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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 definition of personal potential and it s place in the treatability of social problems by casework method, and an evaluation of cri t e r i a found in pertinent professional literature. by KATHERINE ALDWORTH DALY Thesis Submitted in Partial Fulfilment of the Requirements for the Degree of MASTER OF SOCIAL WORK in the School of Social Work Accepted as conforming to the standard required for the degree of Master of Social Work School of Social Work 1955 The University of British Columbia ABSTRACT The treatability of social problems by social casework method needs study for two reasons: (1) the obligation of the profession to those i t serves, to always refine and develop i t s services; (2) the practical consider-ation of achieving optimum economy of service. Among the factors enumerated by authorities in the f i e l d of social casework as components of treatability are: the scope of social casework, the development of the profession, agency function, community resources, the s k i l l of the caseworker, the problem, the reality situation and the client. Of these only the latter 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 this factor, which could be submitted to the test of empirical research for v a l i d i t y and r e l i a b i l i t y . The potentialities of individuals for personal change is not a new concept i n the profession, but one which has only recently begun to receive special consider-ation. Personal potential, as defined within this thesis, is the a b i l i t y of the individual 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 positive change in relation to the problem. Evaluation of this factor, therefore, presumes a c l a r i t y of diagnosis, which points up the need for developing more satisfactory diagnostic classifications than exist at present. Professional literature offering c r i t e r i a of personal potential was found to be limited i n quantity and generally incidental 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 cr i t e r i a varied widely among the authorities, as did the form i n which they were presented. It was at f i r s t hoped to be able to sort and classify these. However i t became apparent that the ambiguity and inconsistency with which terms were used would make such classification a highly subjective task. The c r i t e r i a found did not possess generally accepted or precise definitions, 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 va l i d i t y suggested that of the two main categories into which they seemed to f a l l , namely, level of adjustment and motivation, there was some theoretical and practical basis for considering motivation as essential for personal potential, and for considering level of adjustment as helpful and as an indication of the level at which treatment should start. 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 readily be defined, detected and measured for validi 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, practitioners w i l l continue to rely 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 is of prime importance, there is reason for evaluating the adequacy of casework diagnostic and treatment s k i l l s and for clarifying how treatment goals are established. ACKNOWLEDGEMENTS The writer wishes to express appreciation to the several members of the Faculty of the School of Social Work, at the University of Brit i s h Columbia, whose knowledge and support have contributed to the development of this thesis. Particular thanks are due to Dr. Leonard C. Marsh for the stimulation provided by his enthusiastic and conscientious approach to research and for 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 criticism contributed greatly to the formulation of method, ideas and exposition, which do not however adequately reflect the richness and incisiveness of his mind; and to Mr. Arthur Abrahamson whose generous and consistent guidance was of great theoretical and practical help, and whose fai t h in the worth of individuals and in their capacity for development has been a constant inspiration. The writer also wishes to thank the School of Social Work and the Family Welfare Bureau of Greater Vancouver, particularly Miss Mary McPhedran, i t s former Director, Miss Barbara Finlayson and Miss L i l l i a n Carscadden, for their cooperation and helpfulness i n providing case-material. She is also grateful to Miss Marjorie J. Smith, Director of the School of Social Work, and to Mr. Geoffrey Glover for the use of unpublished material i n their possession. In addition appreciation is 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 in trouble whose needs and responses are insistent provocation to form and reform our understanding. TABLE OF CONTENTS Page Chapter I: Introduction - Background and Plan 1 1. Why do we need to study treatability? 1 2. What constitutes treatability? 5 3. Focus of the thesis: personal potential 21 Chapter II: Personal Potential of the Client 24 1. Development of the concept 24 2. A Definition 31 3. Sources of cri t e r i a i n professional literature . 35 4. Consideration of the c r i t e r i a : amenability to research 40 Chapter III: General Assessment of the Criteria 53 1. Motivation and Capacity 53 2. Limitations of level of adjustment as a component of personal potential 56 3. Arguments for motivation as the essential component 64 Chapter IV: Conclusion 72 1. Summary 72 2. Conclusions and Recommendations 73 3. Implications for other aspects of social casew>rk 75 Appendix: Bibliography 80 Tables i n the Text Table 1. Number and distribution 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 definition of personal potential and i t s place i n the treatability of social problems by casework method, and an evaluation of c r i t e r i a found i n pertinent professional literature. CHAPTER It INTRODUCTION - BACKGROUND AND PLAN OF THE THESIS 1. Why do we need to study treatability? The many years of experience and the thousands of clients seen have made i t essential that the social work profession c r i t i c a l l y examine the effectiveness of the social 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 treatability (prognosis) makes possible the selection of appropriate treatment goals and techniques in any case. Although diagnosis of adjustment problems is not perfected, intake interview s k i l l s have developed to a point where i t is increasingly easy to define a problem and to infer i t s general causative factors i n the light of the client's behaviour and the information he gives. The same is not true of personality evaluation i n any explicit way, although practitioners 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 is always an ethical responsibility to the profession and to those who are served by that profession to refine and develop existing services. In addition, there are practical considerations which should stimulate research into the question of treatability. The demanding pressures for casework help upon an already limited supply of casework resources calls for the maximum efficiency of service. In order to achieve this, i t is v i t a l that the social worker know i f possible which cases w i l l normally respond favorably to social treatment and which w i l l not. Where caseloads are large, an agency or an individual worker may have to select from i t s applicants those on which to concentrate Its efforts. 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 in many instances no clear goals, or unrealistic ones, have been set. The writer has considerable doubts about the val i d i t y of terming many such cases "failures" and suspects that If treatability had been adequately considered, the degree of the client's movement could have been anticipated and worked toward. If this had been done, such cases would terminate with a feeling of accomplishment on the part of the worker, rather than the frustration or dissatisfaction which is so often the case. When a social worker feels thus, the feeling is 3. conveyed to the client, who has been forced to withdraw or to carry on reluctantly. As a result the client may also feel guilty about his failure to measure up to the worker's expectations; this guilt 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 feeling, but he may, under pressure to meet the worker's requirement leave treatment before he has even achieved his own goal. "If the therapist has such an aim (i.e. a complete Intellectual and emotional l i f e for everyone) i n many instances he may destroy the patient's opportunities for achievement in any area." ^ The result i s an unnecessary investment of time, effort and money, for clients receiving and waiting for help, as i t is also for workers, agencies and communities. The lack of c l a r i t y in prognostic thinking has not only limited casework practice directly, i n agencies and social service departments, but has done so Indirectly, by imposing a limitation on the a b i l i t y of supervisors and teachers i n schools of social work to impart principles of casework to students and practitioners of varying degrees of training and experience. Without a clear formulation of treatability, what i t i s , what i t s components are, and how 1 Adelaide M. Johnson, M.D., i n Alexander and French, et alv, Psychoanalytic Therapy. Ronald Press Company, New York: 194-6, p. 323, quoted i n Regina Flesch, "Treatment Goals and Techniques i n Marital Discord", Journal of Social  Casework. XXIX, (December, 1948), p. 388. 4. they can be recognized and assessed, those responsible for the training and professional development of social workers are unable to communicate with economy what is already "known". It is possible too that the lack of c l a r i t y has restricted research and community organization programs. If i t were known for instance that a certain proportion of those seeking help could not benefit appreciably by any methods or resources now available, such knowledge might stimulate and guide efforts to develop new methods and new resources. We need then to study treatability, because we do not know enough about i t , and because i t is important to know about i t i n order to improve professional practice, training, and related aspects of the profession. The writer along with leaders i n the f i e l d of the study of human relations believes that although every individual is 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 is not. The least that can be said at the present time is that some clients 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 later to 5. display a more encouraging progress toward a more favour-able close. 2. What constitutes treatability? Prognosis in medicine is the forecast of the course of a disease. In the context of this thesis, i t would mean the prediction of future development of a social problem under social casework treatment. Treatability is the extent to which the problem can be resolved by such treatment. What are the factors which limit or permit treatment? It is 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 reality situation of the client; and the client himself. Each of these, and any other relevant factors, must be assessed i n order to determine treatability. Recognized leaders i n social work have, at various times, voiced these as factors limiting treatment, formulated on the basis of theoretical knowledge and experience from social work practice. It i s the last of these, the client himself, on which this study i s focussed, but before moving toward this, consideration w i l l be given to the others. (a) The scope of casework.2 Treatment is naturally limited 2 Fern Lowry, "The Client's Needs as The Basis for Differential Approach in Treatment", i n "Differential Approach i n Case Work Treatment". New York: Family Welfare Association of America, 1936. p. 10. 6. by the aims and goals of the profession, or rather by the aims and goals i t does not hold. This is perhaps a more fixed limitation than the development of the profession, except insofar as goals are influenced by the knowledge and s k i l l available. Father Bowers defines casework as "an art i n which knowledge of the science of human relations, and s k i l l i n relationship are used to mobilize capacities in the individual and resources i n the community approp-riate for the better adjustment between the client and a l l or any part of his total environment."3 He states i t s intr i n s i c end to be the rendering mobile of an individual's capacities and the community's resources appropriate to a  proximate extrinsic end.3a This last qualifying phrase indicates the point that is 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 relation to a particular situation or problem; i t does not aim at rendering mobile a l l capacities, but those which are pertinent or "appropriate". In other words complete personality change is not attempted. This i n turn Is based on the intent of service. As Hunt defines i t , "caseworkers aim to help their clients behave more happily and effectively i n relation to their previous 3 Swithin Bowers, "The Nature and Definition of Social Casework", Journal of Social 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 static perfection." 