u s t r a t e d these elements most c l e a r l y i t was observed that they appeared i n d i f f e r e n t order and as an ex-pression of d i f f e r e n t needs on the part of the c l i e n t . 5o. In record "C" already r e f e r r e d to i n Chapter Three, B i l l i n d i c a t e d that he was moving through a l l three aspects of growth i n treatment at about the same time. His problem on entering treatment was summarized by the worker i n t h i s way. Problem described at f i r s t by mother on the b a s i s of B i l l ' s superior a t t i t u d e at home with r e s u l t a n t quarreling, and h i s nervous habits and i n a b i l i t y to get along with boys. B i l l was interviewed concerning the problem of f a m i l y r e l a t i o n s h i p s , p a r t i c u l a r l y with h i s s i s t e r . He claimed h i s mother was f a i l i n g to b r i n g her up properly, and quarreling r e s u l t e d from B i l l ' s t r y i n g to f i l l the parental r o l e i n checking up on.this matter... B i l l ' s r e l a t i o n s h i p with father was poor i n interviews and.he brought out a l o t of d i r e c t resentment against him. In the f i f t h interview B i l l i n d i c a t e d that he was accepting the idea of having i n some ways taken h i s f a t h e r ' s place i n -the house-hold. The worker recorded that -B i l l agreed with worker's suggestion that he f i l l e d i n f o r the husband i n many.respects, such as taking h i s mother to shows and her discussing questions v/ith him instead of t a l k i n g over problems with h i s f a t h e r . • Treatment preceding t h i s d i r e c t i n t e r p r e t a t i o n to B i l l con-s i s t e d of p e r s o n a l i t y strengthening and motivating to p a r t i c i p a t e and develop as an i n d i v i d u a l . In the next interview he showed that B i l l was seeing himself more as an i n d i v i d u a l with h i s own l i f e to l i v e . B i l l stated that he wished to handle h i s own s i t u a t i o n by seeking h i s own o u t l e t s , developing h i s own way of l i f e apart from the f a m i l y . T h i s passage i n the r e c o r d was preceded by the worker's ex-pressions of confidence i n B i l l ' . s capacity to take care of himself (personality strengthening) and a discussion c l a r i f y i n g broad i s s u e s , and past d i f f i c u l t i e s i n r e l a t i o n to the present (holding to a frame of reference). At approximately the same time i n treatment B i l l showed that 51. h i s conception of the elements i n h i s problem was becoming i n c r e a s i n g l y c l e a r . For him t h i s stage was also c l o s e l y i n t e r - r e l a t e d with the working through of emotional c o n f l i c t . In the four t h interview B i l l had v e r b a l i z e d a good deal of h o s t i l i t y f o r h i s s i s t e r and the ^ iv'orker both accepted h i s expression of f e e l i n g and rechannelled h i s impulses to other areas. The worker had recorded here that "while he understood B i l l 1 s concern, perhaps he was not achieving what he wanted and some other way of doing t h i s might be looked f o r . " In the next interview B i l l stated that he had "cut down" h i s verbal c r i t i c i s m s of h i s s i s t e r at home, r e a l i z i n g that i t had no e f f e c t . In t h i s same interview the discussion moved i n t o B i l l ' s negative f e e l i n g s about h i s parents. A f t e r the worker had aided the expression of t h i s f e e l i n g and accepted i t , he was able to say p o s i t i v e l y about h i s mother that "he f e l t she had l i v e d rather a deprived l i f e In her companionships and associations." About the father he admitted that the negative expressions to himself were u s u a l l y when h i s mother and s i s t e r were around. When they were e n t i r e l y alone they seemed to get along f a i r l y w e l l . C h i e f l y i n r e l a t i o n to the worker's acceptance of h i s negative expression of f e e l i n g , B i l l had achieved an extension of i n s i g h t i n t o the meaning of h i s r e l a t i o n s h i p s with h i s family. Worker "C" continued work with t h i s boy over a period of two years. Besides the support given i n a r e l a t i o n s h i p with a f r i e n d l y adult, help was given environmentally. The t h i r d general phase of treatment over-lapped the pre-ceding one, and while the worker continued h i s support and encourage-ment through interviews the c l i e n t showed d e f i n i t e signs of growth. In the s i x t h interview he had already responded to the worker's method that has been c a