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Evaluating the modifiability of the client : one factor in determining treatability : a definition of… Daly, Katherine Aldworth 1955

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EVALUATING THE MODIFIABILITY OF THE CLIENT; ONE FACTOR IN DETERMINING TREATABILITY A d e f i n i t i o n of personal p o t e n t i a l and i t s place i n the t r e a t a b i l i t y of s o c i a l problems by casework method, and an evaluation of c r i t e r i a found i n pertinent professional l i t e r a t u r e . by KATHERINE ALDWORTH DALY  Thesis Submitted i n P a r t i a l Fulfilment of the Requirements f o r the Degree of MASTER OF SOCIAL WORK i n the School of S o c i a l Work  Accepted as conforming to the standard required f o r the degree of Master of S o c i a l Work  School of S o c i a l Work  1955 The University of B r i t i s h Columbia  ABSTRACT The t r e a t a b i l i t y of s o c i a l problems by s o c i a l casework method needs study f o r two reasons: (1) the obligation of the profession to those i t serves, to always r e f i n e and develop i t s services; (2) the p r a c t i c a l considera t i o n of achieving optimum economy of service. Among the factors enumerated by a u t h o r i t i e s i n the f i e l d of s o c i a l casework as components of t r e a t a b i l i t y are: the scope of s o c i a l casework, the development of the profession, agency function, community resources, the s k i l l of the caseworker, the problem, the r e a l i t y s i t u a t i o n and the c l i e n t . Of these only the l a t t e r has been singled out for independent study. The purpose of the study was to survey professional l i t e r ature for c r i t e r i a , necessary for recognition and assessment of t h i s f a c t o r , which could be submitted to the test of empirical research f o r v a l i d i t y and r e l i a b i l i t y . The p o t e n t i a l i t i e s of i n d i v i d u a l s f o r personal change i s not a new concept i n the profession, but one which has only recently begun to receive s p e c i a l consideration. Personal p o t e n t i a l , as defined within t h i s thesis, i s the a b i l i t y of the i n d i v i d u a l to solve his personal problem by means of casework treatment, the problem being defined as the inner d i f f i c u l t y underlying his symptomatic d i f f i c u l t y , and solution being considered as an inner and p o s i t i v e change i n r e l a t i o n to the problem. Evaluation of t h i s factor, therefore, presumes a c l a r i t y of diagnosis, which points up the need for developing more s a t i s f a c t o r y diagnostic c l a s s i f i c a t i o n s than exist at present. Professional l i t e r a t u r e offering c r i t e r i a of personal p o t e n t i a l was found to be l i m i t e d i n quantity and generally i n c i d e n t a l to other subject matter, and therefore not thoroughly or systematically considered. On the other hand, the quantity of c r i t e r i a suggested was proportionately large. The number and nature of c r i t e r i a varied widely among the a u t h o r i t i e s , as did the form i n which they were presented. I t was at f i r s t hoped to be able to sort and c l a s s i f y these. However i t became apparent that the ambiguity and inconsistency with which terms were used would make such c l a s s i f i c a t i o n a highly subjective task. The c r i t e r i a found did not possess generally accepted or precise d e f i n i t i o n s , and could not be measured s t a t i s t i c a l l y . A subjective appraisal of the c r i t e r i a i n terms of v a l i d i t y suggested that of the two main categories into which they seemed to f a l l , namely, l e v e l of adjustment and motivation, there was some t h e o r e t i c a l and p r a c t i c a l basis for considering motivation as e s s e n t i a l f o r personal  potential, and f o r considering l e v e l of adjustment as h e l p f u l and as an i n d i c a t i o n of the l e v e l at which treatment should s t a r t . There was also the suggestion that a l l people can be helped. The findings indicated that current c r i t e r i a need to be reduced to items which can r e a d i l y be defined, detected and measured f o r v a l i d i t y and r e l i a b i l i t y . Until such time as c r i t e r i a are developed, p r a c t i t i o n e r s w i l l continue to r e l y on c l i n i c a l judgements. In view of the hypothesis that a l l people can be helped and that motivation i s of prime importance, there i s reason f o r evaluating the adequacy of casework diagnostic and treatment s k i l l s and for c l a r i f y i n g how treatment goals are established.  ACKNOWLEDGEMENTS The writer wishes to express appreciation to the several members of the Faculty of the School of S o c i a l Work, at the University of B r i t i s h Columbia, whose knowledge and support have contributed to the development of this thesis. P a r t i c u l a r thanks are due to Dr. Leonard C. Marsh f o r the stimulation provided by his enthusiastic and conscientious approach to research and f o r the encouragement offered by his personal understanding and patience; to Mr. Adrian Marriage whose thorough and b r i l l i a n t c r i t i c i s m contributed greatly to the formulation of method, ideas and exposition, which do not however adequately r e f l e c t the richness and incisiveness of his mind; and to Mr. Arthur Abrahamson whose generous and consistent guidance was of great t h e o r e t i c a l and p r a c t i c a l help, and whose f a i t h i n the worth of individuals and i n their capacity for development has been a constant i n s p i r a t i o n . The writer also wishes to thank the School of S o c i a l Work and the Family Welfare Bureau of Greater Vancouver, p a r t i c u l a r l y Miss Mary McPhedran, i t s former Director, Miss Barbara Finlayson and Miss L i l l i a n Carscadden, f o r their cooperation and helpfulness i n providing case-material. She i s also g r a t e f u l to Miss Marjorie J . Smith, Director of the School of S o c i a l Work, and to Mr. Geoffrey Glover f o r the use of unpublished material i n their possession. In addition appreciation i s owing to fellow-students and colleagues whose ideas and experience have raised and resolved many questions, and f i n a l l y to those i n trouble whose needs and responses are i n s i s t e n t provocation to form and reform our understanding.  TABLE OF CONTENTS Page Chapter I:  1  Introduction - Background and Plan  1.  Why do we need to study t r e a t a b i l i t y ?  1  2.  What constitutes t r e a t a b i l i t y ?  5  3.  Focus of the thesis:  Chapter I I :  personal p o t e n t i a l  21  Personal P o t e n t i a l of the C l i e n t  24  1.  Development of the concept  24  2.  A Definition  31  3.  Sources of c r i t e r i a i n professional l i t e r a t u r e . 35  4.  Consideration of the c r i t e r i a :  amenability  to research Chapter I I I :  40 53  General Assessment of the C r i t e r i a  1.  Motivation and Capacity  2.  Limitations of l e v e l of adjustment as a  53  56  component of personal p o t e n t i a l 3.  Arguments for motivation as the e s s e n t i a l component  64  Chapter IV: Conclusion  72  1.  Summary  72  2.  Conclusions and Recommendations  73  3.  Implications for other aspects of s o c i a l casew>rk 75  Appendix: Bibliography  80  Tables i n the Text Table 1.  Number and d i s t r i b u t i o n of c r i t e r i a according to source:? and sub-groups  _  42  EVALUATING THE MODIFIABILITY OF THE CLIENTt ONE FACTOR IN DETERMINING TREATABILITY A d e f i n i t i o n of personal p o t e n t i a l and i t s place i n the t r e a t a b i l i t y of s o c i a l problems by casework method, and an evaluation of c r i t e r i a found i n pertinent professional literature.  CHAPTER It 1.  Why  INTRODUCTION - BACKGROUND AND PLAN OF THE THESIS  do we need to study t r e a t a b i l i t y ? The many years of experience and the thousands of  c l i e n t s seen have made i t e s s e n t i a l that the s o c i a l work profession c r i t i c a l l y examine the effectiveness of the s o c i a l treatment methods i t employs.  Their effectiveness  depends not only on the s k i l l with which they are applied but on the s k i l l with which they are selected.  An under-  standing of the psycho-social problem (diagnosis) i n conjunction with an understanding of t r e a t a b i l i t y  (prognosis)  makes possible the s e l e c t i o n of appropriate treatment goals and techniques  i n any  case.  Although diagnosis of adjustment problems i s not perfected, intake interview s k i l l s have developed to a point where i t i s increasingly easy to define a problem and to i n f e r i t s general causative factors i n the l i g h t of the c l i e n t ' s behaviour and the information he gives.  The same  i s not true of personality evaluation i n any e x p l i c i t  way,  although p r a c t i t i o n e r s undoubtedly recognize "symptoms" of strength and weakness i n the problem situations they encounter, and act i n accordance with them.  In order to  examine the effectiveness of professional service, a clear formulation of prognostic, as well as diagnostic and treatment processes, must eventually take place.  2.  There i s always an e t h i c a l r e s p o n s i b i l i t y to the profession and to those who are served by that profession to refine and develop existing services.  In addition,  there are p r a c t i c a l considerations which should stimulate research into the question of t r e a t a b i l i t y .  The demanding  pressures f o r casework help upon an already l i m i t e d supply of casework resources c a l l s f o r the maximum e f f i c i e n c y of service.  In order to achieve t h i s , i t i s v i t a l that the  s o c i a l worker know i f possible which cases w i l l normally respond favorably to s o c i a l treatment and which w i l l not. Where caseloads are large, an agency or an i n d i v i d u a l worker may have to select from i t s applicants those on which to concentrate Its e f f o r t s .  Workers should be able  to select, i n addition to those which are most urgent, those which are most promising. The frequency of "unsuccessful" cases, withdrawals, and chronic unimproved cases suggests that i n many instances no clear goals, or u n r e a l i s t i c ones, have been set. The writer has considerable doubts about the v a l i d i t y of terming many such cases " f a i l u r e s " and suspects that I f t r e a t a b i l i t y had been adequately considered, the degree of the c l i e n t ' s movement could have been anticipated and worked toward. If t h i s had been done, such cases would terminate with a f e e l i n g of accomplishment on the part of the worker, rather than the f r u s t r a t i o n or d i s s a t i s f a c t i o n which i s so often the case.  When a s o c i a l worker f e e l s thus, the feeling i s  3. conveyed to the c l i e n t , who or to carry on r e l u c t a n t l y .  has been forced to withdraw As a r e s u l t the c l i e n t  may  also f e e l g u i l t y about his f a i l u r e to measure up to the worker's expectations; this g u i l t extends his already existing emotional burdens.  Not only may he be given the  impression that his own goals are not good enough, and leave treatment with an uneasy f e e l i n g , but he may, pressure to meet the worker's requirement  leave  before he has even achieved his own goal.  treatment  " I f the therapist  has such an aim ( i . e . a complete I n t e l l e c t u a l and l i f e for everyone) i n many instances he may  under  emotional  destroy the  patient's opportunities f o r achievement i n any area." ^ The r e s u l t i s an unnecessary investment  of time, e f f o r t  and money, f o r c l i e n t s receiving and waiting for help, as i t i s also f o r workers, agencies and communities. The lack of c l a r i t y i n prognostic thinking has not only l i m i t e d casework p r a c t i c e d i r e c t l y , i n agencies  and  s o c i a l service departments, but has done so I n d i r e c t l y , by imposing  a l i m i t a t i o n on the a b i l i t y of supervisors and  teachers i n schools of s o c i a l work to impart p r i n c i p l e s of casework to students and practitioners of varying degrees of t r a i n i n g and experience.  Without a clear formulation of  t r e a t a b i l i t y , what i t i s , what i t s components are, and  how  Adelaide M. Johnson, M.D., i n Alexander and French, et a l v , Psychoanalytic Therapy. Ronald Press Company, New York: 194-6, p. 323, quoted i n Regina Flesch, "Treatment Goals and Techniques i n M a r i t a l Discord", Journal of S o c i a l Casework. XXIX, (December, 1948), p. 388. 1  4.  they can be recognized and assessed, those responsible f o r the training and professional development of s o c i a l workers are unable to communicate with economy what i s already "known".  I t i s possible too that the lack of c l a r i t y has  r e s t r i c t e d research and community organization programs. If i t were known f o r instance that a c e r t a i n proportion of those seeking help could not benefit appreciably by any methods or resources now available, such knowledge might stimulate and guide e f f o r t s to develop new methods and new resources. We need then to study t r e a t a b i l i t y , because we do not know enough about i t , and because i t i s important to know about i t i n order to improve professional practice, t r a i n i n g , and related aspects of the profession.  The  writer along with leaders i n the f i e l d of the study of human r e l a t i o n s believes that although every i n d i v i d u a l i s unique, i t w i l l eventually be possible, as has been the case i n diagnosis, to evaluate prognosis with increasing exactness. Prognostic evaluation w i l l always depend on prevailing knowledge and s k i l l .  As these are subject to change,, so  w i l l be our understanding of what i s treatable and what i s not.  The least that can be said at the present time i s that  some c l i e n t s respond to treatment and some do not; that some are amenable to treatment at some points i n their experience and not at others*  Most agencies probably have had several  cases which close unsuccessfully and which reopen l a t e r to  5. display a more encouraging progress toward a more favourable close. 2.  What constitutes t r e a t a b i l i t y ? Prognosis i n medicine i s the forecast of the course  of a disease.  In the context of this thesis, i t would mean  the p r e d i c t i o n of future development of a s o c i a l problem under s o c i a l casework treatment.  T r e a t a b i l i t y i s the extent  to which the problem can be resolved by such treatment. What are the factors which l i m i t or permit treatment?  It  i s a complex, made up of many things, which include:  the  scope of casework; the development of the profession; agency function; the s k i l l of the worker; community resources; the problem; the r e a l i t y s i t u a t i o n of the c l i e n t ; and the c l i e n t himself.  Each of these, and any other relevant  factors, must be assessed i n order to determine  treatability.  Recognized leaders i n s o c i a l work have, at various times, voiced these as factors l i m i t i n g treatment, formulated on the basis of t h e o r e t i c a l knowledge and experience from s o c i a l work p r a c t i c e .  I t i s the l a s t of these, the c l i e n t  himself, on which this study i s focussed, but before moving toward t h i s , consideration w i l l be given to the others. (a) The scope of casework.  2  Treatment i s n a t u r a l l y l i m i t e d  Fern Lowry, "The C l i e n t ' s Needs as The Basis f o r D i f f e r e n t i a l Approach i n Treatment", i n " D i f f e r e n t i a l Approach i n Case Work Treatment". New York: Family Welfare Association of America, 1936. p. 10. 2  6. by the aims and goals of the profession, or rather by the aims and goals i t does not hold.  This i s perhaps a more  fixed l i m i t a t i o n than the development of the profession, except insofar as goals are influenced by the knowledge and s k i l l a v a i l a b l e . Father Bowers defines casework as "an a r t i n which knowledge of the science of human r e l a t i o n s , and s k i l l i n r e l a t i o n s h i p are used to mobilize capacities i n the i n d i v i d u a l and resources i n the community appropr i a t e for the better adjustment between the c l i e n t and a l l or any part of his t o t a l environment."3  He states i t s  i n t r i n s i c end to be the rendering mobile of an i n d i v i d u a l ' s capacities and the community's resources appropriate to a proximate e x t r i n s i c end.3  a  This l a s t qualifying phrase  indicates the point that i s relevant here, namely the p a r t i a l i t y of casework purpose.  That i s , i t does not aim  at rendering mobile an individual's capacities i n some vague context, but i n r e l a t i o n to a p a r t i c u l a r s i t u a t i o n or problem; i t does not aim at rendering mobile a l l c a p a c i t i e s , but those which are pertinent or "appropriate".  In other  words complete personality change i s not attempted. i n turn Is based on the intent of service.  This  As Hunt defines  i t , "caseworkers aim to help their c l i e n t s behave more happily and e f f e c t i v e l y i n r e l a t i o n to t h e i r previous 3 Swithin Bowers, "The Nature and D e f i n i t i o n of S o c i a l Casework", Journal of S o c i a l Casework. XXX, December, 1949, p. 417. 3a  l  D  i  d  )  p  .  316.  7. functioning - rather than to have them f i t some i d e a l i s t i c pattern of s t a t i c perfection." " 4  The p a r t i a l i t y of casework  i s therefore based on philosophical considerations as well as professional competency; that i s to say, the casework aim determines the methods that are developed to accomplish t h i s aim, rather than the casework methods determining the aim.  