4" The p a r t i a l i t y of casework is therefore based on philosophical considerations as well as professional competency; that is to say, the casework aim determines the methods that are developed to accomplish this 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 individual or to force him to measure up to some external yardstick. Rather i t aims at helping specific individuals with specific problems find successful ways of achieving their own aims i n place of the unsuccessful ways of which their social adjustment problems are a symptom. It aims at helping them achieve a more harmonious relationship to them-selves and to their external situation, to the degree of which they are capable. Casework then does not aim at fundamental personality change, nor, for that matter, at fundamental change of the environment, whether social or natural. It i s a helping profession, dealing with what is "given" whether i n the individual or family, or i n the total situation. The goals and techniques of casework seem to rest not only on a philosophical base but on practical experience with people i n terms of what i s helpful, how 4 J. McVicker Hunt and Leonard S. Kogan, Measuring  Results i n Social Casework; a Manual on Judging Movement. New York: Family Service Association of America, 1950, p. 7» 8. they are helped and what they want. These are supported by current theoretical knowledge about human development, whether within a treatment situation or within less spec-ialized life-situations. Adjustment like any growth or any learning is a gradual and uneven development, involving periods of change and reintegration. It i s true that for some years, through i t s interest i n psychiatry and in drawing on that profession to make i t s own services more effective, social work tended to be preoccupied with personality problems and personality change. The reasons for this were many: the great need for under-standing what the "new psychology" had to contribute to the social work f i e l d ; fascination with the material i t s e l f ; i n addition, governments have increasingly taken over programs of financial aid, so that many private agencies were less pressed to deal with concrete needs; the depression created a situation where concrete help was lacking or inadequate, and in the face of this frustration, social work was compelled to be more resourceful about intangible services; another element was the shortage of psychiatric treatment and the tremendous demand for i t . Garrett points out that there are two trends today: one is for caseworkers to retain 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 psychiatric supervision; 9 the other is to return to the professional orientation that belongs to social work, which is neither wholly con-cerned with the effect of the environment, not wholly 5 concerned with the effect of personality maladjustment. As part of the social work profession, casework is concerned with multi-faceted situations. "The caseworker does not define the problems he deals with i n terms of intra-psychic conflict; rather i t is the problem of the client i n relation to a distressing situation, usually of an economic, health, or interpersonal nature. It is this relatedness aspect of personal problems which is 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 individual personal relationship between the client and worker, i n which the usual form of communication is talking. The problem must be considered in 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, "Historical Survey of the Evolution of Casework", Journal of Social Casework, XXX (June, 1949), p. 224. 6 Jules Coleman, "Distinguishing Between Psycho-therapy and Casework", Journal of Social Casework, XXX (June, 1949), p. 247. 10 treatment of a particular problem, or w i l l only p a r t i a l l y answer the needs of a situation, community resources w i l l assume importance as an alternative or complementary source of treatment, 7 (b) Development of the profession might seem to embrace the three factors cited below. However the term as used implies more than the bringing of caseworkers, agencies and community resources up to the level of the profession's current understanding of diagnosis and treatment. It would appear to include the level 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 is treatable. However we can only be guided by our current level of understanding and consider treatability or untreat-a b i l i t y as relative to that. (c) Another factor voiced as a determinant of treatability is agency function.^ One of the articles citing this as a basis for differential treatment in 1936 seemed to be describing methods of treatment as differing between agencies, a situation as i t existed rather than as i t should or need be. 7 Gordon Hamilton, "Theory and Practice of Social  Casework", New York: Columbia University Press, 1940, p. 209. ^ Marcella Farrar, "The Approach to the Client's Needs as i t i s Conditioned by the Function of the Agency", in Differential 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 for different purposes, to deal with specific types of problem: they therefore are offering different services. The point relevant here is whether the particular agency to which a social problem has been presented can, according to i t s policy 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 is some discrepancy between the latter and the agency1s intended range and quality of service, due to, inadequate numbers or qualifications of staff, conditions of work, administrative deficiencies and so on. However this might be considered a separate point among the limiting factors enumerated here.) It might be argued that a caseworker i n an intake interview might, on making a tentative diagnosis, determine that the social 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 deter-mining treatability. However we remind ourselves that treatability i s a complex "participation category" and that another factor that worker would consider is community resources. If another agency, with a program more suited to the social problem existed i n the community, a referral 12 to i t would complete his assessment of treatability. If such an agency did not exist, then for a l l practical pur-poses the problem was not treatable. The limitation imposed by agency function points up the responsibility of the professional worker. Because of the generic nature of social work training, a caseworker, regardless of the setting i n which he works, is prepared and responsible for arriving at a social diagnosis, and is capable of providing the treatment required. If the agency i n which he works and to which the client applies does not provide the necessary services, the worker would help the client to one which does. This also points up the need for inter-agency relationships to be such that referral is easily effected, or cooperative treatment worked out. (d) Community resources,9 a s indicated above, present another qualifier of treatment. The av 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 situation is of course essential. This refers to resources i n the larger community in which the client lives rather than i n his immediate environment which constitutes a separate factor. It might be seen as including almost any kind of established service to a l l members of the community or particular groups: 9 Hamilton, loc c i t . 13. social, medical, legal, educational, religious, vocational and even commercial resources. The importance of this 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 social work profession to expand existing social services, and to work for the establishment of other resources to correct apparent lacks. Social welfare planning within a community should be such that needs for which no service exists can be met by setting up new ones. As with agency function, we find that for a l l practical purposes a social problem is untreatable i f resources are lacking, even though we know that this is the only limiting factor. (e) The s k i l l of the worker 1 0 is also mentioned as a determinant of success, and i t has also been mentioned as a determinant of differential treatment. Individual workers differ i n natural capacities just as clients do, not only i n diagnostic s k i l l , but i n their a b i l i t y to give effective service. Although workers w i l l vary as to their s k i l l i n using one treatment technique or another, for the same reason, the significance of the s k i l l of the worker for selection of treatment method does not have the same importance today t 1 0 Ruth Smalley, "The Approach to the Client's Needs as i t is Conditioned by The Equipment of the Worker," in Differential Approach i n Case Work Treatment. New York: Family Welfare Association of America, 1936, pp. 53* 14. as i t did when the statement was made, that is i n 1936, when "insight development" was a relatively new approach. Today a qualified caseworker has received training which enables him to use any social case-work techniques that the situation 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 individual differences i n the personal experience of workers, differences i n the degrees of training and experience of those holding positions of similar responsibility. (f) The problem of the cl i e n t ^ - is another factor which is regularly put forward as a factor in treatability. There has been some feeling 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, sub-divided into various c l i n i c a l syndromes, e.g. psychopathic personality, schizophrenia, obsessive-compulsive neurosis arid so on. Social work has not as yet developed a system of diagnostic classification because of the enormous complexity of social 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 psychiatric thinking about the relatively fixed relation of diagnosis to prognosis. Although the c l i n i c a l 1 1 Regina Flesch, "Treatment Goals and Techniques in Marital Discord", Journal of Social Casework. XXIX, (December, 1948) p. 2ET. 15. syndromes of psychiatry have been roughly correlated with differing degrees of t r e a t a b i l i t y , 1 2 these correlations are not firmly established. The direction of thinking now seems to be toward the idea that the problem or the diagnosis does not indicate the treatability, but rather indicates the goals and methods of treatment. Most practitioners could probably r e c a l l f a i r l y readily from their experience problems usually regarded as serious which have responded to treatment and problems usually regarded as less serious which have not. The explanation is not necessarily that the hypothesis as to the association between increasing severity of the problem and decreasing prognostic hopefulness is erroneous. Again we must remind ourselves of the fact that treatability is composed of a complex of factors, any one of which is insufficient for accurate prediction. Although diagnosis may not of i t s e l f indicate treatability, i t may indicate the amount of time, effort and resources that are to be taken up in treatment. It could perhaps be assumed that the more serious the problem is (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: 1 2 Lucille Austin, "Trends in Differential Treatment in Casework", Journal of Social Casework, XXIX, (June, 194-8) pp. 206 f f . 16. the more d i f f i c u l t the problem, the more essential 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 available, the limitations of time available, as permitted by society, the situation or the lifespan of the client, may alter considerably the picture of treatability. This factor, particularly where the problem is at least p a r t i a l l y within the personality of the client, is very d i f f i c u l t to separate out from the last factor, the client himself. In fact these last three are very closely interrelated as might be expected. Some of the aspects of the problem which have been cited in the literature as cr i t e r i a of treatability, are actually diagnostic c r i t e r i a , or more exactly diagnostic clues: for instance, evidences of physical or emotional pathology, sources of the pathology, duration, extent, severity and so on. It i s true that some of the same facts that have diagnostic significance may also have prognostic value. However i t may be possible to consider both aspects of a single item separately. (g) Another important factor limiting or f a c i l i t a t i n g 1-3 treatment i s the "reality situation". J To the social worker, ^ Charlotte Towle, "Factors in Treatment", Proceedings of the National Conference of Social Work, New York: Columbia University Press, 1936, p. 179. 17 who thinks of clients " i n context", this is a most important item to be considered in evaluating treatability. The r e a l i t y situation i s a very broad term which might i t s e l f be broken down into different components. It includes the client's immediate environment, physical and social, the latter including individuals and groups with which he i s connected, their attitudes and behaviour toward him. It includes the larger community i n which he finds himself. It includes his social and economic status, educational and vocational circumstances, his responsibilities 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 is the degree of mobility of the client's external circumstances.