l l e d "personality strengthening". A f t e r t a l k i n g of h i s s o c i a l inadequacy, and rec e i v i n g the worker's verbal support he stated 52. that when he was a c t u a l l y i n a d i f f i c u l t s o c i a l p o s i t i o n he u s u a l l y got along much b e t t e r than he expected; most of the worry was before-hand or a f t e r . He expressed confidence i n h i s own c a p a c i t i e s i n the following passage during the same interview. He told' the worker of desire to be chosen as one of the a i r cadets from a l l Canada v/ho are making annual a i r tours of other countries.... He i s working very hard to e s t a b l i s h himself w e l l i n h i s own group here. The tenth interview stated that -B i l l has been spending week-ends at the RCAF base on the Island, a p r i v i l e g e f o r some of the harder working boys i n the a i r cadets.... He t o l d the worker he was t r y i n g to pay a t t e n t i o n to h i s own a f f a i r s and keep out of family d i f f i c u l t i e s . Mrs. White moved through s i m i l a r treatment stages, but at a d i f f e r e n t rate and i n r e l a t i o n to d i f f e r e n t treatment needs. The summary of the worker described the d i r e c t i o n that was taken i n treatment. The case was r e f e r r e d f o r a c h i l d who was described as "unhappy, not doing w e l l at school, and t e l l i n g l i e s . " Twelve interviews were h e l d with Mrs. White and nine Yvith Judy. Mrs. White decided e a r l y that she would b e t t e r be able to help Judy i f she could c l a r i f y some of her own c o n f l i c t s . She l e d discussion i n t o her m a r i t a l l i f e and the meaning of her husband's behaviour. The c h i e f area of weakness seemed to be around her own f e e l i n g s of adequacy, shaken by her nine years of married l i f e . She was helped to c l a r i f y c o n f l i c t i n g f e e l i n g s and to define her own a t t i t u d e s . As she v e r b a l i z e d and defined her c o n f l i c t , Mrs. White was encouraged to take more i n i t i a t i v e and r e s p o n s i b i l i t y i n the process. She was able to say d e f i n i t e l y that she was going to sue f o r divorce when she could gain necessary evidence, and that with the d i s s o l u t i o n of much of the b i t t e r n e s s around marriage she vrould again consider marrying. She was able t o decide on her own i n i t i a t i v e to take a b e t t e r job out of town, p a r t l y a means of avoiding her husband but also as a d e f i n i t e step toward achieving greater f i n a n c i a l s e c u r i t y . . . . She stated that she understood h e r s e l f and h e r s i t u a t i o n b e t t e r , and was b e t t e r able to give emotionally to Judy. In the second general stage of treatment Mrs. White f i r s t worked through her emotional c o n f l i c t with the worker's help i n ex-pressing and re-experiencing the past emotionally. She then showed 53. increased acceptance•of h e r s e l f as a f e e l i n g person instead of denying and repressing her emotions. The worker d i d not d i r e c t i n t e r p r e t a t i o n but i n s i g h t was achieved during and a f t e r the c l i e n t ' s v e r b a l i z a t i o n and expression of emotion. I t was f e l t that the worker's act of accepting expressed negative f e e l i n g was c l o s e l y l i n k e d with the i n -sight that followed. The following passage which was discussed i n Chapter Three with a view to the worker's methods, i s now considered f o r I t s meaning i n treatment. I recognized that anyone who had been through her experience would very l i k e l y have a l o t of deep f e e l i n g about i t . Mrs. White said i n an agitated way that marriage was supposed to be a 50-50 a f f a i r with companionship and l o t s of 'give and take', but hers had been a l l one-sided. Judy needed someone to be l i k e a father to her, to t r e a t her l i k e a human being. Mrs. White was ' t i r e d of being nagged and nagged at, sneered and screamed and y e l l e d a t'. She paused here f o r a second, saying that I shouldn't get the idea that there hadn't been some good times together however. In t h i s passage the worker guided the c l i e n t i n t o a d i s -cussion of her experiences, but i n such a way that she was not forc e d to answer. However, Mrs. White d i d go on, expressing f u l l y . The worker accepted her expression of negative f e e l i n g , and Mrs. White l e d the discussion temporarily i n t o her f e e l i n g about her mother-in-law. She r e c a l l e d having fought with Ted's mother several