In disavowing absolute  standards or norms, casework  then does not attempt to impose a goal external to the i n d i v i d u a l or to force him to measure up to some external yardstick.  Rather i t aims at helping s p e c i f i c individuals  with s p e c i f i c problems f i n d successful ways of achieving their own aims i n place of the unsuccessful ways of which their s o c i a l adjustment problems are a symptom.  I t aims at  helping them achieve a more harmonious r e l a t i o n s h i p to themselves and to their external s i t u a t i o n , to the degree of which they are capable.  Casework then does not aim at  fundamental personality change, nor, f o r that matter, at fundamental change of the environment, whether s o c i a l or natural.  I t i s a helping profession, dealing with what i s  "given" whether i n the i n d i v i d u a l or family, or i n the t o t a l situation.  The goals and techniques of casework seem to  rest not only on a p h i l o s o p h i c a l base but on p r a c t i c a l experience with people i n terms of what i s h e l p f u l , how J . McVicker Hunt and Leonard S. Kogan, Measuring Results i n S o c i a l Casework; a Manual on Judging Movement. New York: Family Service Association of America, 1950, p. 7» 4  8.  they are helped and what they want.  These are supported  by current t h e o r e t i c a l knowledge about human development, whether within a treatment s i t u a t i o n or within less specialized life-situations.  Adjustment l i k e any growth or  any learning i s a gradual and uneven development, involving periods of change and r e i n t e g r a t i o n . I t i s true that f o r some years, through i t s i n t e r e s t i n psychiatry and i n drawing on that profession to make i t s own  services more e f f e c t i v e , s o c i a l work tended to be  preoccupied with personality problems and personality change. The reasons f o r this were many: standing what the "new  the great need for under-  psychology" had to contribute to the  s o c i a l work f i e l d ; f a s c i n a t i o n with the material i t s e l f ; i n addition, governments have increasingly taken over programs of f i n a n c i a l aid, so that many private agencies were less pressed to deal with concrete needs; the depression a s i t u a t i o n where concrete help was  created  lacking or inadequate,  and i n the face of t h i s f r u s t r a t i o n , s o c i a l work was  compelled  to be more resourceful about intangible services; another element was  the shortage of p s y c h i a t r i c treatment and  tremendous demand for i t . two trends today:  the  Garrett points out that there are  one i s f o r caseworkers to r e t a i n this  concern with psychology per se, and to tend to become the equivalent of lay-analysts or lay-psychotherapists,  espec-  i a l l y i n c l i n i c a l settings under p s y c h i a t r i c supervision;  9 the other i s to return to the professional o r i e n t a t i o n that belongs to s o c i a l work, which i s neither wholly concerned with the e f f e c t of the environment, not wholly  5 concerned with the e f f e c t of personality maladjustment. As part of the s o c i a l work profession, casework i s concerned with multi-faceted s i t u a t i o n s .  "The caseworker does not  define the problems he deals with i n terms of intra-psychic c o n f l i c t ; rather i t i s the problem of the c l i e n t i n r e l a t i o n to a d i s t r e s s i n g s i t u a t i o n , usually of an economic, health, or interpersonal nature.  I t i s this relatedness aspect of  personal problems which i s the concern of the caseworker."^ Also under this heading of the scope of casework should be included some consideration of casework method as well as aim.  As mentioned elsewhere, casework uses the  well-established ways of helping people i n trouble, that i s , personal influence and concrete services.  Both of these  are conveyed through an i n d i v i d u a l personal r e l a t i o n s h i p between the c l i e n t and worker, i n which the usual form of communication i s t a l k i n g .  The problem must be  considered  i n terms of whether i t f a l l s within the scope of casework. Where casework aims or methods do not seem pertinent to 5 Annette Garrett, " H i s t o r i c a l Survey of the Evolution of Casework", Journal of S o c i a l Casework, XXX (June, 1949), p. 224. 6 Jules Coleman, "Distinguishing Between Psychotherapy and Casework", Journal of S o c i a l Casework, XXX (June, 1949), p. 247.  10 treatment of a p a r t i c u l a r problem, or w i l l only p a r t i a l l y answer the needs of a s i t u a t i o n , community resources w i l l assume importance as an a l t e r n a t i v e or complementary source of treatment, 7  (b) Development of the profession the three factors c i t e d below.  might seem to embrace  However the term as used  implies more than the bringing of caseworkers, agencies and community resources up to the l e v e l of the profession's current understanding of diagnosis and treatment.  I t would  appear to include the l e v e l of understanding i t s e l f .  It is  obvious that knowledge i s always changing, and i t can be assumed from past experience that new understanding, new services and techniques may modify our concept of what i s treatable.  However we can only be guided by our current  l e v e l of understanding and consider t r e a t a b i l i t y or untreata b i l i t y as r e l a t i v e to that. (c) Another factor voiced as a determinant of t r e a t a b i l i t y i s agency function.^  One of the a r t i c l e s c i t i n g t h i s as a  basis f o r d i f f e r e n t i a l treatment i n 1936 seemed to be describing methods of treatment as d i f f e r i n g between agencies, a s i t u a t i o n as i t existed rather than as i t should or need be. 7 Gordon Hamilton, "Theory and Practice of S o c i a l Casework", New York: Columbia University Press, 1940, p. 209. ^ Marcella Farrar, "The Approach to the C l i e n t ' s Needs as i t i s Conditioned by the Function of the Agency", i n D i f f e r e n t i a l Approach i n Case Work Treatment. New York: Family Welfare Association of America, 1936, p. 45.  11 However, even at a time when standards of service are more uniform, agency function may  be considered  relevant.  Different agencies are, of course, set up f o r d i f f e r e n t purposes, to deal with s p e c i f i c types of problem: therefore are o f f e r i n g d i f f e r e n t services.  The  they  point  relevant here i s whether the p a r t i c u l a r agency to which a s o c i a l problem has been presented can, according  to i t s  p o l i c y and the services provided, meet the demands of the situation.  (One would have to consider, not only the  function of the agency as defined by law or charter, but also i t s "functioning" insofar as there i s some discrepancy between the l a t t e r and the agency s intended range and q u a l i t y of 1  service, due to, inadequate numbers or q u a l i f i c a t i o n s of s t a f f , conditions of work, administrative d e f i c i e n c i e s and so on.  However this might be considered a separate point  among the l i m i t i n g factors enumerated here.) I t might be argued that a caseworker i n an intake interview might, on making a tentative diagnosis, determine that the s o c i a l problem presented was  treatable although  not within the function of his own agency, and therefore that agency function should not be considered a factor i n determining t r e a t a b i l i t y .  However we remind ourselves  that  t r e a t a b i l i t y i s a complex " p a r t i c i p a t i o n category" and  that  another factor that worker would consider i s community resources.  I f another agency, with a program more suited  to the s o c i a l problem existed i n the community, a r e f e r r a l  12  to i t would complete his assessment of t r e a t a b i l i t y .  If  such an agency did not e x i s t , then f o r a l l p r a c t i c a l purposes the problem was not treatable.  The l i m i t a t i o n  imposed by agency function points up the r e s p o n s i b i l i t y of the professional worker.  Because of the generic nature  of s o c i a l work t r a i n i n g , a caseworker, regardless of the setting i n which he works, i s prepared and responsible f o r a r r i v i n g at a s o c i a l diagnosis, and i s capable of providing the treatment required.  I f the agency i n which he works  and to which the c l i e n t applies does not provide the necessary services, the worker would help the c l i e n t to one which does.  This also points up the need f o r inter-agency  relationships to be such that r e f e r r a l i s e a s i l y effected, or cooperative treatment worked out. (d) Community resources,9  a s  indicated above, present another  q u a l i f i e r of treatment. The a v a i l a b i l i t y of f a c i l i t i e s and services to meet the requirements of the problem s i t u a t i o n i s of course e s s e n t i a l .  This refers to resources i n the  larger community i n which the c l i e n t l i v e s rather than i n his immediate environment which constitutes a separate f a c t o r . I t might be seen as including almost any kind of established service to a l l members of the community or p a r t i c u l a r groups: 9  Hamilton, l o c c i t .  13. s o c i a l , medical, l e g a l , educational, r e l i g i o u s , vocational and even commercial resources.  The importance  of t h i s  factor would vary according to the nature of the problem being considered. Casework constantly a l l i e s i t s e l f with the whole s o c i a l work profession to expand existing s o c i a l services, and to work f o r the establishment of other resources to correct apparent lacks.  S o c i a l welfare planning within a  community should be such that needs f o r which no service exists can be met by setting up new ones.  As with agency  function, we f i n d that f o r a l l p r a c t i c a l purposes a s o c i a l problem i s untreatable i f resources are lacking, even though we know that this i s the only l i m i t i n g f a c t o r . (e)  The s k i l l of the w o r k e r  10  i s also mentioned as a  determinant of success, and i t has also been mentioned as a determinant of d i f f e r e n t i a l treatment.  Individual workers  d i f f e r i n natural capacities just as c l i e n t s do, not only i n diagnostic s k i l l , but i n t h e i r a b i l i t y to give e f f e c t i v e service.  Although workers w i l l vary as to t h e i r s k i l l i n  using one treatment technique or another, f o r the same reason, the s i g n i f i c a n c e of the s k i l l of the worker f o r s e l e c t i o n of treatment method does not have the same importance today Ruth Smalley, "The Approach to the C l i e n t ' s Needs as i t i s Conditioned by The Equipment of the Worker," i n D i f f e r e n t i a l Approach i n Case Work Treatment. New York: Family Welfare Association of America, 1936, pp. 53* 1 0  t  14.  as i t did when the statement was made, that i s i n when " i n s i g h t development" was  a r e l a t i v e l y new  1936,  approach.  Today a q u a l i f i e d caseworker has received t r a i n i n g which enables him to use any s o c i a l case-work techniques that the s i t u a t i o n warrants so that wide variations i n s k i l l s have decreased since the comment was  made.  However i n a f i e l d  where the demand exceeds the supply, there are s t i l l , i n addition to i n d i v i d u a l differences i n the personal experience of workers, differences i n the degrees of t r a i n i n g and experience of those holding positions of s i m i l a r r e s p o n s i b i l i t y . ( f ) The problem of the c l i e n t ^ - i s another factor which i s regularly put forward as a factor i n t r e a t a b i l i t y .  There  has been some f e e l i n g that the more severe the problem, the more unfavorable the prognosis, with the implication that problems can be graded into some sequence of severity. Psychiatry does have general diagnostic categories, subdivided into various c l i n i c a l syndromes, e.g. psychopathic personality, schizophrenia, arid so on.  obsessive-compulsive neurosis  S o c i a l work has not as yet developed a system of  diagnostic c l a s s i f i c a t i o n because of the enormous complexity of s o c i a l problems, and has therefore tended to lean on the diagnostic c r i t e r i a of psychiatry and consequently to be influenced by p s y c h i a t r i c thinking about the r e l a t i v e l y f i x e d r e l a t i o n of diagnosis to prognosis.  Although the  clinical  Regina Flesch, "Treatment Goals and Techniques i n M a r i t a l Discord", Journal of S o c i a l Casework. XXIX, (December, 1948) p. 2ET. 1 1  15. syndromes of psychiatry have been roughly correlated with d i f f e r i n g degrees of t r e a t a b i l i t y , are not f i r m l y established.  1 2  these correlations  The d i r e c t i o n of thinking  seems to be toward the idea that the problem or the  now  diagnosis  does not indicate the t r e a t a b i l i t y , but rather indicates the goals and methods of treatment.  Most p r a c t i t i o n e r s  could probably r e c a l l f a i r l y r e a d i l y from t h e i r experience problems usually regarded as serious which have responded to treatment and problems usually regarded as less serious which have not.  The explanation i s not necessarily that  the hypothesis as to the association between increasing severity of the problem and decreasing i s erroneous.  prognostic hopefulness  Again we must remind ourselves of the f a c t  that t r e a t a b i l i t y i s composed of a complex of factors, any one of which i s i n s u f f i c i e n t f o r accurate p r e d i c t i o n . Although diagnosis may t r e a t a b i l i t y , i t may resources  not of i t s e l f indicate  indicate the amount of time, e f f o r t and  that are to be taken up i n treatment.  I t could  perhaps be assumed that the more serious the problem i s (as judged by i t s severity, extent and duration), the more d i f f i c u l t treatment w i l l be.  Here one can see the  relevance  of the other factors mentioned above and the ones to follow: L u c i l l e Austin, "Trends i n D i f f e r e n t i a l Treatment i n Casework", Journal of S o c i a l Casework, XXIX, (June, 194-8) pp. 206 f f . 1 2  16.  the more d i f f i c u l t the problem, the more e s s e n t i a l becomes a favorable assessment of the other components.  Even i f  a l l the factors i n the problem are modifiable, and  the  necessary resources a v a i l a b l e , the l i m i t a t i o n s of time available, as permitted by society, the s i t u a t i o n or the l i f e s p a n of the c l i e n t , may a l t e r considerably the picture of t r e a t a b i l i t y . This factor, p a r t i c u l a r l y where the problem i s at least p a r t i a l l y within the personality of the c l i e n t , i s very d i f f i c u l t to separate out from the l a s t f a c t o r , the c l i e n t himself.  In fact these l a s t three are very c l o s e l y  i n t e r r e l a t e d as might be expected.  Some of the aspects of  the problem which have been c i t e d i n the l i t e r a t u r e as c r i t e r i a of t r e a t a b i l i t y , are a c t u a l l y diagnostic c r i t e r i a , or more exactly diagnostic clues: of physical or emotional pathology,  for instance,  evidences  sources of the  duration, extent, s e v e r i t y and so on.  pathology,  I t i s true that some  of the same facts that have diagnostic s i g n i f i c a n c e may have prognostic value.  also  However i t may be possible to  consider both aspects of a single item separately. (g) Another important  f a c t o r l i m i t i n g or f a c i l i t a t i n g 1-3  treatment i s the " r e a l i t y s i t u a t i o n " .  J  To the s o c i a l worker,  ^ Charlotte Towle, "Factors i n Treatment", Proceedings of the National Conference of S o c i a l Work, New York: Columbia University Press, 1936, p. 179.  17 who  thinks of c l i e n t s " i n context", this i s a most important  item to be considered i n evaluating t r e a t a b i l i t y .  The  reality  s i t u a t i o n i s a very broad term which might i t s e l f be broken down into d i f f e r e n t components.  I t includes the c l i e n t ' s  immediate environment, physical and s o c i a l , the l a t t e r including individuals and groups with which he i s connected, t h e i r attitudes and behaviour toward him.  I t includes the  larger community i n which he finds himself.  I t includes  his s o c i a l and economic status, educational and vocational circumstances,  his r e s p o n s i b i l i t i e s and opportunities.  It  could also be seen to include l i f e : . - crises and events which happen to him or i n which he i s involved.  The  important question i n considering this factor i s the degree of mobility of the c l i e n t ' s external circumstances.-^  The  reason f o r i t s significance i s that i n the i n t e r a c t i o n between the c l i e n t and his environment, the problem has  had  i t s source, finds i t s expression, and w i l l achieve i t s resolution.  From this point of view the r e a l i t y s i t u a t i o n  i s an indispensable consideration.  I f i t i s the main source  or cause of the problem, i t s m o d i f i a b i l i t y i s of great importance. ^ 1  importance.  I f i t i s one source or cause i t i s s t i l l of The less modifiable the r e a l i t y s i t u a t i o n , the  more w i l l be demanded of the other f a c t o r s . 1  Lowry, loc c i t .  15  i b i d , p.  4  7.  Unless i t can be  -  I  18.  