-^ The reason for i t s significance is that i n the interaction between the client 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 situation is an indispensable consideration. If i t is the main source or cause of the problem, i t s modifiability is of great importance. 1^ If i t is one source or cause i t is s t i l l of importance. The less modifiable the r e a l i t y situation, the more w i l l be demanded of the other factors. Unless i t can be 14 Lowry, loc c i t . 15 ibid, p. 7. - I 18. changed, i t may be impossible for the client, for instance, to make necessary modifications in himself. 1^ Similarly, though i t may be possible for him to do so, i t may be fu t i l e ; i f after he has achieved new attitudes and insights, his situation 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 for an unfavorable one here. (h) The last major factor, and the one with which this study •I Q i s specifically concerned, is the client himself. The individual again is composed of many aspects. Physically we must consider his appearance, sex, health, physical condition and age. Intellectually we must consider his capacity and the degree to which i t is developed or function-ing; socially and emotionally we must consider his behaviour and attitudes toward himself and others. A l l these facets are, of course, interrelated and make up the person. The question that is usually asked about this factor is again one of modifiability. 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 social problems when diagnosed show "problems" i n both person and environment. It might be Coleman, op. c i t . , p. 248. Carl Rogers, Counselling and Psychotherapy, p. 78, Hamilton, loc c i t . 19. postulated that determining modifiability of the client involves weighing the personal resources against the personal problems; that determining the modifiability of the environment involves weighing environmental resources against environmental problems. Where the resources of either are deficient, the resources of the other, and of the additional factors, assume greater importance. Generally speaking treatment potential only needs to be evaluated when and where casework diagnosis reveals that forces within the client's personality have contributed to the development of the problem, and where modification i n the client i s therefore necessary to resolution of the problem. Theoretically, where casework diagnosis shows that the problem stems only from environmental sources or an emergency situation, solution of the problem would depend on modification of the environment perhaps through the use of concrete "social services". However i n some cases the environmental stresses cannot be modified or appropriate services and resources are not available; i n such a situation, modifiability of the client s t i l l needs to be assessed i n terms of the client's a b i l i t y to accept and adapt himself to this situation. Treatability, then, is determined by a consideration of a l l the factors mentioned above, and perhaps others. It is relative to the frame of reference of the person making the assessment of treatability, 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 treatability, nor even i n doing this with individual ones. We know only vaguely, that although each factor must be considered separately, i t is i n the consideration of them a l l together, that the significance of any one becomes apparent. For instance, where the client's resources are limited, the environmental resources w i l l assume greater importance, and where the client's resources are considerable, the environmental resources may be of lesser significance for prognosis. We are inclined to forget that a l l factors are important. Sometimes this may be because assessment of the most immediate or most obvious ones indicates a favorable prog-nosis 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 social problem presented receive deliberate consideration, i.e., the problem, the r e a l i t y situation and the client. Again i t may be that experienced workers, with considerable familiarity with the profession and with their community, do not "forget" or neglect to assess a l l the relevant factors, but do so almost "intuitively" so that their assessment is not apparent, even to themselves. So far as this writer knows there is v i r t u a l l y no work on the whole question of treatability, that i s , no attempt to make a complete statement of i t s components, to ) 2 1 . determine their relative values, to set out ways of assessing them or to establish c r i t e r i a for doing so. This may be partly because some are f a i r l y readily assessed, such as agency function, development of the profession and so on. However this is not the whole explanation, as of the three most frequently cited, one i n particular, the r e a l i t y situation or external circumstances, has received almost no consider-ation in terms of how one would proceed to evaluate this very large and complex item* 3. Focus of the thesis: personal potential. Although, as stated above, a l l factors must be assessed in determining treatability, 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 fact, i t would seem possible to separate them at least for pur-poses of discussion. Some seem to be more inextricably related than others, particularly the problem, the client, and his environment. These have already become intertwined before treatment was considered. In this study i t i s intended to focus on the aspect of treatability last mentioned, that i s , the modiflability of the client. Its purpose i s mainly an exploratory one with the hope of mapping out more clearly what is currently known or thought about this subject, and what is s t i l l uncharted territory. 22. No attempt w i l l be made to tackle the other factors, nor w i l l there be an attempt to relate assessment of the client to the other factors either individually or collectively. Although this needs to be done from a research point of view as well as in actual practice, i t w i l l not be undertaken here. In one sense, evaluation of the client is closely related to evaluation of the re a l i t y situation. That i s , an individual may be considered from two points of view; i n one sense he is a client, and i n another he i s part of the environment of another individual. It could probably be assumed that the same procedures would be required i n evaluating the potential of a "primary" client, or applicant, as would be required in evaluating a "secondary" client or a member of the applicant's environment. The reason for selecting this particular aspect for study is mainly one of personal interest. It is 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. It holds a central position, as without the client there would be no problem to treat and no means of treatment. From a practical point of view a greater understanding of this factor is 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 re a l i t y situation a l l apparently being favorable, the degree of resolution and the method of obtaining that degree are dependent only on the 23 client's capacity to respond. Indeed the significance of this capacity i s revealed i n a negative way by the fact that i n situations where the other factors are not favorable, the capacity to benefit from help differs markedly from one individual 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 in the reali t y situation, 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 potential w i l l be traced b r i e f l y and a tentative definition stated. Having established this frame of reference we shall proceed to make a survey of professional monographs and periodicals on social casework theory and practice, and on the theory and practice of related professions working i n the f i e l d of human relations to obtain c r i t e r i a which have been used to assess personal potential. Once they have been assembled, an attempt w i l l be made to systematize them, by means of sorting and classification, and following this 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 for v a l i d i t y and r e l i a b i l i t y by predictive application to actual cases, though such application 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 their value from a theoretical point of view. On the basis of this examination, conclusions w i l l be drawn as to the implications for the need and direction of further research. 24. CHAPTER II: PERSONAL POTENTIAL OF THE CLIENT. 1. Development of the concept. Before attempting to consider c r i t e r i a of this component of treatability, i t seems advisable to c l a r i f y the concept i t s e l f by br i e f l y tracing i t s development and arriving at a working definition that w i l l provide a ready frame of reference. Casework has long applied i t s principle of individ-ualization to the problems presented by i t s clients. Gradually i t was seen that the same presenting problem could come from a variety of causes, originally interpreted as worthy and unworthy.1 Financial need or poverty were seen as the result of either misfortune or wilfulness. One case of financial 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 failure to work when physically able, were seen as forms of unworthy need, stemming from intellectual, educational or moral inadequacy. Defective intelligence or education were considered something an individual could not help; therefore services of a certain quality were provided to compensate for these deficiencies. However, for the morally inadequate, un t i l the turn of the 1 Annette Garrett, "Historical Survey of the Evolution of Casework", Journal of Social Casework. XXX, (June, 1949) p. 220. 25. twentieth century, there was no solution beyond the passing of : judgment. Finally psychiatry revealed that personality defects, for which an individual was not totally responsible, could also account for social inadequacies and were often amenable to treatment when understood as such. Gradually the judgemental divisions were changed, at least verbally, to terms such as external or internal, 2 objective or sub-jective. ^  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 situation: one was simply that for this period a l l the attention was applied to diagnosis, to the knowledge and s k i l l that yielded understanding, resulting i n neglect of treatment. There was another factor: i t was apparently thought that once a problem was understood, this understanding could be conveyed 2 Florence Hollis, "Environmental (Indirect) Treat- . ment as Determined by The Client's Needs", Differential  Approach i n Case Work Treatment,, New York: Family Welfare Association of America, 1936, p. 16. 3 Fern Lowry, "The Client's Needs as The Basis for Differential Treatment, Differential Approach i n Case Work  Treatment. New York: Family Welfare Association of America, 1936, p. 7. 26. to the client or patient, and change or cure would auto-matically follow on this "welcome" interpretation. 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 different personality problems. Even so, i t became apparent that there were s t i l l cases i n which the therapist could see clearly what was wrong and knew in theory what should be done, but where i t was impossible to achieve favorable results. Casework during this period, attempted to locate the source of a social problem either in the environment or in the client. Logically, ;some deduced that i f the source was external, treatment would be the same, and i f i t was internal, treatment should be "direct", and i f both, both.4" Results were not always forthcoming, and at f i r s t this was interpreted as the failure of casework to admit that certain problems were outside i t s f i e l d . It was assumed that social treatment was not sufficient 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 in the scope of psychiatry. In certain respects this was and w i l l always be true, but soon therafter both social workers and psychiatrists discovered that psychotherapy too was unable to help a l l individuals resolve their problems. At the Loc. c i t 27 time, however, judging by the lack of reference to this aspect of treatability, the social workers of the 1920's and 1930's found d i f f i c u l t y i n admitting that the client's potentialities had anything to do with the failure of a case, (though they might not have denied them i n relation to success!) This was because they knew i t had been a con-venient excuse for failures i n the period when the uncon-scious motivations of the client were as unconscious for them as for the client. In 1936 Miss Lowry decried the tendency to blame the client for failure of a case and assumed the blame for the profession's lack of s k i l l and i t s attempt to undertake a l l thingsS However in the same paper she indicated an awareness of another factor, although reluctant to name i t as such, namely the capacity of the client to use treatment. In discussing the "needs" of the client as one basis for differen t i a l treatment, she asked various questions which would have to be answered i n assessing those needs. For instance: "Is the client aware of this difficulty? How uncomfortable is he because of i t s existence? ... Has he in any way indicated a desire for change? ... What attitudes does he show in relation to his difficulty? 