times. Mrs. White had spoken to her husband about h i s mother not helping around the house when she v i s i t e d during -the preg-nancy with Judy. Ted's mother had flown i n t o a rage when t h i s was brought up i n f r o n t of her, and she attacked Mrs. White, who fought back, both of them scratching and p u l l i n g h a i r . I commented that i t must have been a r e a l shock to her to be forced i n t o t h i s with her husband's mother. She sa i d i t c e r t a i n l y was. Mrs. White was quiet f o r a few-minutes then went on to r e c a l l other scenes of viole n c e around the home, during which her husband, i n f i t s of rage u s u a l l y over things of no consequence, picked up the nearest thing to him and smashed i t against the w a l l . 'He treated the dog better than he treated her, although once i n a while he beat the dog too. ' The worker's act of reco g n i z i n g Mrs. White's deepest f e e l i n g s was a way of encouraging her to continue, and she vent on to r e c a l l and " r e - f e e l " p a i n f u l memories of her married l i f e . The c l i e n t expressed h e r s e l f i n tears with some r e s t r a i n t i n the next passage. The worker apparently f e l t then that her expression had gone deep enough, and brought the discussion back to r e a l i t y f a c t o r s . Mrs. White, who had formerly denied having any f e e l i n g a t a l l about her marriage was f i n a l l y able to say i n t h i s interview "I guess I r e a l l y am b i t t e r J " He then r e f e r r e d to the general frame of reference which was her daughter's family adjustment. Mrs. White's eyes were flooded with tears at t h i s point, although she seemed to b e struggling to hold them back. I said that i t was a l l r i g h t to c r y here and that her f e e l i n g s were understood. I said nothing f u r t h e r as she c r i e d , but without a c t u a l l y breaking down. She apologized a f t e r having dri e d her eyes a few minutes l a t e r with " I t ' s been a long time since I ever d i d that." I remarked that there was nothing wrong with expressing oneself t h i s way, and the f a c t that she had brought her f e e l i n g out i n t h i s way showed that she was r e a l l y f a c i n g p a i n f u l memories, i n a way r e -l i v i n g some of them. I t was important to seel.all these things i n r e l a t i o n to the r e s t of her l i f e . Was she able to go on with-this? What meaning d i d these experiences have f o r her now? Mrs. White talk e d b r i e f l y about having known from the very f i r s t that things v/ere not going to work out, but that f o r some reason she had j u s t seemed to hold on, hoping i t would come r i g h t . Instead, things got worse and worse. She guessed marriage could be a l l r i g h t , but she wasn't sure... she s a i d "I guess I r e a l l y am b i t t e r . " I summarized what I thought had been discussed today, the f a c t that she had been b i t t e r l y disappointed and humiliated i n marriage, and that i t was only n a t u r a l f o r her f e e l i n g s about her own marriage to ca r r y over to the whole ide a of family l i v i n g . This interview was apparently important i n the c l i e n t ' s treatment. In the next interview Mrs. White v e r b a l i z e d her desire to seek a divorce and eventually to remarry. She obtained the worker's help i n meeting a prospective employer since a change i n her job si t u a t i o n was the only way of paying o f f debts. The c l i e n t was able to 55. follow through on her decision t o take a job out of the c i t y because i t meant a higher income. Only sections from records " A " and "C" have been reproduced here since "B" and "D" d i d not i l l u s t r a t e f u l l y the d i r e c t i o n t aken i n treatment. Both of these records i n d i c a t e d that the problem had been dealt with s u c c e s s f u l l y without showing^except i n a summary way, how t h i s was accomplished. The a p p l i c a t i o n of techniques with s e n s i t i v i t y and i n close r e l a t i o n to the c l i e n t ' s immediate and long-term needs, was seen as a d e f i n i t e influence i n treatment. I t i s apparent however, that the s k i l l s of the worker i n applying methods, are not separate from h i s s k i l l s i n making e f f e c t i v e use of r e l a t i o n s h i p or g i v i n g environmental help. From the i l l u s t r a t i o n s given i t w i l l be obvious that increased s k i l l i n the use of interviewing methods means an increase i n the e n t i r e range of the vrorker' s ways of helping. 