changed, i t may be impossible f o r the c l i e n t , f o r instance, to make necessary modifications i n h i m s e l f . ^ 1  Similarly,  though i t may be possible f o r him to do so, i t may be f u t i l e ; i f a f t e r he has achieved new attitudes and i n s i g h t s , his s i t u a t i o n i s s t i l l so adverse that he cannot cope with i t , the problem i s not soluble. '' 1  On the other hand,  favorable assessment of the other factors might be able to compensate f o r an unfavorable one here. (h) The l a s t major factor, and the one with which this study •I Q  i s s p e c i f i c a l l y concerned, i s the c l i e n t himself. i n d i v i d u a l again i s composed of many aspects.  The  Physically  we must consider his appearance, sex, health, physical condition and age.  I n t e l l e c t u a l l y we must consider h i s  capacity and the degree to which i t i s developed or functioning; s o c i a l l y and emotionally we must consider his behaviour and attitudes toward himself and others.  A l l these facets  are, of course, i n t e r r e l a t e d and make up the person. The question that i s usually asked about t h i s factor i s again one of m o d i f i a b i l i t y .  The importance of this w i l l depend  on the nature of the problem, that i s , to what degree the origins of the problem are within the person, rather than external to him.  Most s o c i a l problems when diagnosed show  "problems" i n both person and environment.  I t might be  Coleman, op. c i t . , p. 248. C a r l Rogers, Counselling and Psychotherapy, p. 78, Hamilton, l o c c i t .  19. postulated that determining  m o d i f i a b i l i t y of the c l i e n t  involves weighing the personal resources against the personal problems; that determining  the m o d i f i a b i l i t y of  the environment involves weighing environmental resources against environmental problems.  Where the resources  of  either are d e f i c i e n t , the resources of the other, and of the a d d i t i o n a l f a c t o r s , assume greater importance. Generally speaking treatment p o t e n t i a l only needs to be evaluated when and where casework diagnosis reveals that forces within the c l i e n t ' s personality have contributed to the development of the problem, and where modification i n the c l i e n t i s therefore necessary to r e s o l u t i o n of the problem.  T h e o r e t i c a l l y , where casework diagnosis shows  that the problem stems only from environmental sources or an emergency s i t u a t i o n , s o l u t i o n of the problem would depend on modification of the environment perhaps through the use of concrete " s o c i a l services".  However i n some  cases the environmental stresses cannot be modified or appropriate services and resources are not a v a i l a b l e ; i n such a s i t u a t i o n , m o d i f i a b i l i t y of the c l i e n t s t i l l needs to be assessed i n terms of the c l i e n t ' s a b i l i t y to accept  and  adapt himself to t h i s s i t u a t i o n . T r e a t a b i l i t y , then, i s determined by a consideration of a l l the factors mentioned above, and perhaps others. I t i s r e l a t i v e to the frame of reference of the person making the assessment of t r e a t a b i l i t y , and to actual conditions not hypothetical ones.  We have not, at this  20.  point, developed s k i l l i n assessing systematically the whole "syndrome" of factors making up t r e a t a b i l i t y , nor even i n doing t h i s with i n d i v i d u a l ones.  We know only vaguely,  that although each factor must be considered  separately,  i t i s i n the consideration of them a l l together, that the significance of any one becomes apparent. For where the c l i e n t ' s resources  instance,  are l i m i t e d , the environmental  resources w i l l assume greater importance, and where the c l i e n t ' s resources resources  may  are considerable, the environmental  be of lesser significance f o r prognosis.  We  are i n c l i n e d to forget that a l l factors are important. Sometimes t h i s may  be because assessment of the most  immediate or most obvious ones indicates a favorable prognosis without going any further, or an unfavorable one without going any further.  Sometimes i t may  be that within  a worker's or an agency's caseload, or within a community, most of the variables are f a i r l y constant,  so that only the  ones pertaining to the s o c i a l problem presented receive deliberate consideration, i . e . , the problem, the r e a l i t y s i t u a t i o n and the c l i e n t .  Again i t may  be that experienced  workers, with considerable f a m i l i a r i t y with the profession and with t h e i r community, do not "forget" or neglect to assess a l l the relevant factors, but do so almost " i n t u i t i v e l y " so that t h e i r assessment i s not apparent, even to themselves. So f a r as this writer knows there i s v i r t u a l l y no work on the whole question of t r e a t a b i l i t y , that i s , no attempt to make a complete statement of i t s components, to  ) 21.  determine t h e i r r e l a t i v e values, to set out ways of assessing them or to establish c r i t e r i a f o r doing so.  This may  be  p a r t l y because some are f a i r l y r e a d i l y assessed, such as agency function, development of the profession and so on. However t h i s i s not the whole explanation, as of the three most frequently cited, one i n p a r t i c u l a r , the r e a l i t y s i t u a t i o n or external circumstances, has received almost no consideration i n terms of how one would proceed to evaluate t h i s very large and complex item* 3.  Focus of the thesis:  personal p o t e n t i a l .  Although, as stated above, a l l factors must be assessed i n determining t r e a t a b i l i t y , each needs to be considered independently before they can be considered i n combination with each other.  Although a l l are interdependent i n f a c t ,  i t would seem possible to separate them at l e a s t f o r purposes of discussion. Some seem to be more i n e x t r i c a b l y related than others, p a r t i c u l a r l y the problem, the c l i e n t , and h i s environment.  These have already become intertwined  before treatment was considered. In t h i s study i t i s intended to focus on the aspect of t r e a t a b i l i t y l a s t mentioned, that i s , the m o d i f l a b i l i t y of the c l i e n t .  Its purpose i s mainly an exploratory one  with the hope of mapping out more c l e a r l y what i s currently known or thought about this subject, and what i s s t i l l uncharted t e r r i t o r y .  22. No attempt w i l l be made to tackle the other factors, nor w i l l there be an attempt to r e l a t e assessment of the c l i e n t to the other factors either i n d i v i d u a l l y or collectively.  Although t h i s needs to be done from a research  point of view as well as i n actual practice, i t w i l l not undertaken here.  be  In one sense, evaluation of the c l i e n t i s  c l o s e l y r e l a t e d to evaluation of the r e a l i t y s i t u a t i o n . That i s , an i n d i v i d u a l may  be considered from two points of  view; i n one sense he i s a c l i e n t , and i n another he i s part of the environment of another i n d i v i d u a l . I t could probably be assumed that the same procedures would be required i n evaluating the p o t e n t i a l of a "primary" c l i e n t , or applicant, as would be required i n evaluating a "secondary" c l i e n t or a member of the applicant's environment. The reason for selecting t h i s p a r t i c u l a r aspect f o r study i s mainly one of personal i n t e r e s t .  I t i s of prime  importance as attested by the fact that of a l l the variables i t seems to be the one most frequently discussed.  I t holds  a central p o s i t i o n , as without the c l i e n t there would be problem to treat and no means of treatment.  no  From a p r a c t i c a l  point of view a greater understanding of t h i s factor i s a crying need:  there are cases, where the competency of the  worker, the agency's function, community resources,  the  nature of the problem and the r e a l i t y s i t u a t i o n a l l apparently being favorable, the degree of r e s o l u t i o n and method of obtaining that degree are dependent only on the  the  23 c l i e n t ' s capacity to respond.  Indeed the s i g n i f i c a n c e of  this capacity i s revealed i n a negative way by the f a c t that i n situations where the other factors are not favorable, the capacity to benefit from help d i f f e r s markedly from one i n d i v i d u a l to another.  In addition, as suggested above, i f  greater understanding of this factor were developed, one aspect of another factor, i . e . , the human elements i n the r e a l i t y s i t u a t i o n , would simultaneously be elucidated. The plan of the study w i l l include the following steps:  f i r s t , the development of the concept of personal  p o t e n t i a l w i l l be traced b r i e f l y and a tentative d e f i n i t i o n stated.  Having established t h i s frame of reference we s h a l l  proceed to make a survey of professional monographs and periodicals on s o c i a l casework theory and practice, and on the theory and practice of related professions working i n the f i e l d of human r e l a t i o n s to obtain c r i t e r i a which have been used to assess personal p o t e n t i a l .  Once they have been  assembled, an attempt w i l l be made to systematize them, by means of sorting and c l a s s i f i c a t i o n , and following t h i s they w i l l be examined with a view to determining whether, as they stand, they are amenable to s c i e n t i f i c testing f o r v a l i d i t y and r e l i a b i l i t y by predictive a p p l i c a t i o n to actual cases, though such a p p l i c a t i o n w i l l not be undertaken.  In addition  some c r i t i c a l assessment w i l l be made of t h e i r value from a t h e o r e t i c a l point of view.  On the basis of t h i s examination,  conclusions w i l l be drawn as to the implications for the need and d i r e c t i o n of further  research.  24. CHAPTER I I : PERSONAL POTENTIAL OF THE CLIENT. 1.  Development  of the concept.  Before attempting to consider c r i t e r i a of t h i s component of t r e a t a b i l i t y , i t seems advisable to c l a r i f y the concept i t s e l f by b r i e f l y tracing i t s development and a r r i v i n g at a working d e f i n i t i o n that w i l l provide a ready frame of reference. Casework has long applied i t s p r i n c i p l e of i n d i v i d u a l i z a t i o n to the problems presented by i t s c l i e n t s . Gradually i t was seen that the same presenting problem could come from a v a r i e t y of causes, o r i g i n a l l y interpreted as worthy and unworthy.  1  F i n a n c i a l need or poverty were  seen as the r e s u l t of either misfortune or wilfulness.  One  case of f i n a n c i a l need was considered due to inadequate income, another to extra expense resulting from emergencies; these were forms of r e a l i s t i c need.  Other cases of need,  attributed to poor planning or f a i l u r e to work when p h y s i c a l l y able, were seen as forms of unworthy need, stemming from i n t e l l e c t u a l , educational or moral inadequacy.  Defective  i n t e l l i g e n c e or education were considered something an i n d i v i d u a l could not help; therefore services of a c e r t a i n quality were provided to compensate f o r these d e f i c i e n c i e s . However, f o r the morally inadequate, u n t i l the turn of the Annette Garrett, " H i s t o r i c a l Survey of the Evolution of Casework", Journal of S o c i a l Casework. XXX, (June, 1949) p. 220. 1  25. twentieth century, there was no solution beyond the passing of : judgment.  F i n a l l y psychiatry revealed that personality  defects, f o r which an i n d i v i d u a l was not t o t a l l y responsible, could also account f o r s o c i a l inadequacies and were often amenable to treatment when understood as such.  Gradually  the judgemental divisions were changed, at l e a s t verbally, to terms such as external or i n t e r n a l , jective. ^  2  objective or sub-  With the understanding obtained from psychiatry,  some of the "subjective" reasons for getting into d i f f i c u l t i e s could be understood and helped, even i f only because the helping attitude was modified. The new understanding was acclaimed with enthusiasm and with the hope that now " a l l problems could be solved". But i t was soon recognized that understanding was not a l l , that what was done on the basis of the understanding was also important.  Two attitudes had complicated the s i t u a t i o n :  one was simply that f o r t h i s period a l l the attention was applied to diagnosis, to the knowledge and s k i l l that yielded understanding, r e s u l t i n g i n neglect of treatment. was another factor:  There  i t was apparently thought that once a  problem was understood, t h i s understanding could be conveyed Florence H o l l i s , "Environmental (Indirect) Treat- . ment as Determined by The C l i e n t ' s Needs", D i f f e r e n t i a l Approach i n Case Work Treatment,, New York: Family Welfare Association of America, 1936, p. 16. 2  3 Fern Lowry, "The C l i e n t ' s Needs as The Basis f o r D i f f e r e n t i a l Treatment, D i f f e r e n t i a l Approach i n Case Work Treatment. New York: Family Welfare Association of America, 1936, p. 7.  26. to the c l i e n t or patient, and change or cure would automatically follow on this "welcome" i n t e r p r e t a t i o n . The problem of treatment method proved a d i f f i c u l t one, but gradually varied approaches and techniques were developed to help with d i f f e r e n t personality problems. Even so, i t became apparent that there were s t i l l cases i n which the therapist could see c l e a r l y what was wrong and knew i n theory what should be done, but where i t was impossible to achieve favorable r e s u l t s .  Casework during  t h i s period, attempted to locate the source of a s o c i a l problem either i n the environment or i n the c l i e n t .  Logically,  ;some deduced that i f the source was external, treatment would be the same, and i f i t was i n t e r n a l , treatment should be " d i r e c t " , and i f both, both. " 4  Results were not always  forthcoming, and at f i r s t t h i s was interpreted as the f a i l u r e of casework to admit that c e r t a i n problems were outside i t s field.  I t was assumed that s o c i a l treatment was not s u f f i c i e n t  to resolve these d i f f i c u l t i e s .  Therefore there was a tend-  ency to assume that the "needed treatment" belonged i n the scope of psychiatry.  In c e r t a i n respects t h i s was and w i l l  always be true, but soon therafter both s o c i a l workers and p s y c h i a t r i s t s discovered that psychotherapy too was unable to help a l l individuals resolve their problems. Loc. c i t  At the  27 time, however, judging by the lack of reference to this aspect of t r e a t a b i l i t y , the s o c i a l workers of the 1920's and 1930's found d i f f i c u l t y i n admitting that the c l i e n t ' s potentialities  had anything to do with the f a i l u r e of a  case, (though they might not have denied them i n r e l a t i o n to success!)  This was because they knew i t had been a con-  venient excuse f o r f a i l u r e s i n the period when the unconscious motivations of the c l i e n t were as unconscious f o r them as f o r the c l i e n t .  In 1936 Miss Lowry decried the  tendency to blame the c l i e n t f o r f a i l u r e of a case and assumed the blame f o r the profession's lack of s k i l l and i t s attempt to undertake a l l t h i n g s S However i n the same paper she indicated an awareness of another factor, although reluctant to name i t as such, namely the capacity of the c l i e n t to use treatment.  In  discussing the "needs" of the c l i e n t as one basis f o r d i f f e r e n t i a l treatment, she asked various questions which would have to be answered i n assessing those needs. For instance:  "Is the c l i e n t aware of this d i f f i c u l t y ?  How  uncomfortable i s he because of i t s existence? ... Has he i n any way indicated a desire f o r change? ... What attitudes does he show i n r e l a t i o n to his d i f f i c u l t y ?  How r i g i d do  they seem to be i . e . , to what degree do they seem subject to change? ... Is i t r e l a t e d to any evidences of pathology, 5  Ibid, p. 9  28  physical or mental?  Is i t of long duration or has i t  recently developed?..."^ Some of these questions apply to diagnosis, but others to the capacity to change or to benef i t from help. the l i t e r a t u r e . the experience  I d e n t i f i c a t i o n of t h i s factor i s rare i n Awareness of i t developed gradually from of s o c i a l workers but t h e i r understanding of  i t was enhanced by further developments,, i n psychiatry which began to concern i t s e l f , not only with the unconscious i n f a n t i l e c o n f l i c t s , but also the adaptive, healthy part of the personality which attempted to deal with these conf l i c t s and with external r e a l i t y , and therefore a part of the personality that would be e s s e n t i a l to consider i n treatment. Perhaps because s o c i a l work diagnosis tends to be an unwieldy, descriptive thing, rather than a system of c l a s s i f i c a t i o n s , diagnosis of the person with the problem became mixed up with "diagnosis" of the person handling his problem, so that diagnosis and "evaluation" have not often been c l e a r l y d i f f e r e n t i a t e d and are s t i l l to separate.  difficult  Pressure of work has undoubtedly m i l i t a t e d  against the l e i s u r e needed f o r the research that could c l a r i f y some of these issues.  