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 related 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 bene-f i t from help. Identification of this factor is rare i n the literature. Awareness of i t developed gradually from the experience of social workers but their 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 infantile conflicts, but also the adaptive, healthy part of the personality which attempted to deal with these con-f l i c t s and with external reality, and therefore a part of the personality that would be essential to consider in treatment. Perhaps because social work diagnosis tends to be an unwieldy, descriptive thing, rather than a system of classifications, 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 clearly differentiated and are s t i l l d i f f i c u l t to separate. Pressure of work has undoubtedly militated against the leisure needed for the research that could c l a r i f y some of these issues. In addition a strong tradition of individualization may add some reluctance to define and classify, with the fear that individuality may be lost thereby. Although the term "treatability" as applied to Ibid, p. 10. 29 individuals i s a relatively new one, the concept has long been recognized i n the f i e l d of social work. "The London Charity Organization Society, heir to Chalmers' ideas and student of the Elb'erfield system, included i n i t s member-ship from the beginning a small group of social reformers who, while impressed with the necessity for regulating relief-giving, especially concerned themselves with efforts to place distressed people above the need for r e l i e f and, in doing this, 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 in which the London society was founded, Miss Octavia H i l l had given, before the Social Science Association, the f i r s t description that we have been able to find of enquiry with social reinstatement as its motive and aim ... By knowledge of character more is meant than whether a man is a drunkard or a woman is dishonest; i t means knowledge of the passions, hopes, and history of people; where the temptations w i l l touch them, what is the l i t t l e scheme they have made of their lives, or would make, i f they had encouragement; what training long past phases of their lives may have afforded; how to move, touch, teach them. Our memories and our hopes are more truly factors of our lives than we often remember." 7 Richmond herself, who quotes the above, refers to "moral and temperamental characteristics" and "aptitudes" which 7 Mary Richmond, Social Diagnosis. New Yorks Russell Sage Foundation, 1917? p. 29 (underlining is 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 "social diagnosis." 8 Miss Lowry's comments about "needs", i n 1936, imply awareness of the same factor. In the same publication containing Miss Lowry's paper, Miss Hollis stated that where both environmental and personal factors were operative i n a social problem, both types of treatment might be used, but that the emphasis on either environment or personality would depend on which was the q most modifiable. Here i t is recognized that either one may be modifiable or unmodifiable, but what constitutes modifiability is not stated. In 1940, Gordon Hamilton used the word treatability, and indicated that this was ascertained by "evaluation", for the f i r s t time clearly separating this out from diagnosis. "The emphasis on the assets, the potential strengths, of the client in 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 client's potentialities to help himself i n a treatment relationship is not the same as the diagnostic process."1° And further, "If one were to express this i n a sort of mathematical formula, one might say that diagnosis is to a 8 Ibid, p. 381. 9 Hollis, op. c i t . , p. 27. 1 0 Gordon Hamilton, Theory and Practice of Social Case Work. New York: Columbia University Press, 1940, - p. 153. 31. situation as evaluation both of person and resources i s to treatment."11 About the same time, Dr. Hendrick uses the term "ego-potential". 1 2 Various other expressions have been used to refer to the same characteristic: "potentialities to help himself"j 1^ "capacity to rebuild"; 1 4" potentialities 1*5 ifi for ego-development"; y "capacity for adjustment"; x o "capacity for emotional change";1^ "change potential". 1^ 2. A Definition. The "personal potential" of the client is not something to be defined i n the abstract, any more than the other components of treatability, but i n relation 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 pertain to the problem. Similarly we do not 1 1 Ibid, p. 165. 1 2 Ives Hendrick* Facts and Theories of Psychoanalysis. New York: Alfred A. Knopf, 1939» p. v i i . J Hamilton, op. c i t . p. 153• 1 4 Ibid, p. 163. Annett Garrett, "Transference in Casework", The Family. XXII (April, 1941), p. 45. ^ Helene DeUtsch, The Psychology of Women. Vol. I, New York: Grune and Stratton, 1944, p. 354. ^ Regina Flesch, "Treatment Goals and Techniques i n Marital Discord", Journal of Social Casework. XXIX (December, 1948) p. 387. 1 o Margaret Blenkrier , "Predictive Factors i n the I n i t i a l Interview in Family Casework", Social 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 relation to the problem. At this point we need to be clear as to what is 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 is beyond the scope of this thesis. However some common understanding of terms is necessary as a basis for what is to follow, and at the risk of being arbitrary and of over-simplifying, the following distinctions w i l l be made clear. A "problem" (symptom, complaint, need) i s presented to an agency. In arriving at a diagnosis, the worker discovers "problems", usually i n both the environment and in the client, which act as causes i n relation to "problem" number one. However the same "problem" which i s a "cause" of the superficial symptom, may also be a symptom in terms of the environment or the client. For instance, the behaviour or attitudes of the client which are contributing to the social problem, are symptomatic of some personal d i f f i c u l t y . It is this "third degree" of problem with which we are concerned i n assessing the personal potential. That i s , we want to know i f the client has "what i t takes" to overcome his own internal problem, which w i l l i n turn overcome his symptomatic behaviour, which w i l l i n turn overcome his part i n the creation of the "social problem". 33 One writer has called this factor, "modification possible i n the individual to meet the situation" We have to recognize that there are social problems presented by clients i n which the cause is largely external. There-fore i t might be said that the limiting of personal potential to the personal problem is too narrow: that the individual may also have to meet an unfavorable external situation and must have the potential for this as well. However our concept of personal potential has also to be defined i n relation to the larger concept of treatability, as well as i n relation to diagnosis. As mentioned before, each com-ponent needs to be assessed f i r s t Independently. Where there is an external problem, i t s modiflability i s deter-mined by assessing the environmental resources, including those present i n the client's immediate environment, the community, the agency and so on. At the same time the client's resources in relation to his internal problem are being assessed. If i t evolved that assessment of the former (environment) was negative, and the latter (client) was positive, the worker would need to return to the factor of the client's capacities to relate them to this additional problem he faces. This distinction between modiflability ^ Joseph Kage, "Ego-Supportive Therapy with Displaced Persons", Social Casework, (February, 1950), p. 65. 34. with regard to internal or external problems may seem a fine, or an a r t i f i c i a l one, and may i n fact turn out to be so. However i t seems necessary to make some such distinction 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 this factor of treatment potential with that of any other. That i s , the client's capacity for change i n terms of his own problem w i l l not be related to environmental pressures, lack of treatment resources, and so on. It w i l l be undertaken as i f other factors were equal. By the same token, i t can be assumed that many clients that come to the attention of social agencies w i l l not be discussed here, i.e., those whose inner problems have not contributed partly or largely to the problem-symptom. There i s l i t t l e point assessing capacity for change unless some personal change is warranted, except as indicated above, where adverse external factors are unchangeable. With these relationships to diagnosis and treat-a b i l i t y established, we may consider "personal potential" as the capacity of the client to solve his problem. What we want to know is whether present assets, or new ones, can be developed, to cope with present l i a b i l i t i e s . In order to avoid confusion, the writer w i l l attempt to avoid the use of the word "treatability" with regard to this factor, and res t r i c t i t s use to the larger concept of overall prognosis 35. covered i n the f i r s t chapter, 3* Sources of cri t e r i a i n professional literature. As suggested earlier, attention has only recently been drawn to this subject. Consequently the literature is limited i n quantity, although there is probably a wealth of material relevant to i t , but either not identified as such by the authors, or else included i n writings on broader sub-jects. To this writer's knowledge there is as yet no monograph either on personal potential or treatability, and i t is the rare a r t i c l e which is wholly devoted to i t . It is even unusual to find a chapter or a section of a chapter where i t is isolated. Most references are found i n the body of some work on treatment and incidental to other considerations, as can be seen by glancing over t i t l e s i n the bibliography. Because of this, the writer has probably overlooked much valuable material. Because of this, i t also should be noted that the opinions of the various authorities referred to do not necessarily represent them f a i r l y . The selection under consideration here makes no claim to be exhaustive of the literature that does exist. Rather the writer has tried to cover the opinions of representative leaders i n the f i e l d of social work, and to compare their opinions with those in a l l i e d human relations professions, namely psychiatry and psychology. The distribution of the approximately thirty authorities, 36. according to discipline, i s ; eighteen social workers (including one reference jointly prepared with a psych-i a t r i s t but i n terms of social agency practice); nine psychiatrists (including one edited by a social worker, and one jointly prepared with a social worker but i n terms of out-patient practice i n a psychiatric c l i n i c ) ; - several of the psychiatric references are by psychiatrists who have served i n a consultative capacity to social agencies -and two psychologists. Although not true of each individual reference, each of the three disciplines frequently quotes the others as sources for their own work. Within the whole group, practitioners, 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 similarities and differences between each of these, i t is not the part of this study to do so. Suffice i t to say that there is considerable overlapping of method, with certain basic features i n common. It i s therefore not irrelevant to consider the thinking of other human relations professions on the subject of personal potential, about which there seems to be a corresponding similarity. Between the three disciplines there i s actually 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 theoretical and unrelated to specific situations; the social work" sources are practical and 37. related to specific situations, and untheoretical except where drawn directly 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. Some offer indications for casework: with clients i n general (Burlingham, Carscadden, Hamilton, H i l l , Hollis, 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 for psychotherapy (Coleman, Futterman and Reichline, G i l l et a l , Rogers, Ruesch, and Bateson) and for psychotherapeutic medicine (Witmer). Others offer indications for psychoanalysis: i n general (Deutsch, Hendrick, Waelder); with neurotic adults (Dollard 20 and Mille r ) ; with homosexuals (Bergler). (It w i l l be noted that the sources are lacking i n specific reference to children. This does not necessarily reflect professional literature but only the selection of the writer. The reasons for avoiding literature dealing specifically with children are two: for one, this provided one means of setting some limit to the scope of the survey; for another, i t is f a i r l y generally accepted that, on the whole, children, being i n their "formative" years are more malleable than adults and therefore by definition possessed of "personal potential". It i s because of this fact that most of the treat-ment of children i s undertaken by treating their "forming" environment, i n the shape of the adults responsible for their care. In view of these facts i t is assumed for purposes of this study that an understanding of the personal potential of adults could readily be applied to the treatment of children.) 