56. C H A P T E R 5 INTERVIEWING AS TREATMENT S o c i a l case work i s a yoiing profession s t i l l i n the process of d e f i n i t i o n . In i t s growth from decade to decade, i n d i v i d u a l s or groups have emphasized d i f f e r e n t aspects of development as new techniques seemed to o f f e r b e t t e r ways of helping. Whether emphasis was on environmental change or gathering f a c t s and clues, making use of r e l a t i o n s h i p or sensing a t t i t u d e s and f e e l i n g s , the p r i n c i p l e s were unchanging. These d i f f e r e n c e s i n emphasis were attempts to improve service, and workers were able to c r i t i c i z e t h e i r p r a c t i c e because they were conscious of basic aims i n case work. Methods of interviewing are seen as a possible area of improvement wit h i n s o c i a l case work. A greater consciousness of t h e i r meaning could give more purpose and d i r e c t i o n to treatment, and contribute to the greater effectiveness of case work help. Contribution of S o c i a l Case Work Interviewing to the C h i l d Guidance C l i n i c The C h i l d Guidance C l i n i c combines the o r i g i n a l aims of the mental health program and s o c i a l work. The Idea of healing i s fused with the l a r g e r concept of s e r v i c e . S o c i a l work i n t h i s s e t t i n g has been influenced by the medically oriented c l i n i c , and has taken on the r e s p o n s i b i l i t y f o r healing on an i n d i v i d u a l b a s i s . The treatment point of view has therefore been added to one of service f o r s o c i a l vrorkers dealing with people, i n t r o u b l e . The same influence i s noticeable i n the e n t i r e f i e l d of s o c i a l welfare, which considers emotional com- • ponents i n r e l a t i o n to a l l problems. I t i s l i k e l y that s o c i a l workers, i n t h e i r association with members of the w e l l established medical pro-f e s s i o n , take on i n the eyes of the community,some of the prestige accorded to men of medicine. The f a c t that he has achieved more s p e c i a l i z a t i o n of f u n c t i o n i n t h i s s e t t i n g i s also a f a c t o r of some Importance. On the other hand, medical personnel have become more conscious of the s o c i a l work point of view, with i t s emphasis on s o c i a l and emotional f a c t o r s i n i n d i v i d u a l maladjustment. The f a c t that environmental aspects of s o c i a l case work are accorded such an important part i n the treatment program, i l l u s t r a t e s how ddeply t h i s influence has been f e l t . -The diagnostic process at the c l i n i c i s a part of the program which shows how the blending of concepts i s talcing place. The d i r e c t s o c i a l work contribution here i s the face t o face evaluation which takes place during the interview. On the b a s i s of h i s knowledge and under-standing of the underlying meaning of behaviour, the s o c i a l worker i s able to evaluate f a c t s , a t t i t u d e s and f e e l i n g s as they emerge during h i s contact with the c l i e n t . His immediate diagnosis i s f l e x i b l e however, and v a r i e s with the addition of f u r t h e r information. The worker demonstrates h i s capacity to change h i s diagnosis i n the study of h i s own case records e i t h e r within or outside of a n a l y t i c sessions with case work supervisor. The t e n t a t i v e diagnosis of the worker and h i s supervisor may be added to , supported, or v a r i e d by the points of view of other members of the c l i n i c a l team, i n the diagnostic conference. The psychologist, p s y c h i a t r i s t and nurse who may concentrate t h e i r e f f o r t on a single case, a l l contribute to evaluations and plans f o r treatment. The worker i s f r e e at any time during an i n i t i a l p e r i o d of gathering information f o r a s o c i a l h i s t o r y to consult with members of other professions within the organization. A fundamental contribution i s made by the s o c i a l worker i n applying h i s interviewing to treatment. A v i t a l part of h i s interviewing s k i l l i s the use of h i s r e l a t i o n s h i p with the c l i e n t . . The interviewer i s conscious of the bond which may develop between h i s c l i e n t and 5 8 . himself while he i s gaining information i n the period leading up to the diagnostic conference. The c l i e n t may be n o t i c e a b l y a f f e c t e d by the warmth and s i n c e r i t y of the worker's desire to help as w e l l as the actual demonstration of treatment methods at each- contact. The worker demonstrates h i s