In addition a strong t r a d i t i o n  of i n d i v i d u a l i z a t i o n may add some reluctance to define and c l a s s i f y , with the fear that i n d i v i d u a l i t y may be l o s t thereby. Although the term " t r e a t a b i l i t y " as applied to Ibid, p. 10.  29 individuals i s a r e l a t i v e l y new  one, the concept has long  been recognized i n the f i e l d of s o c i a l work.  "The London  Charity Organization Society, heir to Chalmers' ideas and student of the Elb'erfield system, included i n i t s membership from the beginning a small group of s o c i a l reformers who,  while impressed with the necessity f o r regulating  r e l i e f - g i v i n g , e s p e c i a l l y concerned themselves with e f f o r t s to place distressed people above the need f o r r e l i e f  and,  i n doing t h i s , to study and release their latent p o s s i b i l i t i e s . As early as i860, the year i n which the London society was founded, Miss Octavia H i l l had given, before the S o c i a l Science Association, the f i r s t d e s c r i p t i o n that we have been able to f i n d of enquiry with s o c i a l reinstatement as i t s motive and aim  ...  By knowledge of character more i s meant than whether a man i s a drunkard or a woman i s dishonest; i t means knowledge of the passions, hopes, and h i s t o r y of people; where the temptations w i l l touch them, what i s the l i t t l e scheme they have made of t h e i r l i v e s , or would make, i f they had encouragement; what training long past phases of t h e i r l i v e s may have afforded; how to move, touch, teach them. Our memories and our hopes are more t r u l y factors of our l i v e s than we often remember." 7 Richmond herself, who  quotes the above, refers to "moral  and temperamental c h a r a c t e r i s t i c s " and "aptitudes" which 7 Mary Richmond, S o c i a l Diagnosis. New Yorks R u s s e l l Sage Foundation, 1917? p. 29 (underlining i s that of the writer)  30. must be recognized as "assets" or " l i a b i l i t i e s " to be reckoned with i n treatment.  This i s one of the components  of her " s o c i a l diagnosis."  Miss Lowry's comments about  "needs", i n 1936,  8  imply awareness of the same f a c t o r .  In the same publication containing Miss Lowry's paper, Miss H o l l i s stated that where both environmental and  personal  factors were operative i n a s o c i a l problem, both types of treatment might be used, but that the emphasis on either environment or personality would depend on which was q most modifiable.  the  Here i t i s recognized that either one  may be modifiable or unmodifiable, m o d i f i a b i l i t y i s not stated.  but what constitutes  In 1940,  Gordon Hamilton used  the word t r e a t a b i l i t y , and indicated that this was  ascertained  by "evaluation", f o r the f i r s t time c l e a r l y separating this out from diagnosis.  "The  emphasis on the assets, the  p o t e n t i a l strengths, of the c l i e n t i n taking the steps of helping himself by seeking help has been, perhaps, a useful corrective to the tendency to become preoccupied  with the  problem material; but we should recognize that the evaluation of a c l i e n t ' s p o t e n t i a l i t i e s to help himself i n a treatment relationship i s not the same as the diagnostic process."1° And further, " I f one were to express this i n a sort of mathematical formula,  one might say that diagnosis i s to a  8  Ibid, p.  381.  9  H o l l i s , op. c i t . , p.  27.  Gordon Hamilton, Theory and Practice of S o c i a l Case Work. New York: Columbia University Press, 1940, - p. 1 0  153.  31. s i t u a t i o n as evaluation both of person and resources i s to treatment."11  About the same time, Dr. Hendrick uses the  term " e g o - p o t e n t i a l " .  Various other expressions have been  12  used to refer to the same c h a r a c t e r i s t i c :  "potentialities  to help h i m s e l f " j ^ "capacity to r e b u i l d " ; " p o t e n t i a l i t i e s 1  14  1*5  for ego-development";  y  ifi  "capacity f o r adjustment";  xo  "capacity f o r emotional change"; ^ "change p o t e n t i a l " . ^ 1  2.  1  A Definition. The "personal p o t e n t i a l " of the c l i e n t i s not  something to be defined i n the abstract, any more than the other components of t r e a t a b i l i t y , but i n r e l a t i o n to the psycho-social diagnosis.  We do not need to enumerate a l l  the resources i n the community, or a l l the functions of the agency, or a l l the s k i l l s of the worker, but only to assess them as they p e r t a i n to the problem. 1 1  1 2  New York: J  1 4  Ibid, p.  S i m i l a r l y we do not  165.  Ives Hendrick* Facts and Theories of Psychoanalysis. Alfred A. Knopf, 1939» p. v i i . Hamilton, op. c i t . p. Ibid, p.  153•  163.  Annett Garrett, "Transference i n Casework", The Family. XXII ( A p r i l , 1941), p. 45. ^ Helene DeUtsch, The Psychology of Women. V o l . I, New York: Grune and Stratton, 1944, p. 354. ^ Regina Flesch, "Treatment Goals and Techniques i n M a r i t a l Discord", Journal of S o c i a l Casework. XXIX (December, 1948) p. 387. 1o  Margaret Blenkrier , "Predictive Factors i n the I n i t i a l Interview i n Family Casework", S o c i a l Service Review. XXVIII (March, 1954) p. 73.  32 necessarily need to know or evaluate a l l the individual's resources, or determine his capacity to change, except i n r e l a t i o n to the problem. At t h i s point we need to be clear as to what i s meant by "problem".  There i s singular ambiguity i n the use  of this word, and c l a r i f i c a t i o n of i t s various meanings would necessitate a whole study i n i t s e l f , which i s beyond the scope of t h i s thesis.  However some common understanding  of terms i s necessary as a basis for what i s to follow, and at the r i s k of being a r b i t r a r y and of over-simplifying, the following d i s t i n c t i o n s w i l l be made clear.  A "problem"  (symptom, complaint, need) i s presented to an agency.  In  a r r i v i n g at a diagnosis, the worker discovers "problems", usually i n both the environment and i n the c l i e n t , which act as causes i n r e l a t i o n to "problem" number one. However the same "problem" which i s a "cause" of the s u p e r f i c i a l symptom, may also be a symptom i n terms of the environment or the c l i e n t .  For instance, the behaviour or attitudes  of the c l i e n t which are contributing to the s o c i a l problem, are symptomatic of some personal d i f f i c u l t y .  I t i s this  " t h i r d degree" of problem with which we are concerned i n assessing the personal p o t e n t i a l .  That i s , we want to  know i f the c l i e n t has "what i t takes" to overcome his own i n t e r n a l problem, which w i l l i n turn overcome h i s symptomatic behaviour, which w i l l i n turn overcome his part i n the creation of the " s o c i a l problem".  33 One possible We  writer has  c a l l e d this factor, "modification  i n the i n d i v i d u a l to meet the  situation"  have to recognize that there are s o c i a l problems presented  by c l i e n t s i n which the cause i s l a r g e l y external.  There-  fore i t might be said that the l i m i t i n g of personal p o t e n t i a l to the personal problem i s too narrow: that the may  individual  also have to meet an unfavorable external s i t u a t i o n  must have the potential for this as well.  and  However our  concept of personal p o t e n t i a l has also to be defined i n r e l a t i o n to the larger concept of t r e a t a b i l i t y , as well i n r e l a t i o n to diagnosis.  as  As mentioned before, each com-  ponent needs to be assessed f i r s t Independently.  Where  there i s an external problem, i t s m o d i f l a b i l i t y i s determined by assessing the environmental resources,  including  those present i n the c l i e n t ' s immediate environment, the community, the agency and  so on.  At the same time the  c l i e n t ' s resources i n r e l a t i o n to his i n t e r n a l problem are being assessed.  I f i t evolved that assessment of  former (environment) was was  negative, and  the  the l a t t e r ( c l i e n t )  p o s i t i v e , the worker would need to return to the  of the c l i e n t ' s capacities problem he faces.  to r e l a t e them to this  factor  additional  This d i s t i n c t i o n between m o d i f l a b i l i t y  ^ Joseph Kage, "Ego-Supportive Therapy with Displaced Persons", S o c i a l Casework, (February, 1950), p. 65.  34. with regard to i n t e r n a l or external problems may f i n e , or an a r t i f i c i a l one, and may so.  seem a  i n fact turn out to be  However i t seems necessary to make some such d i s t i n c t i o n  i n order to minimize the complexities at this point.  As has  been stated before, i t i s not intended within this study to compare the assessment of t h i s factor of treatment with that of any other.  potential  That i s , the c l i e n t ' s capacity  for change i n terms of his own problem w i l l not be related to environmental on.  pressures, lack of treatment resources, and so  I t w i l l be undertaken as i f other factors were equal.  By the same token, i t can be assumed that many c l i e n t s that come to the attention of s o c i a l agencies w i l l not be discussed here, i . e . , those whose inner problems have not contributed p a r t l y or l a r g e l y to the problem-symptom.  There i s l i t t l e  point assessing capacity for change unless some personal change i s warranted, except as indicated above, where adverse external factors are unchangeable. With these relationships to diagnosis and t r e a t a b i l i t y established, we may  consider "personal p o t e n t i a l " as  the capacity of the c l i e n t to solve his problem. want to know i s whether present assets, or new developed,  to cope with present l i a b i l i t i e s .  What we  ones, can be In order to  avoid confusion, the writer w i l l attempt to avoid the use of the word " t r e a t a b i l i t y " with regard to t h i s factor, and r e s t r i c t i t s use to the larger concept of o v e r a l l prognosis  35. covered i n the f i r s t 3*  chapter,  Sources of c r i t e r i a i n professional l i t e r a t u r e . As suggested e a r l i e r , attention has only recently  been drawn to this subject.  Consequently the l i t e r a t u r e i s  l i m i t e d i n quantity, although there i s probably a wealth of material relevant to i t , but either not i d e n t i f i e d as such by the authors, or else included i n writings on broader subjects.  To t h i s writer's knowledge there i s as yet no  monograph either on personal p o t e n t i a l or t r e a t a b i l i t y , and i t i s the rare a r t i c l e which i s wholly devoted to i t .  It  i s even unusual to f i n d a chapter or a section of a chapter where i t i s i s o l a t e d . Most references are found i n the body of some work on treatment and i n c i d e n t a l to other considerations, as can be seen by glancing over t i t l e s i n the bibliography.  Because of t h i s , the writer has probably  overlooked much valuable material.  Because of t h i s , i t  also should be noted that the opinions of the various authorities referred to do not necessarily represent them fairly. The s e l e c t i o n under consideration here makes no claim to be exhaustive of the l i t e r a t u r e that does e x i s t . Rather the writer has t r i e d to cover the opinions of representative leaders i n the f i e l d of s o c i a l work, and to compare their opinions with those i n a l l i e d human r e l a t i o n s professions, namely psychiatry and psychology.  The  d i s t r i b u t i o n of the approximately t h i r t y a u t h o r i t i e s ,  36. according to d i s c i p l i n e , i s ;  eighteen s o c i a l workers  (including one reference j o i n t l y prepared with a psychi a t r i s t but i n terms of s o c i a l agency p r a c t i c e ) ; nine p s y c h i a t r i s t s (including one edited by a s o c i a l worker, and one j o i n t l y prepared with a s o c i a l worker but i n terms of out-patient practice i n a psychiatric c l i n i c ) ; - several of the p s y c h i a t r i c references are by p s y c h i a t r i s t s  who  have served i n a consultative capacity to s o c i a l agencies and two psychologists.  Although not true of each i n d i v i d u a l  reference, each of the three d i s c i p l i n e s frequently quotes the others as sources f o r t h e i r own work. Within the whole group, p r a c t i t i o n e r s , teachers and research workers are represented, as are various schools of thought and treatment methods, including casework, counselling, psychotherapy,  and psychoanalysis.  Even i f i t were possible  to define the s i m i l a r i t i e s and differences between each of these, i t i s not the part of t h i s study to do so.  Suffice  i t to say that there i s considerable overlapping of method, with c e r t a i n basic features i n common.  I t i s therefore not  i r r e l e v a n t to consider the thinking of other human r e l a t i o n s professions on the subject of personal p o t e n t i a l , about which there seems to be a corresponding s i m i l a r i t y .  Between  the three d i s c i p l i n e s there i s a c t u a l l y less difference i n content than there i s i n the form of presentation.  It is  interesting to note that, on the whole, the psychiatric sources are more t h e o r e t i c a l and unrelated to s p e c i f i c situations; the s o c i a l work" sources are p r a c t i c a l and  37. related to s p e c i f i c situations, and untheoretical except where drawn d i r e c t l y from psychiatry; and the psychological sources combine the two aspects and attempt to organize their material into some systematic form. There are many differences among the whole group of sources, f i r s t i n what they claim to present. indications f o r casework:  Some offer  with c l i e n t s i n general (Burlingham,  Carscadden, Hamilton, H i l l , H o l l i s , LeMar, Lowry, Perlman and Orr,  Richmond, Taft, Towle); with displaced persons (Kage);  with family cases (Blenkner); with marital problems (Flesch, Preston et a l ) .  Others offer indications f o r psychotherapy  (Coleman, Futterman and Reichline, G i l l et a l , Rogers, Ruesch, and Bateson) and for psychotherapeutic medicine Others offer indications for psychoanalysis:  (Witmer).  i n general  (Deutsch, Hendrick, Waelder); with neurotic adults (Dollard 20 and M i l l e r ) ; with homosexuals (Bergler). (It w i l l be noted that the sources are lacking i n s p e c i f i c reference to children. This does not necessarily r e f l e c t professional l i t e r a t u r e but only the s e l e c t i o n of the writer. The reasons f o r avoiding l i t e r a t u r e dealing s p e c i f i c a l l y with children are two: f o r one, this provided one means of setting some l i m i t to the scope of the survey; f o r another, i t i s f a i r l y generally accepted that, on the whole, children, being i n t h e i r "formative" years are more malleable than adults and therefore by d e f i n i t i o n possessed of "personal p o t e n t i a l " . I t i s because of this fact that most of the t r e a t ment of children i s undertaken by treating t h e i r "forming" environment, i n the shape of the adults responsible f o r their care. In view of these facts i t i s assumed f o r purposes of this study that an understanding of the personal p o t e n t i a l of adults could r e a d i l y be applied to the treatment of children.)  38. Not only are the major treatment approaches so d i f f e r e n t i a t e d , and the scope of individuals or problems being considered, but also d i f f e r e n t aspects of treatment within them.  Some of the authorities present c r i t e r i a f o r  determining the " d i r e c t i o n " of treatment, i t s "emphasis", "duration":and l e v e l " ( H o l l i s , LaMar, Towle, Lowry).  Others  give indications as to the "type" of treatment, i . e . f o r " i n d i r e c t " or " d i r e c t " , and i n the l a t t e r category, f o r more s p e c i f i c techniques, such as "supportive" treatment or "insight development" (Austin, Burlingham, Flesch, H o l l i s , Lowry, Rogers).  Carscadden,  There i s a tendency i n some  of the e a r l i e r writings to arrange the various treatment techniques into a hierarchy, with "insight development" i n the p o s i t i o n of honour.  Accordingly, what we are now  c a l l i n g personal p o t e n t i a l was assessed In r e l a t i o n to this "treatment of choice", and i f capacity f o r that technique was d e f i c i e n t , personal p o t e n t i a l was considered d e f i c i e n t and a " l e s s e r " treatment technique applied.  Such a s t a t i c  grading of techniques does not seem tenable according to current professional thinking. Some writers seem to f e e l that indications f o r the use of one technique as opposed to another i s only a refine-* ment of the basic Indications f o r treatment of any sort, and not an e s s e n t i a l difference. on that assumption,  The writer i s proceeding  i n view of the f a c t that there appears  39  to be no conclusive evidence that capacity f o r one technique or another a f f e c t s personal p o t e n t i a l as a whole.  Moreover  s o c i a l work techniques are varied and so can be brought to bear as indicated, the e s s e n t i a l factor f o r the use of any or a l l being an i n d i c a t i o n of personal p o t e n t i a l . a l state that "a r e a l l y comprehensive  G i l l et  discussion of t h i s issue  (indications f o r psychtherapy) would d i s t i n g u i s h between supportive and exploratory psychotherapy and the indications Pi  and contraindications f o r each".  Although suggesting i n  this remark that some patients would respond to the face-toface method as opposed to another, the authors have presented indications f o r psychotherapy which are presumably basic to either approach.  