38. Not only are the major treatment approaches so differentiated, and the scope of individuals or problems being considered, but also different aspects of treatment within them. Some of the authorities present cr i t e r i a for determining the "direction" of treatment, i t s "emphasis", "duration":and level" (Hollis, LaMar, Towle, Lowry). Others give indications as to the "type" of treatment, i.e. for "indirect" or "direct", and i n the latter category, for more specific techniques, such as "supportive" treatment or "insight development" (Austin, Burlingham, Carscadden, Flesch, Hollis, Lowry, Rogers). There is a tendency i n some of the earlier writings to arrange the various treatment techniques into a hierarchy, with "insight development" i n the position of honour. Accordingly, what we are now calling personal potential was assessed In relation to this "treatment of choice", and i f capacity for that technique was deficient, personal potential was considered deficient and a "lesser" treatment technique applied. Such a static grading of techniques does not seem tenable according to current professional thinking. Some writers seem to feel that indications for the use of one technique as opposed to another i s only a refine-* ment of the basic Indications for treatment of any sort, and not an essential difference. The writer is proceeding on that assumption, in view of the fact that there appears 39 to be no conclusive evidence that capacity for one technique or another affects personal potential as a whole. Moreover social work techniques are varied and so can be brought to bear as indicated, the essential factor for the use of any or a l l being an indication of personal potential. G i l l et a l state that "a really comprehensive discussion of this issue (indications for psychtherapy) would distinguish between supportive and exploratory psychotherapy and the indications Pi and contraindications for each". Although suggesting i n this remark that some patients would respond to the face-to-face method as opposed to another, the authors have presented indications for psychotherapy which are presumably basic to either approach. If this i s true for different techniques in psychotherapy, i t i s l i k e l y true for different techniques in "direct" casework with clients. The difference between direct and indirect treatment would presumably demand greater differences i n capacity, assuming that the difference between direct and indirect treatment is greater than the difference between two forms of direct treatment. However Miss Hamilton's statement indicates that the differences even here are not basic: "Personality 21 Merton G i l l , Richard Newman and Frederick C. Redlock, The I n t i a l Interview in Psychiatric Practice. Collaborator: Margaret Sommers, New York: International Universities Press, Inc., 1954, p. 95. 40. adjustment may be attempted through direct or through indirect environmental treatment, or through a combination of both, the fundamental conditions being that the client wishes to change himself and that he can actively assist in whatever course of treatment w i l l help him to change." 2 2 The sources to be considered differ not only i n the various orientations mentioned above, but i n the basis on which their cri t e r i a are presented. Some indications of potential are presented on the basis of empirical findings; others on the basis of theoretical 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 literature, we are not concerned to consider their val i d i t y at this point, that i s whether they are cr i t e r i a of personal pot-ential or not. Determination of validity would require research into a large number of cases to discover whether the cr i t e r i a were significantly present i n successful cases and absent in unsuccessful ones, other variables of treat-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 criterion, 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 criterion or units of measurement; this in turn would presuppose an adequate definition of the criterion i t s e l f . What we are concerned with here is to see whether the cr i t e r i a already put forward by the authorities are of such a nature that they can be tested for validity, i.e., are clearly defined and possessed of standards of measurement. It had been the hope that a l l the indications offered could be sorted and classified, each classification being a criterion. Each criterion then could have been considered in terms of relative discreteness or lack of overlapping with the others, as well as i n terms of i t s measureability. As a result we would have had a set of testable c r i t e r i a which could then be applied to cases for evaluation of validity, 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 in the case of "ego-strength", even where an identical term is used, the meanings are various. With cr i t e r i a which were less similar, the danger of erroneous classification would be that much greater. The variety of presentation i s considerable, to the point that identical terms are a ra r i t y . Presentation may be in the 42. form of nouns ('*motIvation"),23 phrases ("no authoritative assertion of incurability"), 2 4- questions ("has he ... indicated a desire for change?"). 2^ Presentation may also be positive ("sees worker as a counsellor rather than as a 26 source of concrete service"), neutral ("how does he expect treatment to help?"), 2? or negative ("seeking an a l l y " ) . 2 8 As the meaning or significance of the items are not consist-ently elaborated on by the sources, i t would seem hazardous to attempt any sort of classification which could presume to be exact. If classification and systematization are ruled out we are faced with a tremendous number of items to consider. The following table attempts to give, quantitatively, a rough picture of the distribution of the c r i t e r i a and their 23 G i l l et a l , op. c i t . p. 93. 2 4" Edmund Bergler, The Basic Neurosis. New York: Grune & Stratton, Inc., 1949, p. 225. 25 Lowry, op. c i t . p. 10, 26 Blenkner.1, op. c i t . , p. 70. 2 7 G i l l et a l , loc c i t . 2 8 Loc c i t . 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 is rare to find c r i t e r i a l i s t e d i n point form or even li 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 arbitrary than the count, due to the fact that almost none of the sources arrange their items i n order of progressive conereteness. The f i r s t column indicates the number of cr 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 third, the number of items into which the "secondary" criter i a were s t i l l further broken down. Table 1: Number and distribution of cr i t e r i a according to sources and sub-groups. Sources (a ) Criteria (b) Sub-criteria (c) Evidences Totals Bergler 7 I Coleman 2 4 6 Deutsch 1 1 1 3 Futterman and 6 10 Reionline 1 3 G i l l et a l 2 6 9 17 Hendrlck - 4 3 3 10 Waelder 6 1 3 10 Witmer 10 10 Dollard and 39 Miller 7 19 13 Rogers 8 3 3 14 Blenkner 9 13 22 Burlingham 4 12 4 Carscadden 8 20 Flesch 2 1 3 43. Table 1 (continued) Sources (a) Criteria (b) Sub-criteria (c) Evidences Totals Hamilton 2 5 7 H i l l 6 6 Hollis 11 9 20 Kage 2 2 LaMar 2 2 Lowry 15 3 18 Perlman i and Orr 1 2 10 13 Preston 4 12 16 Richmond 2 2 4 Taft 4 4 Towle 5 1 6 130 103 45 278 The table shows the diversity between the authorities as to the number of crite r i a each puts forward for personal potential. As can be seen, the range is from one criterion ("ego-strength") 2^ to fifteen (a series of questions to be answered in "differentiating the client's needs").3° * This range indicates two possible things: one is that there i s lack of agreement as to what the c r i t e r i a are; the other is that there i s lack of agreement as to how to express the c r i t e r i a about which there is agreement. That there i s lack of agreement is obvious: only four of the sources specifically refer to "intelligence"3l and two § The range, not of " c r i t e r i a but of total items, is from two to thirty-nine. 29 Samuel Futterman and Philip B. Reichllne, "Intake Techniques i n a Mental Hygiene C l i n i c " , Journal of  Social Casework, XXIX (February 1948), p. 50. 3Q Lowry, loc. c i t . Hendrick, op. c i t . , p. 238; Carl Rogers, Counselling & Psychotherapy. Boston: Houghton M i f f l i n , 1942, p. 77; Robert Waelder, Introductory Lectures on Psycho-analysis", (unpublished) 1940, p. 6; John Dollard & Neal E. Miller, 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. Similarly, "motivation" is mentioned e x p l i c i t l y only three times and in three forms which may or may not be identical (motivation for therapy,3 4 motivation for change, 35 motivation for psychotherapy36). Logically the c r i t e r i a (a) should be the more general terms, with the sub-criteria (b) the more specific, and the "evidences" (c) the most specific. It would presum-ably be the latter which would serve as indices of the various components of personal potential 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 right. Instead the reverse is true. This does not indicate that i n the "spelling out" the authors have made the c r i t e r i a progress-ively more abstract, as in most instances this is not so. The explanation with regard to any one author i s rather that he spells out one factor but not another, i f he spells 32 Rogers, loc c i t . 33 Susan Burlingham, "Differential Diagnosis as a Basis for Selection i n a Family Agency", Diagnostic  Treatment Processes in Family Social Work. New York: Family Science Association of America, 1935> p. 9. 34 Dollard & Miller, op. c i t . p. 234. 35 Hamilton, op. c i t ; p. 295. 36 G i l l et a l , loc c i t . 45. them out at a l l . Another reason i s that one author starts off with cr i t e r i a which are relatively concrete while another starts off with c r i t e r i a which are relatively abstract. As a result one finds in the same category items of such unequal weight as " a b i l i t y i n relationship"37 and "therapeutic preferability of homosexual re a l i t y to homo-sexual fantas v"38. Both seem concerned with a b i l i t y to relate but at quite different levels! The quantity of items makes i t impossible within the scope of this study to consider each one separately i n an effort to assess i t s practical 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 impossibility 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 are typical of those met i n the whole group of c r i t e r i a . In addition, being such an all-inclusive concept, i t includes many of the other characteristics. It is also the most frequently mentioned. Of the crite r i a presented there are almost none which clearly 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 British Columbia, Vancouver, Canada, 195l> P* 20, 38 Bergler, loc. c i t . 46 do, not necessarily to measurement by a social worker. The only ones for which there exist currently accepted standards of measurement are intelligence, age39 and physical health. 4"^ But these are s t i l l not prognostically measurable. Other personal qualities which are considered important do not seem to possess units of measurement which have been agreed on. This is seen in the single factor of "ego-strength" about which much has been written and many indications offered. It might be anticipated that ego-strength therefore would be available to measurement; however on examining what the various sources say about i t , this does not seem to be the case. Ego-strength: Source Indicated by G i l l et a l 4 - ! self-perspective Futterman and history he gives Reichline42 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, loc. c i t . , Dollard & Miller, op. c i t . , p. 235; Rogers, loc. c i t . , Burlingham, loc c i t . 4 - 0 Dollard & Miller, 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 Hendrick43 Waelder44 Austin 4^ Hollis 46 Perlman and 0rr47 Indicated by a b i l i t y to endure excess of tension capacity to strive for reasonable goals i n spite of inner d i f f i c u l t i e s capacity for fighting d i f f i c u l t i e s (secondary gain) ft intellectual desire to change a b i l i t y to learn previous history: (efforts in relation to purposes (achievements (behaviour i n d i f f i c u l t situations (reaction to danger (none) 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 •reaction to facing the request for 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 affect his a b i l i t y to deal with his reality? 