treatment s k i l l s i n short-terra interviews as w e l l as i n those extending over many months. Even i n a single interview he i s often able to influence the c l i e n t through the medium of h i s p e r s o n a l i t y and the conscious use of methods. Giving information, p e r s o n a l i t y strengthening, aiding expression of f e e l i n g and accepting i t , are often applied i n short contacts. Over longer periods of time, and i n r e l a t i o n to a c l i e n t ' s p e r s o n a l i t y strengths^ the worker undertakes to influence the c l i e n t on more fundamental emotional levels^while keeping i n mind diagnosis and aims of treatment. The concept that a c l i e n t b e n e f i t s by h i s p a r t i c i p a t i o n i n working out a plan f o r treatment, was an emphasis given by s o c i a l work to t h i s f i e l d . In helping a c l i e n t t o p a r t i c i p a t e , the worker helps by such methods described as motivating, guiding, g i v i n g information, and moving through treatment with respect to the c l i e n t ' s wishes. The worker undertakes intensive treatment, as w e l l as treatment of a l e s s complicated nature i n l i n e with the c l i n i c ' s development since 1932. Cases c a r r i e d by s o c i a l workers on an intensive b a s i s amount to 11 per cent of the t o t a l number of l i p . . About h a l f t h i s group make use of i n s i g h t therapy. (26) ( 2 6 )insight therapy requires most s k i l l and depends on a process of transference, i n which the worker i s i d e n t i f i e d with someone i n the c l i e n t ' s personal l i f e . I n t erpreting, rechannelling and c l a r i f y i n g are most commonly used i n t h i s type of work. For instance, the worker may take on the r o l e of a parent or r e l a t i v e , accordingly, the c l i e n t may be as "petulant as he was with h i s mother, as r e b e l l i o u s as he f e l t toward h i s f a t h e r , as e r o t i c as he would l i k e to have been toward h i s s i s t e r or cousin. He can be t h i s way, f e e l t h i s way, and even speak i t out because i t i s understood, not censored but i n t e r p r e t e d to him." Menninger, K a r l , Man Against Himself, Harcourt, Bruce and Company, 1938, p. Sli6. 59 In the study of p r i v a t e cases opened i n 1°U8 and 19H9, i t i s rioted that mothers received more interviews than c h i l d r e n , suggesting that the technique once known as atti t u d e therapy, i s s t i l l a very large component of the case worker's r e s p o n s i b i l i t y at the C h i l d Guidance C l i n i c . As a matter of f a c t the number of interviews with mother i s so large that i t may i n d i c a t e a trend toward more c l i n i c a l work with adults. The "White" case i s an example of the type of work that i s being done. The f a c t that f a t h e r s assumed such a small p a r t of the r e s p o n s i b i l i t y i n treatment i s of s i g n i f i c a n c e since present day thinking i n psychiatry stresses that a c h i l d should have the love and i n t e r e s t of both h i s parents. The f a t h e r i s extremely important i n the l i f e of a c h i l d at c e r t a i n age l e v e l s ; t h i s parent's p a r t i c i p a t i o n should be gained i n the best i n t e r e s t s of a c h i l d ' s emotional health. Figures f o r the two year p e r i o d also shewed that nearly as many interviews were held i n the home as were held at the c l i n i c . The proportion of home interviews i s w e l l above the number u s u a l l y made at the time of diagnosis^to observe the c h i l d i n h i s natural environment. I f overcrowding at the c l i n i c has any r e l a t i o n to t h i s s i t u a t i o n , then measures to deal with i t should be taken. Contemporary vvriters emphasize-the necessaiy of pleasant, comfortable settings where interviewing i s being done.( 2?) I t w i l l be obvious that intensive work i n treatment i s badly handicapped where a worker interviews i n whichever room happens to be vacant at the time of h i s appointment, ^hie f a c t that windows (27)uThe p h y s i c a l s e t t i n g of the interview may ctetermine i t s e n t i r e • p o t e n t i a l i t y . Some degree of p r i v a c y and a comfortable relaxed atmosphere are important.. . I f the interviewee has waited i n a crowded room f o r what seems to him an interminably long period, he i s n a t u r a l l y i n no mood to s i t dovm and discuss what i s on h i s mind." GARRETT, Annette, Interviewing, I t s P r i n c i p l e s and Methods, Family Service Association of America, New York, N.Y., 1°U2, p. 55. 