I f t h i s i s true for d i f f e r e n t techniques  i n psychotherapy, i t i s l i k e l y true for d i f f e r e n t techniques i n " d i r e c t " casework with c l i e n t s . The difference between d i r e c t and i n d i r e c t treatment would presumably demand greater differences i n capacity, assuming that the difference between d i r e c t and i n d i r e c t treatment i s greater than the difference between two forms of d i r e c t treatment.  However Miss Hamilton's statement indicates  that the differences even here are not basic: 21  "Personality  Merton G i l l , Richard Newman and Frederick C. Redlock, The I n t i a l Interview i n P s y c h i a t r i c Practice. Collaborator: Margaret Sommers, New York: International U n i v e r s i t i e s Press, Inc., 1954, p. 95.  40. adjustment may be attempted  through d i r e c t or through i n d i r e c t  environmental treatment, or through a combination of both, the fundamental conditions being that the c l i e n t wishes to change himself and that he can a c t i v e l y a s s i s t i n whatever course of treatment w i l l help him to change."  22  The sources to be considered d i f f e r not only i n the various orientations mentioned above, but i n the basis on which their c r i t e r i a are presented.  Some indications of  p o t e n t i a l are presented on the basis of empirical findings; others on the basis of t h e o r e t i c a l reasoning, others on the basis of research investigations, and s t i l l others with no rationale of any kind being offered. 4.  Consideration of the c r i t e r i a :  amenability to research.  In examing the c r i t e r i a found i n the l i t e r a t u r e , we are not concerned to consider their v a l i d i t y at this point, that i s whether they are c r i t e r i a of personal pote n t i a l or not.  Determination of v a l i d i t y would require  research into a large number of cases to discover whether the c r i t e r i a were s i g n i f i c a n t l y present i n successful cases and absent i n unsuccessful ones, other variables of t r e a t a b i l i t y being held constant.  In order to do such research ,  Hamilton, op. c i t . p. 193*  41. for any one c r i t e r i o n , i t would be necessary f i r s t to possess means of recognizing whether or not i t was present, i . e . , indices of the c r i t e r i o n or units of measurement; t h i s i n turn would presuppose an adequate d e f i n i t i o n of the criterion i t s e l f .  What we are concerned with here i s to see  whether the c r i t e r i a already put forward by the a u t h o r i t i e s are of such a nature that they can be tested for v a l i d i t y , i . e . , are c l e a r l y defined and possessed of standards of measurement. I t had been the hope that a l l the indications offered could be sorted and c l a s s i f i e d , each c l a s s i f i c a t i o n being a criterion.  Each c r i t e r i o n then could have been considered  i n terms of r e l a t i v e discreteness or lack of overlapping with the others, as well as i n terms of i t s measureability. As a r e s u l t we would have had a set of testable c r i t e r i a which could then be applied to cases f o r evaluation of v a l i d i t y , r e l i a b i l i t y , and exhaustiveness. However the project breaks down even at the sorting stage.  As seen i n the case of "ego-strength",  even where  an i d e n t i c a l term i s used, the meanings are various.  With  c r i t e r i a which were less similar, the danger of erroneous c l a s s i f i c a t i o n would be that much greater.  The v a r i e t y  of presentation i s considerable, to the point that i d e n t i c a l terms are a r a r i t y .  Presentation may be i n the  42. form of nouns ('*motIvation"), 3 phrases ("no 2  authoritative  assertion of i n c u r a b i l i t y " ) , - questions ("has 24  indicated a desire for change?"). ^ 2  he  Presentation  ... may  also  be p o s i t i v e ("sees worker as a counsellor rather than as a 26  source of concrete service"),  neutral ("how  does he expect  treatment to help?"), ? or negative ("seeking an 2  ally").  As the meaning or significance of the items are not ently elaborated  2 8  consist-  on by the sources, i t would seem hazardous  to attempt any sort of c l a s s i f i c a t i o n which could presume to be exact. If c l a s s i f i c a t i o n and systematization are ruled out are faced with a tremendous number of items to  we  consider.  The following table attempts to give, quantitatively, a rough picture of the d i s t r i b u t i o n of the c r i t e r i a and t h e i r 2  3  G i l l et a l , op. c i t . p.  93.  " Edmund Bergler, The Basic Neurosis. New Grune & Stratton, Inc., 1949, p. 225. 24  25  Lowry, op. c i t . p.  26  Blenkner. , op. c i t . , p.  2 7  G i l l et a l , loc c i t .  2 8  Loc c i t .  1  10, 70.  York:  42a.  breakdown, among the sources surveyed.  The number of items  mentioned by each author was counted, and the number of items into which he broke each down.  This can only be  considered a very rough count, as i t i s rare to f i n d c r i t e r i a l i s t e d i n point form or even l i s t e d i n sequence, so that i f they were scattered some might have been missed. The breakdown i s even more a r b i t r a r y than the count, due to the fact that almost none of the sources arrange t h e i r items i n order of progressive conereteness.  The  f i r s t column indicates the number of c r i t e r i a as given i n i t i a l l y ; the second indicates the number of items into which one or more of the c r i t e r i a was broken down; and the  t h i r d , the number of items into which the "secondary"  c r i t e r i a were s t i l l further broken down. Table 1:  Number and d i s t r i b u t i o n of c r i t e r i a according to sources and sub-groups.  Sources  (a ) C r i t e r i a  Bergler Coleman Deutsch Futterman and Reionline G i l l et a l Hendrlck Waelder Witmer Dollard and Miller Rogers Blenkner Burlingham Carscadden Flesch  (b) Sub-criteria  7 2 1  4 1  1 2 4  6 6 3 1  6  10 7  8 9 4 8 2  19  3 13 12 1  (c) Evidences  Totals  I  1  6 3  3 9 3 3  10 17 10 10 10  13 3  39 14 22 4 20  3  43. Table 1 (continued) Sources (a) C r i t e r i a Hamilton Hill Hollis Kage LaMar Lowry Perlman i Preston and Orr Richmond Taft Towle  (b) Sub-criteria  2 6 11 2 2 15 1 4 2 4 5 130  (c) Evidences  5  7 6 20 2 2 18 13 16 4 4 6 278  9 3 2 12 2 1 103  Totals  10  45  The table shows the d i v e r s i t y between the authorities as to the number of c r i t e r i a each puts forward f o r personal potential.  As can be seen, the range i s from one c r i t e r i o n  ("ego-strength") ^ to f i f t e e n (a series of questions to 2  be answered i n " d i f f e r e n t i a t i n g the c l i e n t ' s needs").3° This range indicates two possible things:  *  one i s that  there i s lack of agreement as to what the c r i t e r i a are; the other i s that there i s lack of agreement as to how to express the c r i t e r i a about which there i s agreement. there i s lack of agreement i s obvious:  That  only four of the  sources s p e c i f i c a l l y r e f e r to "intelligence"3l and two § The range, not of " c r i t e r i a but of t o t a l items, i s from two to t h i r t y - n i n e . 9 Samuel Futterman and P h i l i p B. Reichllne, "Intake Techniques i n a Mental Hygiene C l i n i c " , Journal of S o c i a l Casework, XXIX (February 1948), p. 50. 2  3  Q  Lowry, l o c . c i t .  Hendrick, op. c i t . , p. 238; C a r l Rogers, Counselling & Psychotherapy. Boston: Houghton M i f f l i n , 1942, p. 77; Robert Waelder, Introductory Lectures on Psychoanalysis", (unpublished) 1940, p. 6; John Dollard & Neal E. M i l l e r , Personality & Psychotherapy: An Analysis i n terms of Learning, Thinking & Culture, New York: Mtgraw-Hill Book Co. Inc., 1950, p. 235.  44. others to "ability"32 or "mental capacity"33 which may  or  may not be equivalents depending on the intentions of the authors.  S i m i l a r l y , "motivation" i s mentioned e x p l i c i t l y  only three times and i n three forms which may or may not be i d e n t i c a l (motivation f o r therapy,3 motivation f o r change, 35 4  motivation f o r  psychotherapy36).  L o g i c a l l y the c r i t e r i a (a) should be the more general terms, with the s u b - c r i t e r i a (b) the more s p e c i f i c , and the "evidences"  (c) the most s p e c i f i c .  I t would presum-  ably be the l a t t e r which would serve as indices of the various components of personal p o t e n t i a l and which would constitute the actual working c r i t e r i a .  According to such a breakdown  from the more abstract to the more concrete, the numbers of items should increase from l e f t to r i g h t . reverse i s true.  Instead the  This does not indicate that i n the  " s p e l l i n g out" the authors have made the c r i t e r i a progressi v e l y more abstract, as i n most instances t h i s i s not so. The explanation with regard to any one author i s rather that he s p e l l s out one factor but not another, i f he spells 32  Rogers, l o c c i t .  33 Susan Burlingham, " D i f f e r e n t i a l Diagnosis as a Basis f o r S e l e c t i o n i n a Family Agency", Diagnostic Treatment Processes i n Family S o c i a l Work. New York: Family Science Association of America, 1935> p. 9. 34  Dollard & M i l l e r , op. c i t . p. 234.  35  Hamilton,  3  G i l l et a l , loc c i t .  6  op. c i t ; p.  295.  45.  them out at a l l . Another reason i s that one author starts off with c r i t e r i a which are r e l a t i v e l y concrete while another s t a r t s o f f with c r i t e r i a which are r e l a t i v e l y abstract.  As a r e s u l t one finds i n the same category items  of such unequal weight as " a b i l i t y i n relationship"37 and "therapeutic p r e f e r a b i l i t y of homosexual r e a l i t y to homosexual fantas v"38. Both seem concerned with a b i l i t y to relate but at quite d i f f e r e n t  levels!  The quantity of items makes i t impossible within the scope of this study to consider each one separately i n an e f f o r t to assess i t s p r a c t i c a l use i n research. However examples w i l l be presented to show the d i f f i c u l t y i f not the i m p o s s i b i l i t y  of testing these c r i t e r i a as they stand.  "Ego-strength" w i l l be the main one referred to as the problems encountered i n that term met i n the whole group of c r i t e r i a .  are t y p i c a l of those In addition, being  such an a l l - i n c l u s i v e concept, i t includes many of the other characteristics.  I t i s also the most frequently mentioned.  Of the c r i t e r i a presented there are almost none which c l e a r l y lend themselves to measurement, and i f they 37 L i l l i a n Carscadden, An Evaluation of the Client-Worker Relationship: Relationship i n a Selected Number of Cases on the Family Welfare Bureau of Greater Vancouver, Unpublished Master's Thesis, The University of B r i t i s h Columbia, Vancouver, Canada, 195l> P* 20, 3  8  Bergler, l o c . c i t .  46 do, not necessarily to measurement by a s o c i a l worker.  The  only ones f o r which there e x i s t currently accepted standards of measurement are i n t e l l i g e n c e ,  age39 n d a  physical health. "^  But these are s t i l l not prognostically measurable.  4  Other  personal q u a l i t i e s which are considered important do not seem to possess units of measurement which have been agreed on.  This i s seen i n the single factor of "ego-strength"  about which much has been written and many indications offered.  I t might be anticipated that ego-strength therefore  would be available to measurement; however on examining what the various sources say about i t , t h i s does not seem to be the case. Ego-strength: Source  Indicated by  G i l l et a l  4 -  !  Futterman and Reichline42  p. 235;  self-perspective h i s t o r y he gives response to the worker ( i . e . a b i l i t y to establish object relationships) response to the enquiry about (presenting symptoms (reasons for coming (time of onset (ideas of causation  39 Hendrick, l o c . c i t . , Dollard & M i l l e r , op. c i t . , Rogers, l o c . c i t . , Burlingham, l o c c i t . 4 - 0  Dollard & M i l l e r , loc c i t . , Burlingham, loc c i t .  41  G i l l et a l , op. c i t . , p. 95.  4 2  Futterman & Reichline, op. c i t . , p. 50.  47. Source  Indicated by  Hendrick43  a b i l i t y to endure excess of tension capacity to s t r i v e f o r reasonable goals i n spite of inner d i f f i c u l t i e s capacity for f i g h t i n g d i f f i c u l t i e s (secondary gain) ft  Waelder44  i n t e l l e c t u a l desire to change a b i l i t y to learn previous history: ( e f f o r t s i n r e l a t i o n to purposes (achievements (behaviour i n d i f f i c u l t situations (reaction to danger  Austin ^  (none)  4  H o l l i s 46  a b i l i t y to repress a b i l i t y to judge r e a l i t y a b i l i t y to use insight  Perlman and 0rr47  3  4  4  4  •reaction to facing the request f o r outside help" ^reaction to hearing what the agency can and can't do): are his defense mechanisms within the normal range? a b i l i t y to grapple with an idea or plan how do his defense mechanisms a f f e c t his a b i l i t y to deal with his r e a l i t y ?  Hendrick, op. c i t . , p.  238.  Waelder, op. c i t . p. 8 f f .  45 L u c i l l e Austin, "Trends i n D i f f e r e n t i a l Treatment i n Casework", Journal of S o c i a l Casework. XXIX (June 1948) p. 206 f f . 46 Florence H o l l i s , "The Relationship between Psychos o c i a l Diagnosis and Treatment", S o c i a l Casework. XXXII, (February 195D> p. 72. 4  7  Helen Perlman & Douglass Orr, M.D.,  Notes on  The P a c i f i c Northwest Regional I n s t i t u t e . (unpublished) 1950. ft brackets are used to indicate a negative index of a c r i t e r i o n .  48. Source.  Indicated by  Perlman and Grr (continued  soundness of judgement with respect to several alternatives appropriateness of a f f e c t relationship with key people i n his l i f e (how they a f f e c t each other) how does he handle his dependency needs how does he handle the h o s t i l e aggressive component of his personality how does he handle h i s sexuality perspective on the problem  F i r s t of a l l , what i s not shown here, i s the varying importance given to the concept of "ego-strength", by the sources using i t .  Futterman presents i t as the c r i t e r i o n  of t r e a t a b i l i t y , H o l l i s offers i t as one out of three c r i t e r i a , G i l l presents i t as one of two s u b - c r i t e r i a of "the capacity f o r psychotherapy", the l a t t e r being one of two indications f o r psychotherapy! S i m i l a r l y we can see the inconsistency with which one of the s u b - c r i t e r i a of ego-strength, namely "secondary gain", Is c l a s s i f i e d , Lowry presents i t as a c r i t e r i o n among several o t h e r s ;  4-8  Hendrick presents i t as a sub-criterion  of ego-strength and Dollard and M i l l e r present i t as a sub-criterion of "reinforcement of symptoms".  Hence i t i s  c l a s s i f i e d under d i f f e r e n t concepts as well as at d i f f e r e n t l e v e l s on the hierarchy of c r i t e r i a . 4  8  Lowry, op. c i t . , p. 10.  49. The manifestations of ego-strength, or i t s "indices" d i f f e r s from one author to another, both i n the nature of the items and the number of them.  With regard to the l a t t e r ,  the number of indices of ego-strength varies from one, i n one author, to eight i n another.  In addition to t h i s , the  indices, whether or not they do indicate ego-strength, are not standards of measurement which could r e a d i l y be applied as they stand, so that the r e s u l t s would be uniform no matter which or how many workers applied them.  For instance,  "self-perspective" i s i n need of i d e n t i f i c a t i o n s of i t s own, as i s "judgement", and these are two of the more s p e c i f i c items mentioned.  As long as these are not "spelled out",  the same confusion i n a p p l i c a t i o n w i l l r e s u l t as occurs with a c r i t e r i o n such as ego-strength:  that i s , that d i f f e r e n t  individuals w i l l give d i f f e r e n t meanings to the same terms. Some of these concepts are r e l a t i v e l y meaningful, i f not measurable as they stand:  for instance the " a b i l i t y  to repress" or "the a b i l i t y to endure an excess of tension". However others are not only immeasurable, but incomprehensible as they stand, for instance "the history he gives".  In  context we may think we know what this means; but out of context, to anyone without considerable t r a i n i n g and experience, (and even to anyone with) i t has no meaning. More t a n t a l i z i n g , but equally f r u s t r a t i n g , are the questions without answers. needs?"  "How  does he handle h i s dependency  This presumes a knowledge of the possible answers  50.  and the possession of c r i t e r i a by which to evaluate them as favorable or unfavorable indications of whatever i s being measured.  S i m i l a r l y we are faced with "response to enquiry  about the presenting symptoms", or "reaction to hearing what the agency can and can't do". "responses" We  What are the possible  or "reactions" and how are they to be  evaluated?  see i n the material on "ego-strength" not only a  vagueness and lack of uniformity of d e f i n i t i o n , but a tendency to c i r c u l a r argument, which i s a r e s u l t that could be anticipated.  For instance, Waelder, as an'indication of  " a n a l y s a b i l i t y " , offers "the a b i l i t y to learn"; this a b i l i t y , he says, presupposes a healthy ego, and i s therefore presumably a manifestation of ego-strength.  