43 Hendrick, op. c i t . , p. 238. 4 4 Waelder, op. c i t . p. 8 f f . 45 Lucille Austin, "Trends in Differential Treatment in Casework", Journal of Social Casework. XXIX (June 1948) p. 206 f f . 46 Florence Hollis, "The Relationship between Psycho-social Diagnosis and Treatment", Social Casework. XXXII, (February 195D> p. 72. 4 7 Helen Perlman & Douglass Orr, M.D., Notes on The Pacific Northwest Regional Institute. (unpublished) 1950. ft brackets are used to indicate a negative index of a criterion. 48. Source. Indicated by Perlman and Grr soundness of judgement with respect (continued to several alternatives appropriateness of affect relationship with key people i n his l i f e (how they affect each other) how does he handle his dependency needs how does he handle the hostile-aggressive component of his personality how does he handle his 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 criterion of treatability, Hollis offers i t as one out of three cr i t e r i a , G i l l presents i t as one of two sub-criteria of "the capacity for psychotherapy", the latter being one of two indications for psychotherapy! Similarly we can see the inconsistency with which one of the sub-criteria of ego-strength, namely "secondary gain", Is classified, Lowry presents i t as a criterion among several others; 4 - 8 Hendrick presents i t as a sub-criterion of ego-strength and Dollard and Miller present i t as a sub-criterion of "reinforcement of symptoms". Hence i t is classified under different concepts as well as at different levels 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" differs from one author to another, both in the nature of the items and the number of them. With regard to the latter, the number of indices of ego-strength varies from one, i n one author, to eight i n another. In addition to this, the indices, whether or not they do indicate ego-strength, are not standards of measurement which could readily be applied as they stand, so that the results would be uniform no matter which or how many workers applied them. For instance, "self-perspective" i s in need of identifications of i t s own, as is "judgement", and these are two of the more specific items mentioned. As long as these are not "spelled out", the same confusion in application w i l l result as occurs with a criterion such as ego-strength: that i s , that different individuals w i l l give different meanings to the same terms. Some of these concepts are relatively 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 training and exper-ience, (and even to anyone with) i t has no meaning. More tantalizing, but equally frustrating, are the questions without answers. "How does he handle his dependency needs?" This presumes a knowledge of the possible answers 50. and the possession of cr i t e r i a by which to evaluate them as favorable or unfavorable indications of whatever i s being measured. Similarly we are faced with "response to enquiry about the presenting symptoms", or "reaction to hearing what the agency can and can't do". What are the possible "responses" or "reactions" and how are they to be evaluated? We see i n the material on "ego-strength" not only a vagueness and lack of uniformity of definition, but a tend-ency to circular argument, which is a result that could be anticipated. For instance, Waelder, as an'indication of "analysability", 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 pre-sumably a manifestation of ego-strength. What i n effect is being said Is that the capacity to solve one's problem under psychoanalysis is indicated by a strong ego which is indicated by the a b i l i t y to learn; or to put i t more baldly, the capacity to change is indicated by the capacity to change! This circular process occurs, not only within any one author's system of c r i t e r i a , but between the systems of different authors, and between c r i t e r i a . As evidences of the a b i l i t y in establishing relationships (which is referred to as a criterion of treatability), Carscadden cites:49 Carscadden, op. c i t . , p. 14 f. 51. concept of self (confidence, sense of goal and achievement awareness of own feelings and toward whom directed ways of coping with rea l i t y (defences constructive and limited i n number) a b i l i t y to endure frustration (and criticism) affective 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 characteristics which have been enumerated under ego-strength are enumerated under capacity for relationships. This is an example of different terms having much the same meaning. It might be even considered as another example of circular argument on another level, i f the meaning i s in effect: ego-strength is evidenced in the capacity to form relationships, and the capacity to form relationships is evidenced in ego-strength. In summary, we have examined indications of personal potential as found In professional literature. Before doing so, we traced b r i e f l y the development of the concept, and found that though i t is 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 potential in 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 this capacity offered by selected authorities i n the human relations professions, with a view to determining whether they are amenable i n their present form to sc i e n t i f i c measurement. We found that the authorities differed widely as to the factors which they stated to be important for 52. treatment, and i n their exposition of them, so that a multiplicity of items, of varying degrees of abstraction, and without established logical relationships, are available. In view of the divergence of exposition, combined with vagueness as to meaning and lack of explanatory comments by most of the authorities, i t was presumed inadvisable to attempt an interpretation of each which i would permit sorting and classification. Because of the amount of material, only a few examples were chosen to ill u s t r a t e the lack of generally accepted definition for the items, and to demonstrate that almost none could be regarded as measurable, being in need of indices of their own. 53. CHAPTER III: GENERAL ASSESSMENT OF THE CRITERIA. 1. Motivation and Capacity. As mentioned previously the items presented i n the literature are too numerous to be considered separately within this study. However some general picture of their scope can be given and some comments made. On the whole two main questions seem to be posed by the authorities i n one form or another, namely, does the individual wish to solve the problem ? and, has he the capacity to solve i t ? The following "inventory" gives examples of those who have specified both motivation and capacity, though i n various terms. The sources constitute almost half the total referred to, and the l i s t does not include those who have specified only one or other of the two categories. Source "Motivation" "Capacity" Deutsch 1 degree of satis capacity (for ad just-faction with the ment) _ environment G i l l et a l 2 motivation (for.... .capacity (for psycho-psychotherapy) therapy Waelder3. .....desire to change....ability to learn x Helen Deutsch, The Psychology of Women. Vol. I, New York: Grune and Stratton, 1944, p. 354-. 2 Mertori G i l l , Richard Newman and Frederick C. Redlock, The I n i t i a l Interview in Psychiatric Practice. Collaborator: Margaret Sommers, New York: International Universities Press, Inc., 1954, p. 96. 3 Robert Waelder, Introductory Lectures on Psycho-analysis, 54. Source "Motivation" "Capacity" Dollard and Miller 4", .motivation (for prerequisite types ^ therapy) of social learning Rogers-? tension capacity (to cope 6 with l i f e Carscadden does he really want.has he sufficient understanding) maturity (to take _ the step) Flescfcr wish for help (with.ability to stand the problem) (insight) q Hamilton motivation (for capacity (to rebuild)" 1 0 change)© H i l l - j hopes. training H o l l i s l l whether wants whether able (to this type of help, participate or i.e. insight benefit by i t ) development). Lowry1^ ..desire for change... capacity (for activity) Richmond^.. plans, ambitions... .assets, l i a b i l i t i e s 4 John Dollard and Neal E. Miller, Personality and  Psychotherapy: An Analysis i n Terms of Learning. Thinking  and Culture. New York: McGraw-Hill Book Company, Inc., 1950, p. 234 f. Carl 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 Client- Worker Relationship, p. 90. 7 Regina Flesch, "Treatment Goals and Techniques i n Mental Discord", Journal of Social Casework. XXIX (December, 1948), p. 382. o 0 Gordon Hamilton, Theory and Practice of Social  Case Work. New York: Columbia University Press, 1940, p. 295. 9 Ibid, p. 163. 1 0 Octavia H i l l quoted in Mary Richmond Social Diagnosis. New York: Russell Sage Foundation, 1917> p. 29. 1 1 Florence Hollis, "The Relationship between Psycho-social Diagnosis and Treatment", Social Casework. XXXII (February 1951) p. 243. 1 2 Fern Lowry, "The Client's Needs as The Basis for Differential Approach in Treatment". Differential Approach i n Case Work Treatment, New York: Family Welfare Association of America, 1936, p. 7 *. 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 universally singled out as having a significance for personal potential. Although the term; is used by only three of the sources, equivalent terms or factors which are f a i r l y clearly indicators of i t are offered by seven of the psychiatric, two of the psychological, and twelve of the social work sources. It is interesting to note that in a l l the sources consulted, there were almost no instances in which the authorities considered motivation as more than motivation to solve the problem or to use the particular form of treatment being offered. This is in contrast to their consideration of most of the other "capacities", which were, as often as not, viewed i n context extending far beyond the problem or helping situation. Actually It would be possible to conceive of motivation similarly, i.e. i n a much broader sense: i n terms of over-a l l "drive", "life - f o r c e " , ambition, or any other concept which indicates an individual's striving for self-preservation, self-development, integrity, "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 is related to his total reality, including self, other people and the remainder of his environment. The degree 56. of the individual's "activity" seems to hold a prominent place i n the hierarchy of factors indicating the level of adjustment, i n view of the frequency with which i t is mentioned. Its importance is not accounted for, but one reason may be the rather obvious fact that "behaviour" is observable i n a way that inner qualities are not, and so is a useful index of "personality resources" which are not accessible to direct observation. 2. "Level of adjustment" as a component of personal potential. The inference, made more or less explicit by different authorities, is that the more "healthy" the individual, the more treatable he i s . This may be true, but i n the f i r s t place i t must be remembered that unless he had some disturbance i n his "relationship to reality", as reflected 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 practitioner evaluating his potential. 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 treatability does not need to be under-taken i n a vacuum, but i n relation to the problem in hand; otherwise we would be undertaking vi r t u a l l y a survey of the universe! Some of these writers make no attempt to relate 57. the "strength" (or equivalent) which they mention to any-thing else, i.e. to the problem of the individual or the helping situation. They do not indicate what specific strengths are essential i n treatment. Nor do they identify the goal they have i n mind. That i s , they do not specify capacity for what, strength for what, adjustment to what. In speaking of the differentiation between the diagnostic and evaluative processes, Gordon Hamilton states, "We shall be less confused i f we think of personality evaluation or characterization as usually related to treatability and treatment. When we characterize we do not estimate person-a l i t y i n the ethical sense of how 'good' a person i s , or how 'fine' or 'ignoble 1 his attitudes, but i n his capacity to perform certain functions, for example, the support role, the marital role, the f i l i a l or parental role. Although such judgements seem arbitrary, they are inescapable i f one is to treat within the f i e l d of conduct and relation-ships. We must know not only from what limitations but to what ends capacities and energies are to be released." 