6 0 . cannot be opened i n some o f f i c e s or t h a t a number of o f f i c e s are very small, means a good deal i n r e l a t i o n to the comfort of a c l i e n t and the effectiveness of treatment. Methods i n Interviewing A case worker gains part of h i s knowledge and t r a i n i n g i n interviewing through h i s studies at a school of s o c i a l work, another part of i t through f i e l d work p r a c t i c e and supervision, and s t i l l another part i n what he may l e a r n from other workers i n conversation, at conferences,and so on. There i s often no organized attempt to answer the learner's question "what to do now?", because no case worker has yet taken the time to write down i n a systematic way, what^ a c t u a l l y does. The purpose of s o c i a l case recording wal to show what happened-i n the contact between worker and c l i e n t . f o r 1atav study» The beginner at interviewing founs^ records an Invaluable a i d to understanding the process. The argument i s at times given that the l e a r n e r should f i n d out what to do through experienceing the interview, and eventually defining methods which are expressions of h i s own i n d i v i d u a l i t y . This study has shown that most workers have c e r t a i n methods i n common. Some workers have a l l thosenamed i n common, besides others which they have added to t h e i r l i s t of "what to do" i n meeting the emotional needs of a c l i e n t . One way of increasing the s k i l l s of a l l workers i s to ex-change more widely the ways of helping used by others i n the f i e l d . There i s some truth however i n the objection that " s p e c i f i c methods should not be l i f t e d from t h e i r context" because a f a l s e impression may be given of the nature of case work interviewing. I t has been i n f e r r e d frequently i n t h i s study that methods i n interviewing are not the only f a c t o r s i n operation at any,given moment, that r e l a t i o n -ship and the i n d i v i d u a l i t y of both interviewer and c l i e n t determine when 61. they v t i l l be used, where, and i n r e l a t i o n to v/hat needs. The advantage of i d e n t i f y i n g s p e c i f i c methods i s i n being able -to transmit to another person some of the ways i n which one worker i s able to help a c l i e n t . The i n t e l l i g e n t worker r e a l i z e s that human r e l a t i o n s are not mechanical and that h i s p a r t i c u l a r way of applying a method gives i t a d i s t i n c t i v e character. I f he keeps i n mind that the c l i e n t i s the gauge of what i s needed i n treatment.,then there i s no need to f e a r that the a p p l i c a t i o n of methods i n common with others i s impersonal and therefore "inhuman". I t i s not necessary t o repeat that most methods are used at a l l stages of treatment interviewing, but i n t e r p r e t a t i o n and channelling take place only a f t e r a strong r e l a t i o n s h i p has been es t a b l i s h e d between worker and c l i e n t . . I t w i l l be abundantly c l e a r that no method i s s e l f - s u f f i c i e n t , and that there i s considerable over-lapping and interdependence i n the process of a p p l i c a t i o n . Some workers w i l l have added to the l i s t of 13 methods drawn up i n t h i s study. I f a comprehensive study could be made of a l l the methods used by a l l workers, the l e s s ingenious could be helped to increase t h e i r s k i l l s and contribute more e f f e c t i v e l y to treatment. Thirteen methods v/ere found i n general case work l i t e r a t u r e . Those terms which were used without a change of name were the "encouragement to t a l k " , " g i v i n g information", "guiding", "accepting f e e l i n g " , " c l a r i f y i n g " , "re-channelling", " i n t e r p r e t i n g " and " s e t t i n g l i m i t s " . Only three v/ere added to the l i s t and i d e n t i f i e d as methods because t h e i r meaning v/as i n f e r r e d ; they were "moving with the c l i e n t " , "aiding the expression of f e e l i n g " , and "motivating". "Personality strengthening" v/as sub-s t i t u t e d f o r a term generally c a l l e d "supporting" because of i t s con-fusion with the case work technique known as "supportive therapy". "Holding to a frame of reference" was used instead of "focusing" becauss the l a t t e r term v/as not c o n s i s t e n t l y and s p e c i f i c a l l y applied. The 62. l i s t of methods may not be complete, and i t i s f e l t t h a t > a s more work i s done i n the area of treatment generally c a l l e d i n s i g h t