What i n e f f e c t i s  being said Is that the capacity to solve one's problem under psychoanalysis i s indicated by a strong ego which i s indicated by the a b i l i t y to learn; or to put i t more baldly, the capacity to change i s indicated by the capacity to change! This c i r c u l a r process occurs, not only within any one author's system of c r i t e r i a , but between the systems of d i f f e r e n t authors, and between c r i t e r i a .  As  evidences  of the a b i l i t y i n establishing relationships (which i s referred to as a c r i t e r i o n of t r e a t a b i l i t y ) , Carscadden cites:49 Carscadden, op. c i t . , p. 14 f .  51. concept of s e l f (confidence, sense of goal and achievement awareness of own feelings and toward whom directed ways of coping with r e a l i t y (defences constructive and l i m i t e d i n number) a b i l i t y to endure f r u s t r a t i o n (and c r i t i c i s m ) a f f e c t i v e tone (spontaneity, depth, f l e x i b i l i t y , appropriateness of response) pattern of relationships (object relationships) Here we see that much the same c h a r a c t e r i s t i c s which have been enumerated under ego-strength are enumerated under capacity for r e l a t i o n s h i p s .  This i s an example of d i f f e r e n t  terms having much the same meaning.  I t might be even  considered as another example of c i r c u l a r argument on another l e v e l , i f the meaning i s i n e f f e c t :  ego-strength i s  evidenced i n the capacity to form r e l a t i o n s h i p s , and the capacity to form relationships i s evidenced i n ego-strength. In summary, we have examined indications of personal p o t e n t i a l as found In professional l i t e r a t u r e .  Before  doing so, we traced b r i e f l y the development of the concept, and found that though i t i s not a new one, i t has received l i t t l e attention u n t i l very recently.  We defined personal  p o t e n t i a l i n terms of the individual's a b i l i t y to use his assets or develop new ones to cope with his inner problem. From this basis, we turned to a consideration of c r i t e r i a of t h i s capacity offered by selected authorities i n the human r e l a t i o n s professions, with a view to determining whether they are amenable i n t h e i r present form to s c i e n t i f i c measurement.  We found that the authorities d i f f e r e d widely  as to the factors which they stated to be important for  52. treatment, and i n t h e i r exposition of them, so that a m u l t i p l i c i t y of items, of varying degrees of abstraction, and without established l o g i c a l r e l a t i o n s h i p s , are a v a i l a b l e . In view of the divergence of exposition, combined with vagueness as to meaning and lack of explanatory comments by most of the a u t h o r i t i e s , i t was presumed inadvisable to attempt an i n t e r p r e t a t i o n of each which i  would permit sorting and c l a s s i f i c a t i o n .  Because of the  amount of material, only a few examples were chosen to i l l u s t r a t e the lack of generally accepted d e f i n i t i o n f o r the items, and to demonstrate that almost none could be regarded as measurable, being i n need of indices of t h e i r own.  53. CHAPTER I I I : GENERAL ASSESSMENT OF THE CRITERIA. 1.  Motivation and Capacity. As mentioned previously the items presented i n  the l i t e r a t u r e are too numerous to be considered within t h i s study.  separately  However some general picture of t h e i r  scope can be given and some comments made.  On the whole  two main questions seem to be posed by the a u t h o r i t i e s i n one form or another, namely, does the i n d i v i d u a l wish to solve the problem ? and, has he the capacity to solve i t ? The following "inventory" gives examples of those who have s p e c i f i e d both motivation and capacity, though i n various terms. to,  The sources constitute almost half the t o t a l r e f e r r e d  and the l i s t does not include those who have s p e c i f i e d  only one or other of the two categories. Source Deutsch  "Motivation" 1  _ G i l l et a l  2  Waelder3. x  New York:  "Capacity"  degree of s a t i s capacity (for ad j u s t f a c t i o n with the ment) environment motivation ( f o r . . . . .capacity (for psychopsychotherapy) therapy .....desire to change....ability to l e a r n  Helen Deutsch, The Psychology of Women. Vol. I, Grune and Stratton, 1944, p. 354-.  Mertori G i l l , Richard Newman and Frederick C. Redlock, The I n i t i a l Interview i n P s y c h i a t r i c P r a c t i c e . Collaborator: Margaret Sommers, New York: International Universities Press, Inc., 1954, p. 96. 2  3 analysis,  Robert Waelder, Introductory Lectures on Psycho-  54. Source  "Motivation"  "Capacity"  Dollard and Miller ", .motivation ( f o r ^ therapy) Rogers-? tension 4  Carscadden  6  _ Flescfcr  prerequisite types of s o c i a l learning capacity (to cope with l i f e does he r e a l l y want.has he s u f f i c i e n t understanding) maturity (to take the step) wish f o r help ( w i t h . a b i l i t y to stand the problem) (insight) motivation ( f o r capacity (to r e b u i l d ) " change)© hopes. training whether wants whether able (to t h i s type of help, p a r t i c i p a t e or i . e . insight benefit by i t ) development). ..desire f o r change... capacity ( f o r a c t i v i t y ) plans, ambitions... .assets, l i a b i l i t i e s q  Hamilton 1 0  Hill-j Hollisll  Lowry ^ Richmond^.. 1  John Dollard and Neal E. M i l l e r , Personality and Psychotherapy: An Analysis i n Terms of Learning. Thinking and Culture. New York: McGraw-Hill Book Company, Inc., 1950, p. 234 f . 4  C a r l Rogers, Counselling and Psychotherapy. Boston: Houghton M i f f l i n , 1942, p. 77. ^ L i l l i a n Carscadden, An Evaluation of the C l i e n t Worker Relationship, p. 90. Regina Flesch, "Treatment Goals and Techniques i n Mental Discord", Journal of S o c i a l Casework. XXIX (December, 7  1948), p. 382. o  Gordon Hamilton, Theory and Practice of S o c i a l Case Work. New York: Columbia University Press, 1940, p. 295. 0  Ibid, p. 163.  9  1  0  New York:  Octavia H i l l quoted i n Mary Richmond S o c i a l Diagnosis. Russell Sage Foundation, 1917> p. 29.  Florence H o l l i s , "The Relationship between Psychos o c i a l Diagnosis and Treatment", S o c i a l Casework. XXXII (February 1951) p. 243. 1  1  Fern Lowry, "The Client's Needs as The Basis f o r D i f f e r e n t i a l Approach i n Treatment". D i f f e r e n t i a l Approach i n Case Work Treatment, New York: Family Welfare Association of America, 1936, p. 7 *. 1 2  13 Richmond, op. c i t . , p. 381.  55  With regard to the f i r s t question, motivation seems to be the factor the most u n i v e r s a l l y singled out as having a significance for personal p o t e n t i a l .  Although the term;  i s used by only three of the sources, equivalent terms or factors which are f a i r l y c l e a r l y indicators of i t are offered by seven of the p s y c h i a t r i c , two of the psychological, and twelve of the s o c i a l work sources.  I t i s interesting to  note that i n a l l the sources consulted, there were almost  no  instances i n which the authorities considered motivation as more than motivation to solve the problem or to use the p a r t i c u l a r form of treatment being offered.  This i s i n  contrast to their consideration of most of the other "capacities", which were, as often as not, viewed i n context extending f a r beyond the problem or helping s i t u a t i o n . Actually I t would be possible to conceive of motivation s i m i l a r l y , i . e . i n a much broader sense:  i n terms of over-  a l l "drive", " l i f e - f o r c e " , ambition, or any other concept which indicates an individual's s t r i v i n g f o r self-preservation, self-development,  i n t e g r i t y , "salvation" and so on.  With regard to the second question of "capacity", various personal attributes or aptitudes are  suggested.  Common to most of them seems to be a consideration of the individual's adjustment, an evaluation of the degree to which he i s related to his t o t a l r e a l i t y , including s e l f , other people and the remainder of h i s environment.  The degree  56. of the individual's " a c t i v i t y " seems to hold a prominent place i n the hierarchy of factors i n d i c a t i n g the l e v e l of adjustment, i n view of the frequency with which i t i s mentioned. reason may  Its importance i s not accounted f o r , but  one  be the rather obvious fact that "behaviour" i s  observable i n a way  that inner q u a l i t i e s are not, and so i s  a useful index of "personality resources" which are not accessible to d i r e c t observation. 2.  "Level of adjustment" as a component of personal p o t e n t i a l . The inference, made more or less e x p l i c i t by  d i f f e r e n t a u t h o r i t i e s , i s that the more "healthy" i n d i v i d u a l , the more treatable he i s . This may  the  be true, but  i n the f i r s t place i t must be remembered that unless he some disturbance  had  i n his "relationship to r e a l i t y " , as  r e f l e c t e d i n one or more areas of his adjustment, he would not be under consideration at a l l .  He would have no problem  and would not have come to the attention of the p r a c t i t i o n e r evaluating his p o t e n t i a l . Part of the problem seems to be that the various "strengths" as presented are extremely broad and unfocussed. As mentioned before assessment of the resources  pertaining  to any component of t r e a t a b i l i t y does not need to be undertaken i n a vacuum, but i n r e l a t i o n to the problem i n hand; otherwise we would be undertaking v i r t u a l l y a survey of the universe!  Some of these writers make no attempt to r e l a t e  57. the "strength" (or equivalent) which they mention to anything else, i . e . to the problem of the i n d i v i d u a l or the helping s i t u a t i o n .  They do not indicate what s p e c i f i c  strengths are essential i n treatment. the goal they have i n mind.  Nor do they i d e n t i f y  That i s , they do not specify  capacity f o r what, strength f o r what, adjustment to what. In speaking of the d i f f e r e n t i a t i o n between the diagnostic and evaluative processes, Gordon Hamilton states, "We s h a l l be less confused i f we think of personality evaluation or characterization as usually related to t r e a t a b i l i t y and treatment.  When we characterize we do not estimate person-  a l i t y i n the e t h i c a l sense of how 'good' a person i s , or how 'fine' or 'ignoble his attitudes, but i n his capacity 1  to perform c e r t a i n functions, f o r example, the support r o l e , the marital r o l e , the f i l i a l or parental r o l e . Although such judgements seem arbitrary, they are inescapable i f one i s to treat within the f i e l d of conduct and r e l a t i o n ships.  We must know not only from what l i m i t a t i o n s but to  what ends capacities and energies are to be released." " 14  Here we have the focus established f o r evaluating general functioning; only i f the purpose and frame of reference i s clear w i l l meaningful material be gathered and meaningfully used once i t i s gathered.  ( I t may be that some of the  diffuseness i n c o l l e c t i n g Information which w i l l contribute  Hamilton, op. c i t . , p. 163  58. to formulation of prognosis i s due to the comparative newness of this concept i n treatment; just as with diagnosis, i n the days when i t was not too c l e a r l y understood, we c o l l e c t a l l the information we can, because we are not,, sure what i s or i s not s i g n i f i c a n t , what i s e s s e n t i a l and what i s of bonus-value.  Therefore the reason f o r some of  the vagueness of the writing about these c r i t e r i a may be that certain writers are vague as to t h e i r importance.  In  other cases the writers may be f a i r l y sure how and how much of the c r i t e r i a i s important, and could apply them to an i n d i v i d u a l s i t u a t i o n and " s p e l l i t out", but have not done so i n t h e i r writing.) Now by the term evaluation, Miss Hamilton means,  15 "'How well does he or can he get along? " 1  She does not  state whether she means that "does" and "can" are the same or whether they are d i s t i n c t . concerns us i n this study.  I t i s the "can" aspect which  The "does" aspect leaves us no  further ahead than a r r i v i n g at a diagnosis. I t does not of i t s e l f Indicate whether he "can" get along better or differently.  Evaluation of functioning, adjustment, ego-  strength, emotional health, or any other facet of "getting along" shows us only that, i . e . how he i s getting along, 5  x  i b i d , p. 159.  59. or his a c t u a l i t y .  I t does not show us how he might get  along, or h i s p o t e n t i a l i t y f o r getting along better, whether current assets can be developed further and whether current l i a b i l i t i e s can be modified or overcome. Does the appraisal of general functioning have a significance for prognosis as w e l l as as an aspect of diagnosis?  One or two of the sources suggest why and how  this appraisal i s related to p o t e n t i a l .  Miss Lowry, i n the  l i s t of questions she poses i n order to " i n d i v i d u a l i z e the need" of the c l i e n t , asks "What attitudes does he show i n r e l a t i o n to his d i f f i c u l t y ? " and then, "What i s the r e l a t i o n of his attitudes toward t h i s d i f f i c u l t y to his habitual attitudes toward other aspects of his l i f e - s i t u a t i o n ? " ^ Here i t becomes clearer that i n assessing the m o d i f i a b i l i t y of some negative c h a r a c t e r i s t i c , the worker looks to general functioning i n search of evidence of the degree to which the negative c h a r a c t e r i s t i c i s t y p i c a l of the person. However i f i t i s t y p i c a l , we s t i l l do not know how modifiable i t i s . I f i t i s not t y p i c a l , we s t i l l do not know whether the more p o s i t i v e c h a r a c t e r i s t i c present i n other aspects of h i s l i f e w i l l be applied to the problem aspect or not. However, on the basis that the i n d i v i d u a l has developed a p a r t i c u l a r strength and applies i t i n some areas, i t i s more l i k e l y that he, other things being equal, can apply i t Lowry, op. c i t . , p. 10.  60 i n r e l a t i o n to the present problem, than another i n d i v i d u a l who  evidences no such a b i l i t y anywhere.  S i m i l a r l y , Miss  Carscadden o f f e r s c r i t e r i a of the a b i l i t y for r e l a t i o n s h i p . Five of these i f evaluated would give a picture of current " r e l a t i n g " , but the s i x t h , "pattern of r e l a t i o n s h i p " , i s 17  more s p e c i f i c a l l y oriented to p o t e n t i a l .  I f the c l i e n t ' s  d e f i c i e n c i e s i n r e l a t i n g to the worker, and husband, c h i l d , or the person on whom his d i f f i c u l t i e s are focussed, are not present i n a l l his r e l a t i o n s h i p s , the worker would know these were not t y p i c a l .  The significance of t h i s factor i s  most e x p l i c i t l y stated by Dollard and M i l l e r i n explaining t h e i r c r i t e r i o n of p o t e n t i a l c a l l e d "prerequisite types of s o c i a l learning":  "...the patient must have higher mental  processes to restore, and the better these are (or i n psychoanalytic  terms, the stronger the Ego),  the better his  prospects of recovery and continued learning on his when repressions and i n h i b i t i o n s are removed.  own  The person  with strong adaptive behaviour i n c e r t a i n areas of his l i f e shows that he has these general elements to b u i l d on. For t h i s reason severe c o n f l i c t l i m i t e d to one area i s more favorable than general retardation of the whole development. The more d i f f e r e n t units of s o c i a l s k i l l the patient to learn, the harder his task w i l l be'.'  18  has  'Note that lack  ^  Carscadden, op. c i t . p.  14.  1 8  Dollard and M i l l e r , op. c i t . , p.  236  61.  of p r i o r learning or areas of s a t i s f a c t o r y adjustment make treatment "harder", not necessarily impossible.  As  mentioned before there may be a point at which the degree of d i f f i c u l t y equates with i m p o s s i b i l i t y . However the present concern i s with p o s s i b i l i t y rather than d i f f i c u l t y , and with factors which are minimal rather than those which may be h e l p f u l and desirable.  In their own elaboration of  t h i s c r i t e r i o n , Dollard and M i l l e r seem to include only those adaptive capacities which they consider are required i n the treatment s i t u a t i o n , not a l l adaptive c a p a c i t i e s . In addition to determining which factors are indispensable, there i s the question of the degree to which these factors must be developed.  Rather than ask, i n evaluating an  individual's p o t e n t i a l , how c l o s e l y some p a r t i c u l a r strength approximates the i d e a l or average, i t might be more useful and pertinent to ask i f he has any of this strength to b u i l d on, or whether he has enough. a d i f f i c u l t question.  What constitutes enough i s  Rogers does not set any a r b i t r a r y  yardstick but uses "some" as a modifier of several of the 19  c r i t e r i a he puts forward. ' Previous as well as current functioning can also be considered applies here:  under this category.  The same p r i n c i p l e  the a v a i l a b i l i t y of adaptive capacities which  appear lacking i n r e l a t i o n to the problem, may be assessed not only by looking at other areas of current functioning, Rogers, op. c i t . , p. 77  62. but at past functioning i n the same or other areas.  