1 4" Here we have the focus established for evaluating general functioning; only i f the purpose and frame of reference is clear w i l l meaningful material be gathered and meaningfully used once i t is gathered. (It may be that some of the diffuseness i n collecting Information which w i l l contribute Hamilton, op. c i t . , p. 163 58. to formulation of prognosis is due to the comparative newness of this concept i n treatment; just as with diagnosis, in the days when i t was not too clearly understood, we collect a l l the information we can, because we are not,, sure what is or is not significant, what is essential and what is of bonus-value. Therefore the reason for 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 their importance. In other cases the writers may be f a i r l y sure how and how much of the cr i t e r i a is important, and could apply them to an individual situation and "spell i t out", but have not done so i n their 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 distinct. It is the "can" aspect which concerns us i n this study. The "does" aspect leaves us no further ahead than arriving at a diagnosis. It 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 is getting along, x5 ibid, p. 159. 59. or his actuality. It does not show us how he might get along, or his potentiality for 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 well as as an aspect of diagnosis? One or two of the sources suggest why and how this appraisal is related to potential. Miss Lowry, i n the l i s t of questions she poses i n order to "individualize the need" of the client, asks "What attitudes does he show i n relation to his dif f i c u l t y ? " and then, "What is the relation of his attitudes toward this 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 modifiability of some negative characteristic, the worker looks to general functioning i n search of evidence of the degree to which the negative characteristic i s typical of the person. However i f i t is typical, we s t i l l do not know how modifiable i t i s . If i t is not typical, we s t i l l do not know whether the more positive characteristic present i n other aspects of his l i f e w i l l be applied to the problem aspect or not. However, on the basis that the individual has developed a particular strength and applies i t i n some areas, i t is 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 relation to the present problem, than another individual who evidences no such a b i l i t y anywhere. Similarly, Miss Carscadden offers c r i t e r i a of the a b i l i t y for relationship. Five of these i f evaluated would give a picture of current "relating", but the sixth, "pattern of relationship", is 17 more specifically oriented to potential. If the client's deficiencies i n relating to the worker, and husband, child, 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 relationships, the worker would know these were not typical. The significance of this factor is most ex p l i c i t l y stated by Dollard and Miller i n explaining their criterion of potential called "prerequisite types of social 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 own when repressions and inhibitions are removed. The person with strong adaptive behaviour i n certain areas of his l i f e shows that he has these general elements to build on. For this reason severe conflict limited to one area is more favorable than general retardation of the whole development. The more different units of social s k i l l the patient has to learn, the harder his task w i l l be'.'18 'Note that lack ^ Carscadden, op. c i t . p. 14. 1 8 Dollard and Miller, op. c i t . , p. 236 61. of prior learning or areas of satisfactory 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 impossibility. However the present concern is with possibility rather than d i f f i c u l t y , and with factors which are minimal rather than those which may be helpful and desirable. In their own elaboration of this criterion, Dollard and Miller seem to include only those adaptive capacities which they consider are required in the treatment situation, not a l l adaptive capacities. In addition to determining which factors are indispensable, there is the question of the degree to which these factors must be developed. Rather than ask, in evaluating an individual's potential, how closely some particular strength approximates the ideal or average, i t might be more useful and pertinent to ask i f he has any of this strength to build on, or whether he has enough. What constitutes enough is a d i f f i c u l t question. Rogers does not set any arbitrary 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 under this category. The same principle applies here: the av a i l a b i l i t y of adaptive capacities which appear lacking i n relation 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 in assessing ego-strength looks to the previous history of the person, specifically his achievements, his efforts i n relation to his purposes, his behaviour i n d i f f i c u l t Of) situations*^ - 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 it?") If 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 confidence, from past experience, and of his s k i l l s . Dollard and Miller are again the most explicit as to the significance of previous functioning,, which is essentially the same as that of current functioning: i f the problem is 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, satisfactions experienced) which would strengthen the picture of motivation and capacity. 2* (These points of current and previous adjustment are of course closely related to the factor of "the problem" and i t s bearing on treatability, particularly i t s extent and duration. However we are just looking at the reverse side of the coin.) Another source of evidence for capacities which may appear to be lacking at f i r s t glance is within the problem Waelder, op. c i t . , p. 24. Dollard and Miller, loc. c i t . 63 i t s e l f : Hendrick points out what is often " f e l t " but a l l too rarely stated, that the advantageous characteristic may be used (and concealed) " i n the structure of the neurosis", may be absorbed by the struggle to attain special attention or may be repressed. 2 2 The consideration of total functioning may, as already suggested, have another value, in the same way as do the characteristics of intelligence, age, health, appearance: 2 1 namely as having some bearing on satisfactions that have been experienced or which exist for the client (other than i n the problem area) and therefore a bearing on motivation. In general i t is assumed that the more satisfactions an individ-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 relation to the problem area. The recognition of their existence does not necessarily 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 is no person who does not possess potentialities which are never realized. 2 2 Ives Hendrick, Facts and Theories of Psychoanalysis. New York: Alfred A. Knopf, 1939, p. 23b. 2 1 Dollard and Miller, loc. c i t . 64. 3. Arguments for Motivation as the essential component of  personal potential. Some writers suggest or state that motivation i s the determining factor, or at least a most useful index of i t . Carl Rogers has recently described ways i n which he and his associates have tried to measure personality change i n psychotherapy, by means of measuring self-perception and ideal self at the beginning and at the end of psychotherapy. One of their hypotheses seemed to be borne out by the results of the investigation, namely that the discrepancy between these two decreased, with a "significant increase in congruence between the self and ideal," the change being i n the former and in the direction of the latter . 2 3 Underlying this hypo-thesis was the speculation that what the individual wants to be he is 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 for change i n psychotherapy. Similarly Deutsch gives a suggestive explanation of what i s essentially involved i n the whole process of change, in the following statements: "adjustment to rea l i t y is the main purpose of a l l education, including psychoanalytic therapy. The individual's capacity for adjustment pre-supposes a certain degree of satisfaction with the * Carl R. Rogers, "Personality Change i n Psycho-therapy," unpublished paper presented at The International Congress on Mental Health, Toronto, August 1954, p. 2. 65. environment., and this i n turn depends on his own emotional  state. The bridge between the environment and the individual, from the beginning of his l i f e , i s his affective relationship to this environment. The acceptance of r e a l i t y is determined by love and need of protection on the one hand and by fear of punishment and of emotional isolation on the other. 1 1 2 4" This statement with a l l i t s implications could be the core of the whole question of prognosis. The essential prerequisite for further adjustment is "a certain degree of satisfaction with the environment." This suggests, as is made more explicit further on i n her statement, that the individual feels need and/or "affection" for 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" is a more satisfactory term than environment, including the individual's inner reality, his own components and attributes.) In other words the environment has some attraction for him, and having this attraction he is motivated to "relate" to i t , to learn how to "get on" with i t , so that his needs w i l l be met and his satisfaction enhanced. His attitude i s one of approach rather than one of retreat or withdrawal. Complete withdrawal or dis-satisfaction with reality probably does not occur short of death, but there certainly exist people who consistently avoid certain aspects of r e a l i t y either physically, Deutsch, loc. c i t 66. emotionally, or intellectually. 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 relationship, even i f by trying to get the environment to do the adjusting! If a total lack of satisfaction with the environment, and so of motivation, were the main deterrent to treatment, then i t would be the rare individual who was lacking i n "capacity for adjustment". There is some similarity to this idea i n the study of Preston et a l , who find that one factor correlating with movement in marital problems is the degree to which the partner being considered is withdrawing from the relationship with the other marital partner: the less evidence there is of such withdrawal, the more l i k e l y movement w i l l be. 2^ One could interpret this i n the following way: that the applicant who has some or many satisfactions i n the relation-ship, though i t is disturbed i n some ways, has more reason or motivation to remove the dissatisfactions; whereas the applicant who shows evidence already of withdrawing from the relationship with the partner finds fewer satisfactions i n i t or has given up hope of doing so. Even more ex p l i c i t l y and assertively than Rogers and Deutsch, another source states the primacy of motivation. Reusch and Bateson use the term "communication"to indicate 25 Malcolm G. Preston, Emily H. Mudd, and Hazel B. Froscher, "Factors Affecting Movement in Casework," Social  Casework. XXXIV, 1953, p. HO. 67. many of the same "strengths" the authorities have cited as criteri a and which we have concluded can be summed up i n the concept of "relationship to reali t y " . They state the effect of communication on development and on adjustment: "Communication f a c i l i t a t e s specialization, differentiation and maturation of the individual. In the process of maturation reliance upon protective and corrective actions of others is gradually replaced by interdependence upon contemporaries in terms of communication. Instead of looking to elders for guidance, the adult person seeks information from contem-poraries on how best to solve a problem. Exchange Is sub-stituted for receiving, and action of self replaces actions of others." And further, "Successful communication with self and with others implies correction by others as well as self-correction. In such a continuing process, up-to-date information about the self, the world and the relationship of the world leads to the acquisition of appropriate tech-niques, 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 2 6 Jurgon Ruesch and Gregory Bateson, Communication: the Social Matrix of Psychiatry. New York: W. W. Morton & Co., Inc., 1951, p. 18 f. 2 ? Loc. c i t . 68. of behaviour are described in terms of disturbances of communication. In the past, these disturbances have been summarized under the heading of psychopathology. It is well to remember that the term 'organic' refers to disruption of the internal communication machinery, that 'intra-personal* refers to a network limited to one individual, and that 'inter-personal' refers to a network composed of several i n d i v i d u a l s . " 2 8 As for treatment, which aims at improving the disturbed communication system, they state that "Regard-less of the school of thought adhered to, or the technical terms used, the therapist's operations always occur in a social context. Implicitly, therefore, a l l therapists use communication as a method of influencing the patient." 2 9 Here i s stated the paradox that exists i n treatment, namely that the very process i n which the individual is deficient is the means of his becoming proficient. How is this possible? How can he communicate (be treated) i f he can't communicate (has a problem)? The authors state: "Fundamentally a l l people can be helped t@ improve their means of communication. Only the level at which patient and doctor start their work varies; some patients are very sick, some are better off, and the speed of improvement fluctuates depending upon a variety of factors. But over a period of years, and without exception, 2 8 Loc. c i t . 