therapy, tfeat f u r t h e r d e f i n i t i o n s w i l l be found. The more important methods i n the l i s t were f e l t to be the "accepting of f e e l i n g " , "p e r s o n a l i t y strengthening", " c l a r i f y i n g " and "motivating". These were found on the whole very frequently and i n d i r e c t r e l a t i o n to fundamental advances by the c l i e n t i n treatment, ^hey were often c l o s e l y l i n k e d to the intermediate stage of intensive - • interviewing which combined the "acceptance of s e l f " , " c l a r i f i c a t i o n of c l i e n t ' s own r e l a t i o n to the problem" and "the working through of emotional c o n f l i c t " . The s e t t i n g of l i m i t s was observed i n recrods r a r e l y , and i n the i n t e r e s t s of the c l i e n t ' s general welfare. Worker's recognize that the setting of l i m i t s i s experienced negatively by many c l i e n t s ; i t i s u s u a l l y modified by introducing p o s i t i v e ones to o f f s e t i t s i n f l u e n c e . The method known s p e c i f i c a l l y as the worker's "acceptance of f e e l i n g " seemed to be a component of h i s own general at t i t u d e s , and f e e l i n g s about the c l i e n t . This i l l u s t r a t i o n points up the f a c t that methods may not be used by a worker v/ho does not f i n d them a natural medium of expression f o r him. The worker's conscious-ness of the p r i n c i p l e s underlying h i s work, and h i s capacity f o r s i n -c e r i t y and naturalness i n expression, remain fundamental to s k i l l e d interviewing. There v/as d i f f i c u l t y i n f i n d i n g records at the C h i l d Guidance C l i n i c v/hich i l l u s t r a t e d f u l l y the techniques of the worker i n r e l a t i o n to movement i n treatment. Although many records were w r i t t e n " i n process"(28) very few gave a c l e a r conception of the worker's methods ( 28)xechnique used by socMworkers to i n d i c a t e a t t i t u d e s , f e e l i n g s and expressions, and the way i n which a c l i e n t gave information i n response to the worker's techniques. 6 3 . f o r the entire progression of the case. The s c a r c i t y of cases shelving good process recording may be explained by the f a c t that hours for d i c t a t i o n are not s u f f i c i e n t , or that workers do not record with a view to i l l u s t r a t i n g the treatment process. Furthermore, the case yrorker's capacity to help i n treatment interviewing could be increased by systematized study of good process recording. Improvement i n treatment methods, and research depending on a knowledge of elements of interviewing, i s hindered by the l a c k of good records. I f each worker followed through one treatment case i n the t o t a l l o a d , prospects f o r research i n case analysis would be improved gre a t l y . Broad Purposes of Treatment Interviewing The use of methods of -intervieTdng as treatment i s i n l i n e with the basic purposes of both s o c i a l case work and the mental health c l i n i c s . A l l treatment i n t h i s s e t t i n g must aim at a combination of -iU t?ro p r i n c i p l e s of healing and service. Healing i s here addressed s p e c i f i c a l l y to the persons of ind i v i d u a l s ^ w i t h the c h i l d as focus. For the younger c h i l d the p l a y interview i s the ^as^mm. through which i n d i v i d u a l i z e d help may be given systematically. The s e t t i n g of t h i s type of interview i s j u s t as important as with the adult, and confusions over the use of equip-ment or o f f i c e f a c i l i t i e s are detrimental to treatment. Although the focus of the c l i n i c a l program i s the c h i l d , i t i s c l e a r from the "White" case i l l u s t r a t i o n used., that work with adults i s done.on very intensive l e v e l s . When t h i s f a c t i s seen i n r e l a t i o n to f i g u r e s on the interviewing time spent with mothers (jltTper cent) 51 /ywfl-fy In. v-v> e<x Y-v*L compared with the c h i l d r e n ( 3 ^ per cent), a trendy which would include adults within the focus of treatment. The C h i l d Guidance C l i n i c i s equipped p r o f e s s i o n a l l y to give the best standard of treatment interviewing w i t h i n the community. No 61u other agency combines the thoroughness of the c l i n i c ' s diagnostic processes with such support i n consultation. The c l i n i c i s also a service agency, and as such^carries the r e s p o n s i b i l i t y f o r meeting cer t a i n community needs. The unique combination of diagnostic and treatment f a c i l i t i e s ^ p