Waelder  i n assessing ego-strength looks to the previous h i s t o r y of the person, s p e c i f i c a l l y his achievements, his e f f o r t s i n r e l a t i o n to his purposes, his behaviour i n d i f f i c u l t Of)  s i t u a t i o n s * ^ - evidence which seems geared to the question, "has he solved d i f f i c u l t i e s before?" (as well as "how  does  he go about i t ? " ) I f so i t i s presumable more l i k e l y that he w i l l be able to solve the present one, from the point of view of his own his s k i l l s .  confidence, from past experience, and of  Dollard and M i l l e r are again the most e x p l i c i t  as to the s i g n i f i c a n c e of previous functioning,, which i s e s s e n t i a l l y the same as that of current functioning:  i f the  problem i s recurrent or of recent onset, i t indicates that there have been a period or periods free of the problem i n which "learning" took place (and, presumably, s a t i s f a c t i o n s experienced) which would strengthen the picture of motivation and c a p a c i t y . * 2  (These points of current and previous  adjustment are of course c l o s e l y related to the factor of "the problem" and i t s bearing on t r e a t a b i l i t y , p a r t i c u l a r l y i t s extent and duration.  However we are just looking at the  reverse side of the coin.) Another source of evidence f o r capacities which may appear to be lacking at f i r s t glance i s within the problem Waelder, op. c i t . , p. 24. Dollard and M i l l e r , l o c . c i t .  63 itself:  Hendrick points out what i s often " f e l t " but a l l  too r a r e l y stated, that the advantageous c h a r a c t e r i s t i c  may  be used (and concealed) " i n the structure of the neurosis", may be absorbed by the struggle to a t t a i n s p e c i a l a t t e n t i o n or may be  repressed.  22  The consideration of t o t a l functioning may, suggested,  as already  have another value, i n the same way as do the  c h a r a c t e r i s t i c s of i n t e l l i g e n c e , age, health, appearance:  21  namely as having some bearing on s a t i s f a c t i o n s that have been experienced or which exist f o r the c l i e n t (other than i n the problem area) and therefore a bearing on motivation.  In  general i t i s assumed that the more s a t i s f a c t i o n s an i n d i v i d ual has experienced, the more confidence he has of obtaining others and therefore the more hope of solving his problem. However, by discovering capacities i n other areas of current functioning, i n the past, or repressed or distorted within the problem, we have s t i l l only discovered capacities which are latent i n r e l a t i o n to the problem area.  The  recognition of their existence does not n e c e s s a r i l y guarantee that they w i l l be applied or developed.  To a greater or  lesser degree i t could probably be said that there i s no person who  does not possess p o t e n t i a l i t i e s which are never  realized. 2 2  New York: 2  1  Ives Hendrick, Facts and Theories of Psychoanalysis. Alfred A. Knopf, 1939, p. 23b. Dollard and M i l l e r , l o c . c i t .  64.  3.  Arguments f o r Motivation as the e s s e n t i a l component of personal p o t e n t i a l . Some writers suggest or state that motivation i s the  determining factor, or at least a most useful index of i t . C a r l Rogers has recently described ways i n which he and his associates have t r i e d to measure personality change i n psychotherapy,  by means of measuring self-perception and  i d e a l s e l f at the beginning and at the end of One of t h e i r hypotheses  psychotherapy.  seemed to be borne out by the r e s u l t s  of the investigation, namely that the discrepancy between these two decreased, with a " s i g n i f i c a n t increase i n congruence between the s e l f and i d e a l , " the change being i n the former and i n the d i r e c t i o n of the l a t t e r . 3 2  Underlying this hypo-  thesis was the speculation that what the i n d i v i d u a l wants to be he i s capable of becoming and that therefore establishing a measure of what he wants to be or of his motivation, would provide a measure of his capacity f o r change i n psychotherapy. S i m i l a r l y Deutsch gives a suggestive explanation of what i s e s s e n t i a l l y involved i n the whole process of change, i n the following statements:  "adjustment  to r e a l i t y i s the  main purpose of a l l education, including psychoanalytic therapy.  The individual's capacity for adjustment  pre-  supposes a c e r t a i n degree of s a t i s f a c t i o n with the * C a r l R. Rogers, "Personality Change i n Psychotherapy," unpublished paper presented at The International Congress on Mental Health, Toronto, August 1954, p. 2.  65. environment., and t h i s i n turn depends on his own emotional state.  The bridge between the environment and the i n d i v i d u a l ,  from the beginning of his l i f e , i s his a f f e c t i v e r e l a t i o n s h i p to t h i s environment.  The acceptance of r e a l i t y i s determined  by love and need of protection on the one hand and by fear of punishment and of emotional i s o l a t i o n on the other. This statement with a l l i t s implications the core of the whole question of prognosis.  1124  "  could be  The e s s e n t i a l  prerequisite f o r further adjustment i s "a c e r t a i n degree of s a t i s f a c t i o n with the environment."  This suggests, as i s  made more e x p l i c i t further on i n her statement, that the i n d i v i d u a l f e e l s need and/or " a f f e c t i o n " f o r the environment. (Environment i n i t s broadest sense includes people and objects, tangible and intangible influences, l i f e i n general. "Reality" i s a more s a t i s f a c t o r y term than environment, including the individual's inner r e a l i t y , his own components and a t t r i b u t e s . )  In other words the environment has some  a t t r a c t i o n f o r him, and having this a t t r a c t i o n he i s motivated to " r e l a t e " to i t , to learn how to "get on" with i t , so that his needs w i l l be met and his s a t i s f a c t i o n enhanced.  His attitude i s one of approach rather than one  of retreat or withdrawal.  Complete withdrawal or d i s -  s a t i s f a c t i o n with r e a l i t y probably does not occur short of death, but there c e r t a i n l y e x i s t people who  consistently  avoid c e r t a i n aspects of r e a l i t y either p h y s i c a l l y , Deutsch, l o c . c i t  66. emotionally, or i n t e l l e c t u a l l y .  An attacking approach  toward r e a l i t y may s t i l l be an "approach", and indicates a "relationship" with the environment and a wish to correct that r e l a t i o n s h i p , even i f by trying to get the environment to do the adjusting!  I f a t o t a l lack of s a t i s f a c t i o n with  the environment, and so of motivation, were the main deterrent to treatment, then i t would be the rare i n d i v i d u a l who was lacking i n "capacity f o r adjustment". There i s some s i m i l a r i t y to this idea i n the study of Preston et a l , who f i n d that one factor correlating with movement i n marital problems i s the degree to which the partner being considered i s withdrawing from the r e l a t i o n s h i p with the other marital partner:  the less evidence there i s  of such withdrawal, the more l i k e l y movement w i l l One could interpret this i n the following way:  be. ^ 2  that the  applicant who has some or many s a t i s f a c t i o n s i n the r e l a t i o n ship, though i t i s disturbed i n some ways, has more reason or motivation to remove the d i s s a t i s f a c t i o n s ; whereas the applicant who shows evidence already of withdrawing from the relationship with the partner finds fewer s a t i s f a c t i o n s i n i t or has given up hope of doing so. Even more e x p l i c i t l y and a s s e r t i v e l y than Rogers and Deutsch, another source states the primacy of motivation. Reusch and Bateson use the term "communication"to indicate 5 Malcolm G. Preston, Emily H. Mudd, and Hazel B. Froscher, "Factors Affecting Movement i n Casework," S o c i a l Casework. XXXIV, 1953, p. HO. 2  67. many of the same "strengths" the authorities have cited as c r i t e r i a and which we have concluded can be summed up i n the concept of "relationship to r e a l i t y " .  They state the  e f f e c t of communication on development and on adjustment: "Communication f a c i l i t a t e s s p e c i a l i z a t i o n , d i f f e r e n t i a t i o n and maturation of the i n d i v i d u a l .  In the process of maturation  reliance upon protective and corrective actions of others i s gradually replaced by interdependence upon contemporaries i n terms of communication.  Instead of looking to elders f o r  guidance, the adult person seeks information from contemporaries on how best to solve a problem.  Exchange Is sub-  s t i t u t e d f o r receiving, and action of s e l f replaces actions of others."  And further, "Successful communication with  s e l f and with others implies correction by others as w e l l as self-correction.  In such a continuing process, up-to-date  information about the s e l f , the world and the r e l a t i o n s h i p of the world leads to the a c q u i s i t i o n of appropriate techniques, and eventually increases the individual's chances of mastery of l i f e .  Successful communication therefore  becomes synonymous with adaptation and l i f e . " ? 2  After summarizing the importance of communication for development and adjustment they proceed to describe problems and their treatment i n the same terms.  "Abnormalities  6 Jurgon Ruesch and Gregory Bateson, Communication: the S o c i a l Matrix of Psychiatry. New York: W. W. Morton & Co., Inc., 1951, p. 18 f . 2  2  ?  Loc. c i t .  68. of behaviour are described i n terms of disturbances of communication.  In the past, these disturbances have been  summarized under the heading of psychopathology. I t i s well to remember that the term 'organic' refers to disruption of the i n t e r n a l communication machinery, that 'intra-personal* refers to a network l i m i t e d to one i n d i v i d u a l , and that 'inter-personal' refers to a network composed of several individuals."  2 8  As f o r treatment, which aims at improving  the disturbed communication system, they state that "Regardless of the school of thought adhered to, or the technical terms used, the therapist's operations always occur i n a s o c i a l context.  I m p l i c i t l y , therefore, a l l therapists use  communication as a method of influencing the p a t i e n t . " 9 2  Here i s stated the paradox that exists i n treatment, namely that the very process i n which the i n d i v i d u a l i s d e f i c i e n t i s the means of his becoming p r o f i c i e n t . How i s t h i s possible?  How can he communicate (be  treated) i f he can't communicate authors state:  (has a problem)?  The  "Fundamentally a l l people can be helped t@  improve t h e i r means of communication.  Only the l e v e l at  which patient and doctor s t a r t their work varies; some patients are very sick, some are better o f f , and the speed of improvement fluctuates depending upon a v a r i e t y of factors.  But over a period of years, and without exception, 2  8  2  9  Loc. c i t . Op. c i t . , p. 19»  69 improvement can be observed I f the patient has the motivat i o n to improve and the desire to  survive."Motivation  i s the f a c t o r which impels the i n d i v i d u a l to communicate or to learn to do so.  "The  human being's need for s o c i a l a c t i o n  i s the moving force which compels him to master the tools of communication.  Without these his a b i l i t y to gather inform-  ation i s imperilled and g r a t i f i c a t i o n of v i t a l needs i s threatened."3^  From this point of view i t i s probably  persistence of " v i t a l needs", ultimately of " l i f e " ,  the  that  determines the basis of personal p o t e n t i a l . Their persistence depends, not only on the degree to which environmental influences have encouraged or discouraged impulses"  the " o r i g i n a l  of the i n d i v i d u a l , but also on the strength of  the o r i g i n a l impulses themselves, that i s , on the c o n s t i t u t i o n a l endowment with which the i n d i v i d u a l met his environment. In view of the opinions of these three authors i t i s i n t e r e s t i n g to remember that we noted the wideness with which the factor of motivation seemed to be  recognized.  The f a c t too that the indicators of motivation seemed to be more s p e c i f i c and to lend themselves to systematization further confirms the impression that i t has received considerable attention. essential one,  3° 31  Although t h i s factor may  be the  i t does not eliminate the importance of the  Op .. c i t . , p. Op. c i t . , p.  93. 38.  70 degree of health or adjustment achieved, but indicates one reason f o r i t s importance.  I f not the e s s e n t i a l f a c t o r ,  the sine qua non of treatment, i t i s a valuable and desirable bonus.  As suggested above, i t s bearing i s on "the l e v e l at  which patient and doctor s t a r t their work", and i n view of the other components of o v e r - a l l t r e a t a b i l i t y , w i l l have a s i g n i f i c a n t part to play.  We have already noted that i t  would have an influence on motivation i t s e l f .  We might also  consider i t as an index of motivation. In reviewing  the group of c r i t e r i a as a whole, we  found that two main categories seemed to be singled out, namely motivation and capacity.  The l a t t e r included a range  of capacities whose assessment would indicate the l e v e l of adjustment achieved by the i n d i v i d u a l , while the former included evidence of the individual's wish f o r change i n terms of his problem.  A cursory and subjective appraisal of  these two categories suggested to the writer that "capacity" i s of diagnostic rather than prognostic value whereas "motivation"  i s more pertinent to the l a t t e r .  There were  arguments on the part of a few authorities supporting  the  idea of motivation as the e s s e n t i a l determinant of personal potential, and of capacity as a determinant of the " l e v e l " at which treatment was  commenced.  However there i s no clear  l i n e between the two concepts, each contributing to and expressing  the other.  This again suggests the vagueness  with which terms are used and raises the question as to whether, i f any one were defined and reduced to measurable units i t would not include the others.  72. CHAPTER IV: CONCLUSION. 1.  Summary: In undertaking this thesis, we undertook an i n i t i a l  reconnaissance into the whole question of t r e a t a b i l i t y , particularly  into one of i t s components, personal  potential.  We stated the reasons f o r studying the t r e a t a b i l i t y of s o c i a l problems as based on the need to constantly improve services and to provide a basis f o r s e l e c t i v i t y when this i s required by excessive demand for services. ponents of t r e a t a b i l i t y :  We outlined the com-  the scope of casework, the  development of the profession, community resources, agency function, s k i l l of the worker, the problem, the r e a l i t y situation  and the c l i e n t .  We d i d not evaluate these i n  terms of their v a l i d i t y and r e l a t i v e importance, but proceeded to select the c l i e n t as our main focus i n the study. We traced b r i e f l y the development of the concept of personal potential,  and defined i t as the a b i l i t y of the person to  resolve his inner problem by means of casework help. We made a survey of professional l i t e r a t u r e i n search of existing  c r i t e r i a of personal potential,  i n order  to determine whether c r i t e r i a are generally agreed upon and whether they could be tested by s c i e n t i f i c means f o r s t a t i s t i c a l r e l i a b i l i t y and v a l i d i t y . l i t e r a t u r e was limited  We found that the  i n quantity, but within what was  available, that there was no uniformity as to the nature of the c r i t e r i a or the way i n which they were expressed.  73. Almost a l l were very broad and as a r e s u l t over-lapping, and i n need of d e f i n i t i o n , 2.  Conclusions and recommendations: We had to conclude that the l i t e r a t u r e contains  almost no indices of personal p o t e n t i a l which could successfully be applied i n a research study to a number of cases or i n professional p r a c t i c e .  Although the c r i t e r i a  may have pragmatic meaning to the users, t h e i r meanings are not apparent and so they are unusable i n t h e i r present form, except by the originators.  We concluded also that the  question of personal p o t e n t i a l i s r e l a t i v e l y untouched and very l i t t l e understood.  Wot  only i s the amount of l i t e r a t u r e  limited, and the number of c r i t e r i a proportionately tremendous, but there does not exist general agreement as to the s p e c i f i c components and manifestations of personal potential, not only i n terms of what they are but also to what degree and i n what combination  they are  important.  Meanwhile, i n the absence of established c r i t e r i a or indices of this factor, p r a c t i t i o n e r s s t i l l have to r e l y for the time being on the use of " c l i n i c a l judgements" i n t h e i r assessment of i t .  The state of a f f a i r s described  points to the need for further research, beginning with the formulation of operational concepts, however crude at f i r s t , which can be detected, measured and e m p i r i c a l l y tested, i n place of the hodge-podge of unanalysed  insights,  74.  generalizations, and observations.  One might s t a r t by  testing the few c r i t e r i a for which standards of measurement exist, namely i n t e l l i g e n c e , age and health, with the a i d of other human relations professions s k i l l e d i n measuring these.  One might devote some e f f o r t to analysing c l i n i c a l  judgements further, as these seem to be the main source of the c r i t e r i a and are e s s e n t i a l l y grounded i n experience. P r a c t i t i o n e r s with experience " i n t u i t i v e l y " recognize indications of an individual's a b i l i t y to change.  In view  of the experience necessary, i t i s questionable just " i n t u i t i v e " are these responses and how  he acts.  to what the c l i e n t  how  tells,  Another approach would be to take any  one of the c r i t e r i a , which are not currently measureable, and establish an operational d e f i n i t i o n and indices for i t . In following the l a t t e r suggestion, one might select a c r i t e r i o n which more than others approaches a state of d e f i n a b i l i t y or measurability, such as s e l f - r e f e r r a l .  Or  one might tackle one which seems, i n the l i g h t of theory and practice so f a r , to offer considerable promise, f o r instance, motivation.  We noticed i n our survey of the  l i t e r a t u r e , that there was a tendency f o r the c r i t e r i a to group themselves into the concepts, and indices of the concepts, of "wish f o r change" and "state of emotional health" or "adjustment".  In considering these two main  areas, there seemed to be reason f o r regarding motivation as determining personal p o t e n t i a l , and regarding the l e v e l  75. of adjustment, as determining starts.  the l e v e l at which treatment  In addition to the t h e o r e t i c a l j u s t i f i c a t i o n f o r  focussing research on motivation, i s the p r a c t i c a l consideration of the a v a i l a b i l i t y of material.  The "indices"  of motivation tend to be more concrete than those for other c r i t e r i a , and i n the f i e l d of psychology there i s a quantity of l i t e r a t u r e on the subject of motivation i n general, 3,  Implications for other aspects of s o c i a l casework. The discussion about motivation and capacity  indicated not only that motivation may be the determining factor i n personal p o t e n t i a l , but that motivation exists i n everyone, and so that we are a l l changing and anyone can be helped to change.  This raises serious questions as to the  adequacy of our treatment  s k i l l s , and underlines our  respon-  s i b i l i t y constantly to further our professional a b i l i t y to determine what i s impeding the i n d i v i d u a l , what he wants and how we can help him.  The l a t t e r point goes beyond  techniques and f a c i l i t i e s to our own attitudes and ultimately to our own motivation and development. Besides learning to define, recognize and assess motivation we must e s t a b l i s h c l e a r l y our focus. speak of motivation, what do we mean? what"?  When we  Motivation " f o r  In t h i s study we have t e n t a t i v e l y defined personal  p o t e n t i a l as the individual's a b i l i t y to solve his problem by means of casework treatment.  Consequently, motivation  76. would be assessed  i n the same context, i . e . the desire to  solve his problem by means of casework treatment.  (The  l a t t e r point i s a relevant part of the d e f i n i t i o n as the i n d i v i d u a l might want to solve his problem, but without help, or with some other form of help.)  This again raises  the question of what we mean by "problem", and suggests that before we can a r r i v e at anything d e f i n i t i v e about personal p o t e n t i a l we must r e f i n e our understanding and statement of s o c i a l diagnosis.  According  to our d e f i n i t i o n  i n this study, the relevant "problem" i s the inner problem of the i n d i v i d u a l as diagnosed by the worker, rather than the "problem" f e l t by the i n d i v i d u a l , or f e l t by his family, society or the worker. This raises further questions as to our professional orientation and philosophy.  How  far are we s t i l l oriented  to symptoms rather than underlying needs?  How  f a r are we  oriented to " s i t u a t i o n s " rather than individuals?  Do  we  not as Miss Hamilton suggests evaluate capacity (and motivation) to be good parents, good marital partners, good citizens?  In the l a s t century one of the pioneers of s o c i a l  work stated that "In our charitable e f f o r t s we think more of what a man  ought to be than of what he i s or what he  may become; and we r u t h l e s s l y force our conventions and standards upon him, with a sterness which we would consider stupid indeed did an educator use i t i n forcing his mature i n t e l l e c t u a l convictions upon an undeveloped mind."  1  Jane Addams, "The Subtle Problems of Charity," The A t l a n t i c Monthly. Bsbruary 1899, quoted i n Florence Sytz, "The Development of Method i n S o c i a l Casework," Journal of S o c i a l Casework. XXIX, (March 194-8) p. 86. 1  77. We cannot reassure ourselves that we are not making t h i s mistake any more.  Most s o c i a l workers today would not  consider imposing the "conventions and standards" probably referred to by Miss Addams, because our standards and conventions are changed.  However we are just as l i a b l e to  impose new and current standards and conventions, i n terms, of maturity, normalcy, and so on. If our treatment i s to be soundly based, the i n d i v i d ual's goal must be established; and i n establishing the c l i e n t ' s goal we must be able to penetrate through the distorted "wants" to the healthy needs which i n v a r i a b l y underly them and assess the presence and strength of these. I f s o c i a l treatment depends on supporting the healthy aspect of personality we must f i n d them, and not be deceived by s u p e r f i c i a l behaviour, or s u p e r f i c i a l motives.  I f we believe  that " a l l behaviour i s purposive" and that growth i s the innate tendency of the organism, then any "motive" however negative seeming, can be reduced to p o s i t i v e terms.  The  negative nature of a, motive i s not the innate abnormality of the organism or the badness of the person, but the d i s t o r t i o n that has taken place i n natural tendencies as a r e s u l t of the l i f e he has experienced or his i n t e r p r e t a t i o n of i t .  The important thing f o r prognosis should be the  l o c a t i o n of these p o s i t i v e tendencies i n r e l a t i o n to the degree of discomfort the c l i e n t i s facing, and i n whatever healthy or unhealthy form they appear, and for treatment,  78. to support what i s wholesome i n these s t r i v i n g s .  -If we  do believe i n the self-determination of the c l i e n t and our function i n helping him as enabling growth to take place, then we must c l a r i f y our thinking about how  this b e l i e f and  t h i s process are to be applied when the needs of one i n d i v i d u a l c o n f l i c t with those of a member of his family or with society. Once our frame of reference i s clear, we are s t i l l faced with the job of discovering how to assess motivation, to establish what the need of the i n d i v i d u a l i s , and to determine the strength of his wish f o r growth and change i n those aspects of himself where development has been hindered. Perhaps a f r u i t f u l suggestion for accomplishing this purpose would be a more creative use of the intake interview.  The  l a t t e r i t s e l f constitutes a demonstration of motivation or the a b i l i t y to change; a " t r i a l - r u n " , or "dress-rehearsal", as one of the authorities terms i t .  We know from theory  and experience that the i n d i v i d u a l must unlearn or re-learn about himself or society i n the same way he o r i g i n a l l y learned or mis-learned, i . e . through experience i n s o c i a l relationships.  To be corrective, this s o c i a l relationship  must provide what was o r i g i n a l l y lacking, that i s , acceptance of and opportunities f o r development.  Providing such an  * Helen Perlman and Douglass Orr, M.D., the P a c i f i c Northwest Regional I n s t i t u t e .  Notes i n  79.  environment of "acceptance" sounds easy but i t i s not. It means accepting the individual's needs i n whatever distorted form they now appear.  I t means recognizing them  through the many superimposed disguises he has donned. I t means believing i n the b a s i c a l l y p o s i t i v e motive underl y i n g the most negative behaviour, and believing In the i n d i v i d u a l i n whatever condition he presents himself, without benefit of understanding the reasons f o r his condition, immediately or perhaps ever.  I t may be that this i s the  only f a i r test of the impulse toward growth, and that u n t i l his response to such an environment i s observed, p o t e n t i a l cannot be conclusively determined. We would do well to remind ourselves of the words of Miss Richmond which are at once sobering and encouraging, and which apply equally to the s t r i v i n g s of individuals and of the profession which seeks to serve them: a l l going somewhere and have not yet a r r i v e d .  "We are  Our character  i s 'not cut i n marble , but i s the sum of our past exper1  iences - a sum which i s to be changed, inevitably, by our future experiences."3  3 Mary Richmond, S o c i a l Diagnosis. Hew York: Russell Sage Foundation, 1917, p. 377.  80. BIBLIOGRAPHY (a) General References Bibring, Grete L., "Psychiatric P r i n c i p l e s i n Casework", Journal of S o c i a l Casework. 30: 230-235, June, 194-9. Bowers, Swithin, "The Nature and D e f i n i t i o n of S o c i a l Casework", Journal of S o c i a l Casework. 30: 311-317, 369-375, 412-417, October, 1949. English, 0. Spurgeon, and Gerald H. J . Pearson, Emotional Problems of Living: Avoiding the Neurotic Pattern. New York: W. W. Norton and Co., Inc., 1945, 438 pp. Farrar, Marcella S., "The Approach to the C l i e n t ' s Needs as i t i s Conditioned by the Function of the Agency", pp. 43-52. D i f f e r e n t i a l Approach i n Case Work Treatment. New York: Family Welfare Association of America, 1936, pp. 64. French, David G., An Approach to Measuring Results i n S o c i a l Work. New York: Columbia University Press,  19^  Garrett, Annette, " H i s t o r i c a l Survey of the Evolution of Casework", Journal of S o c i a l Casework. 30: 219-229, June, 1949. Garrett, Annette, "Transference i n Casework", The Family.  22:42-46, A p r i l , 1941.  Hacker, F. J . , "The Concept of Normality and I t s P r a c t i c a l Significance", American Journal of Orthopsychiatry. 10: 47-64, January, 1945. Hechman, A. A., and A l l a n Stone, "Testing Casework Results: Forging New Tools", Survey Midmonthly. 83:267-70, October, 1947. Hunt, J . McVicker and Leonard S. Kogan, Measuring Results i n S o c i a l Casework: a Manual on Judging Movement. New York: Family Service Association of America, 1950. Hunt, J . McVicker, Margaret Blenkner and Leonard S. Kogan, Testing Results i n S o c i a l Casework: A F i e l d - t e s t of the Movement Scaled New York: Family Service Association of America, 195°. pp. 64.  81. McCormick, Elizabeth, "Recognizing Ego Strengths i n Case Work Treatment", The Family. 22: 148-153, July, 1941. Maeder, Leroy, "Diagnostic C r i t e r i a - The Concept of Normal and Abnormal", The Family. 22:171-179, October, 1941. Marcus, G. F., "Changes i n the Theory of R e l i e f - g i v i n g " , pp. 267-279, Proceedings of the National Conference of S o c i a l Work. New York: Columbia University Press, 1941. pp. 787. S a p i r s t e i n , M. R., Emotional Security. New York: Crown Publishers, 1948. pp. 291. Scope and Methods of the Family Service Agency. Report of the Committee on Methods and Scope, New York: Family Service Association of America, 1953. PP» 22. Smalley, Ruth, "The Approach to the C l i e n t ' s Needs as i t i s Conditioned by the Equipment of the Worker", pp. 53-64, D i f f e r e n t i a l Approach i n Case Work Treatment. New York: Family Welfare Association of America, 1936. pp. 64. Stamm, Isobel, "Understanding the T o t a l Personality i n Treatment", Journal of S o c i a l Casework. 26: 323-329, January, 194o"T Sytz, Florence, "The Development of Method i n S o c i a l Casework", Journal of S o c i a l Casework. 24: 83-88, March, 1948. Voilarid, A l i c e L., Martha Lou Gundelach, and Mildred Corner, Developing Insight i n I n i t i a l Interviews. New York: Family Service Association of America, 1947. 54 pp. ( 1. Guiding P r i n c i p l e s Defined. OMIT ( 2. Guiding P r i n c i p l e s Applied. (3. Importance of the I n i t i a l Interview with ( the Unmarried Mother. (b) S p e c i f i c References 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 Casework". Journal of S o c i a l Casework. 29: 203-11, June, 1948. Bergler, Edmund, The Basic Neurosis. New York: Stratton, Inc., 1949. pp. 353.  Grune and  82  j Blenkner, Margaret, "Predictive Factors i n the I n i t i a l Interview i n Family Casework", S o c i a l Service Review, 28: 65-73, March, 1954. Burlingham, Susan, " D i f f e r e n t i a l Diagnosis as a Basis f o r Selection i n a Family Agency", pp. 1-11. Diagnostic and Treatment Processes i n Family S o c i a l Work. New York: Family Service Association of America, 1935, 27 pp. Carscadden, L i l l i a n , An Evaluation of the Client-Worker Relationship. A Study of Relationship on a Selected Number of Cases i n the Family Welfare Bureau of Greater Vancouver. Thesis submitted f o r the degree of Master of S o c i a l Work i n the School of S o c i a l Work, (Vancouver, B. C.) The University of B r i t i s h Columbia, 1951. PP. 119. Coleman, Jules V., "Distinguishing between Psychotherapy and Casework", Journal of S o e i a l Casework. 30: 244-251, June, 1949. Deutsch, Helene, The Psychology of Women. V o l . I, New York: Grune and Stratton, 1944. pp. 308. Dollard, John and Neal E. M i l l e r , Personality and Psychotherapy: An Analysis i n terms of Learning. Thinking and Culture. New York: McGraw-Hill Book Company, Inc., 1950. 488 pp. Flesch, Regina, "Treatment Goals and Techniques i n M a r i t a l Discord", Journal of S o c i a l Casework. 29: 382-388, December, 1948. Futterman, Samuel and P h i l i p B. Reichline, "Intake Techniques i n a Mental Hygiene C l i n i c " , Journal of S o c i a l Casework. 29: 49-56, February, 1948. G i l l , Merton, Richard Newman, and Frederick C. Redlich, The I n i t i a l Interview i n Psychiatric P r a c t i c e . "Collaborator: Margaret Sommers. International U n i v e r s i t i e s Press, Inc., New York: 1954. 423 pp. Hamilton, Gordon, "Helping People - The Growth of a Profession", Journal of S o c i a l Casework. 29: 291-299, October, 1948. Hamilton, Gordon, Theory and Practice of S o c i a l Case Work. New York: Columbia University Press, 1940. Pp. 388.  83. Hendrick, I., Facts and Theories of Psychoanalysis. New York: Alfred A. Knopf, 1939. pp. 3 0 8 . r  H o l l i s , Florence, "Environmental (Indirect) Treatment as Determined by the C l i e n t ' s Needs", pp. 19-28. D i f f e r e n t i a l Approach i n Case Work Treatment. New York: Family Welfare Association of America, 1936. 64 pp. H o l l i s , Florence, "The Relationship between Psychosocial Diagnosis and Treatment", S o c i a l Casework. 32: 67-74, February, 1951. H o l l i s , Florence, "The Techniques of Casework", Journal of S o c i a l Casework. 30: 235-244. June, 1949. Kage, Joseph, "Ego-Supportive Therapy with Displaced Persons", S o c i a l Casework. 31: 65-70. February, 1950. LaMar, Helen, "The Intake Process i n a Growing Community", S o c i a l Casework. 34: 167-173> A p r i l , 1953. Lowry, Fern, "The C l i e n t ' s Needs as the Basis f o r D i f f e r e n t i a l Approach i n Treatment", pp. 1-13. D i f f e r e n t i a l Approach i n Case Work Treatment. New York: Family Welfare Association of America, pp. 64.  1936,  McGeoch, John A., The Psychology of Human Learning: An Introduction. New York: Longmans, Green And Co., 1942. pp. 633. Perlman, Helen Harris and Douglass Orr, M.D., Notes on the P a c i f i c Northwest Regional I n s t i t u t e . Family Service Society, Spokane, Washington, 1950. Preston, Malcolm G., Emily H. Mudd and Hazel B. Froscher, "Factors Affecting Movement i n Casework", S o c i a l Casework. 34: 103-11, March, 1953. Richmond, Mary E., S o c i a l Diagnosis. New York: Sage Foundation, 1917, 511 pp.  Russell  Rogers, C. R. Counselling and Psychotherapy. Boston: Houghton M i f f l i n , 1942. pp. 450. Rogers, C a r l R., Personality Change In Psychotherapy. Unpublished paper read at the F i f t h International Congress on Mental Health held i n Toronto, August  1954.  84. Ruesch, Jurgen and Gregory Bateson, Communication: The S o c i a l Matrix of Psychiatry. New York: W. W. Norton and Co., Inc., 1951, 314- pp. Schmldl, F., "The Rorschach Personality Test i n Family Case Work", The Family. 24: 83-90. May, 1943. Taft, Jessie, "Conception of the Growth Process Underl y i n g S o c i a l Casework Practice", S o c i a l Casework. 31: 311-18, October, 1950. Towle, Charlotte, "Factors i n Treatment", pp. 179-91. Proceedings of the National Conference of S o c i a l Work, New York: Columbia University Press, 1936. pp. 655. Waelder, Robert, "Introductory Lectures on Psychoanalysis". (Unpublished lectures given under the auspices of St. Elizabeth's Hospital, Federal Security Agency, Washington, D. C , (Dr. Winfred Overholser, Superintendent.) 1940. Witmer, Helen L., editor, Teaching Psychotherapeutic Medicine, an experimental course f o r general physicians, given by Walter Bauer and others. New York: The Commonwealth Fund, 1947. pp. 464.  

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