l a c e s t h i s agency i n the best p o s i t i o n to meet the need f o r an adult mental health service. The c l i n i c ' s capacity f o r giving more intensive help with adults i s due i n part to the developing of s k i l l s i n treatment i n t e r -viewing. A program of research i n case studies and case analysis would i n d i c a t e exactly what are the a g e n c y r e s o u r c e s i n meeting needs. A program of t h i s type depends very much on how w e l l case records reveal which s k i l l s s u c c e s s f u l l y meet p a r t i c u l a r needs i n treatment. The program could expand i n order to give more e f f e c t i v e l y to emotionally disturbed adults, but t h i s should not mean that environ-mental aids should be l e s s emphasized as a way of meeting community needs. The d i f f e r i n g needs are met by a d i v e r s i f i c a t i o n i n the ways of giving help. The lessening of external pressures can be accomplished only by environmental manipulation and t h i s s k i l l remains a very important supplement to treatment interviewing. The case worker may add to h i s t o t a l effectiveness by looking to h i s interviewing methods. The primary i n t e r e s t of a l l who take on r e s p o n s i b i l i t i e s i n healing and service should be t h e i r e f f e c t i v e n e s s i n g i v i n g help. More purpose and d i r e c t i o n may be given to treatment i f workers are conscious of t h e i r s k i l l s within a proper frame of reference. However, t h e i r i n -tention to improve services i n t h i s respect i s hindered by imperfect p h y s i c a l conditions.-'Ah increased appropriation to t h i s agency would leakd greater support to i t s e f f o r t to meet i t s r e s p o n s i b i l i t i e s to the community. 65 BIBLIOGRAPHY Books Bingham, ¥., and Moore, B.V., How to Interview, Harper and Brothers, Publishers, New York and London, 191*1. Buzelle, George B., Individuality i n the Work of Charity, Proceedings of the National Conference of 1556. Conducting the Youth and Employer Interview, reprint from the Occupational .follow-up and Adjustment Service Plan, National Association of Secondary School Principals, Washington, D.C, 19ijl French, Lois Meredith, Psychiatric Social Work, The Commonwealth Fund, New York, 19U0 Garrett, Annette, Interviewing, Its Principles and Methods, Family Service Association of America, New York, N.Y., 191*2. Glenn, Mary Willcox, The Growth of Social Case Work i n the  United States, from Readings i n Social Case Work, 1920-35, edited by Fern Lowry, published for the New York School of Social Work, Columbia University Press, New York, 1939. Gordon, George, Appraising the Contribution of the Mental  Hygiene Clinic to the Community, Orthopsychiatry, January, Hamilton, Gordon, Theory and Practice of Case Work Today, Proceedings of the National Conference of Social Work, 191*1. Hamilton,, Gordon, Social Work Year Book for 1939. Hollis, Florence, Social Gase "Work i n Practice, Family Welfare Association of % i e r i c a , New York, N.Y., 1939. Marcus, .Grace:'F;;~--Responsibility of 1 the Case Worker i n Conflict Between Interests of Individual and Interests of Society, Proceedings of the National Conference of Social Work, 191*0. Pepinsky, H.B., The Selection and Use of Diagnostic  Categories i n Cl i n i c a l Counselling, -American Psychological Association, Stanford University Press, Stanford, 19i*8 Reynolds, Bertha C, An Experiment i n Short-Contact Inter- viewing, North Hampton, Smith College, School of Social "fork, 1932. Robertson, Virginia, A Changing Psychology i n Social Case  Work, Chapel H i H , University of North Carolina Press, 1930. Taft, Jessie, The Dynamics of Therapy i n a Controlled  Relationship, New York, MacMillan, 1933. Witman, H.L., Psyhciatric Clinics for Children, Commonwealth Fund, New York, 191*0. Periodicals Tbwle, Charlotte, Underlying S k i l l s of Gase Work Today, Proceedings of .the National Conference of Social Work, 191*1. Austin, Luci l l e , Trends i n Differential Treatment i n C a s e Work, Proceedings of the National Conference of Social Work, 19k Pray, Kenneth, K.L.M., General Principles of Case Work Practice i n 19U7, Proceedings of the National Conference of Social Work, 191*7 Other Studies Roberts, .^M., Mental Health C l i n i c a l Services (A Study of the c h i l d r e n between 6 and 12 years of age examined by Mental Health C l i n i c s i n Vancouver from 19k$ to 19h7 i n c l u s i v e ) , U n i v e r s i t y of B r i t i s h Columbia t h e s i s , 1°U9. I 

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