2 9 Op. c i t . , p. 19» 69 improvement can be observed If the patient has the motiva-tion to improve and the desire to s u r v i v e . " M o t i v a t i o n is the factor which impels the individual to communicate or to learn to do so. "The human being's need for social action is 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 gratification of v i t a l needs is threatened."3^ From this point of view i t is probably the persistence of " v i t a l needs", ultimately of " l i f e " , that determines the basis of personal potential. Their persistence depends, not only on the degree to which environmental influences have encouraged or discouraged the "original impulses" of the individual, but also on the strength of the original impulses themselves, that i s , on the constit-utional endowment with which the individual met his environ-ment. In view of the opinions of these three authors i t is interesting to remember that we noted the wideness with which the factor of motivation seemed to be recognized. The fact too that the indicators of motivation seemed to be more specific and to lend themselves to systematization further confirms the impression that i t has received con-siderable attention. Although this factor may be the essential one, i t does not eliminate the importance of the 3° Op .. c i t . , p. 93. 31 Op. c i t . , p. 38. 70 degree of health or adjustment achieved, but indicates one reason for i t s importance. If not the essential factor, the sine qua non of treatment, i t is a valuable and desirable bonus. As suggested above, i t s bearing is on "the level at which patient and doctor start their work", and in view of the other components of over-all treatability, w i l l have a significant 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 cr 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 latter included a range of capacities whose assessment would indicate the level of adjustment achieved by the individual, while the former included evidence of the individual's wish for 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" is more pertinent to the latter. There were arguments on the part of a few authorities supporting the idea of motivation as the essential determinant of personal potential, and of capacity as a determinant of the "level" at which treatment was commenced. However there is no clear line 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 treatability, particularly into one of i t s components, personal potential. We stated the reasons for studying the treatability of social problems as based on the need to constantly improve services and to provide a basis for selectivity when this is required by excessive demand for services. We outlined the com-ponents of treatability: the scope of casework, the development of the profession, community resources, agency function, s k i l l of the worker, the problem, the re a l i t y situation and the client. We did not evaluate these i n terms of their validity and relative importance, but proceeded to select the client as our main focus in 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 literature 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 sc i e n t i f i c means for s t a t i s t i c a l r e l i a b i l i t y and validity. We found that the literature was limited i n quantity, but within what was available, that there was no uniformity as to the nature of the cr 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 result over-lapping, and in need of definition, 2. Conclusions and recommendations: We had to conclude that the literature contains almost no indices of personal potential which could successfully be applied i n a research study to a number of cases or i n professional practice. Although the cr i t e r i a may have pragmatic meaning to the users, their meanings are not apparent and so they are unusable i n their present form, except by the originators. We concluded also that the question of personal potential is relatively untouched and very l i t t l e understood. Wot only is the amount of literature 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 specific components and manifestations of personal potential, not only i n terms of what they are but also to what degree and in 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, practitioners s t i l l have to rely for the time being on the use of " c l i n i c a l judgements" i n their assessment of i t . The state of affairs 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 empirically tested, in place of the hodge-podge of unanalysed insights, 74. generalizations, and observations. One might start by testing the few cr i t e r i a for which standards of measurement exist, namely intelligence, age and health, with the aid of other human relations professions skilled i n measuring these. One might devote some effort 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 essentially grounded i n experience. Practitioners with experience "intuitively" 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 how "intuitive" are these responses to what the client t e l l s , and how he acts. 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 definition and indices for i t . In following the latter suggestion, one might select a criterion which more than others approaches a state of definability 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 light of theory and practice so far, to offer considerable promise, for instance, motivation. We noticed in our survey of the literature, that there was a tendency for the cr i t e r i a to group themselves into the concepts, and indices of the concepts, of "wish for change" and "state of emotional health" or "adjustment". In considering these two main areas, there seemed to be reason for regarding motivation as determining personal potential, and regarding the level 75. of adjustment, as determining the level at which treatment starts. In addition to the theoretical justification for focussing research on motivation, is the practical con-sideration 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 literature on the subject of motivation in general, 3, Implications for other aspects of social casework. The discussion about motivation and capacity indicated not only that motivation may be the determining factor i n personal potential, 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 is impeding the individual, what he wants and how we can help him. The latter 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 establish clearly our focus. When we speak of motivation, what do we mean? Motivation "for what"? In this study we have tentatively defined personal potential 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 in the same context, i.e. the desire to solve his problem by means of casework treatment. (The latter point i s a relevant part of the definition as the individual 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 arrive at anything definitive about personal potential we must refine our understanding and statement of social diagnosis. According to our definition i n this study, the relevant "problem" is the inner problem of the individual as diagnosed by the worker, rather than the "problem" f e l t by the individual, 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 far are we oriented to "situations" rather than individuals? Do we not as Miss Hamilton suggests evaluate capacity (and mot-ivation) to be good parents, good marital partners, good citizens? In the last century one of the pioneers of social work stated that "In our charitable efforts we think more of what a man ought to be than of what he is or what he may become; and we ruthlessly 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 intellectual convictions upon an undeveloped mind."1 1 Jane Addams, "The Subtle Problems of Charity," The Atlantic Monthly. Bsbruary 1899, quoted i n Florence Sytz, "The Development of Method i n Social Casework," Journal of  Social Casework. XXIX, (March 194-8) p. 86. 77. We cannot reassure ourselves that we are not making this mistake any more. Most social workers today would not consider imposing the "conventions and standards" probably referred to by Miss Addams, because our standards and con-ventions are changed. However we are just as liable to impose new and current standards and conventions, in terms, of maturity, normalcy, and so on. If our treatment i s to be soundly based, the individ-ual's goal must be established; and i n establishing the client's goal we must be able to penetrate through the distorted "wants" to the healthy needs which invariably underly them and assess the presence and strength of these. If social treatment depends on supporting the healthy aspect of personality we must find them, and not be deceived by superficial behaviour, or superficial motives. If we believe that " a l l behaviour i s purposive" and that growth is the innate tendency of the organism, then any "motive" however negative seeming, can be reduced to positive terms. The negative nature of a, motive is not the innate abnormality of the organism or the badness of the person, but the distortion that has taken place in natural tendencies as a result of the l i f e he has experienced or his interpretation of i t . The important thing for prognosis should be the location of these positive tendencies in relation to the degree of discomfort the client is facing, and i n whatever healthy or unhealthy form they appear, and for treatment, 78. to support what is wholesome in these strivings. -If we do believe in the self-determination of the client and our function in helping him as enabling growth to take place, then we must c l a r i f y our thinking about how this belief and this process are to be applied when the needs of one individual conflict with those of a member of his family or with society. Once our frame of reference is 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 individual i s , and to determine the strength of his wish for 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 latter i t s e l f constitutes a demonstration of motivation or the a b i l i t y to change; a "trial-run", or "dress-rehearsal", as one of the authorities terms i t . We know from theory and experience that the individual must unlearn or re-learn about himself or society in the same way he originally learned or mis-learned, i.e. through experience i n social relationships. To be corrective, this social relationship must provide what was originally lacking, that i s , acceptance of and opportunities for development. Providing such an * Helen Perlman and Douglass Orr, M.D., Notes in  the Pacific Northwest Regional Institute. 79. environment of "acceptance" sounds easy but i t is not. It means accepting the individual's needs i n whatever distorted form they now appear. It means recognizing them through the many superimposed disguises he has donned. It means believing in the basically positive motive under-lying the most negative behaviour, and believing In the individual i n whatever condition he presents himself, without benefit of understanding the reasons for his condition, immediately or perhaps ever. It may be that this is 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 is observed, potential 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 strivings of individuals and of the profession which seeks to serve them: "We are a l l going somewhere and have not yet arrived. Our character is 'not cut i n marble 1, but is the sum of our past exper-iences - a sum which i s to be changed, inevitably, by our future experiences."3 3 Mary Richmond, Social Diagnosis. Hew York: Russell Sage Foundation, 1917, p. 377. 80. BIBLIOGRAPHY (a) General References Bibring, Grete L., "Psychiatric Principles in Casework", Journal of Social Casework. 30: 230-235, June, 194-9. Bowers, Swithin, "The Nature and Definition of Social Casework", Journal of Social 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 Client's Needs as i t i s Conditioned by the Function of the Agency", pp. 43-52. Differential 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  Social Work. New York: Columbia University Press, 19^ Garrett, Annette, "Historical Survey of the Evolution of Casework", Journal of Social Casework. 30: 219-229, June, 1949. Garrett, Annette, "Transference in Casework", The Family. 22:42-46, April, 1941. Hacker, F. J., "The Concept of Normality and Its Practical Significance", American Journal of Orthopsychiatry. 10: 47-64, January, 1945. Hechman, A. A., and Allan Stone, "Testing Casework Results: Forging New Tools", Survey Midmonthly. 83:267-70, October, 1947. Hunt, J. McVicker and Leonard S. Kogan, Measuring Results  in Social 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 Social Casework: A Field-test 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 Criteria - The Concept of Normal and Abnormal", The Family. 22:171-179, October, 1941. Marcus, G. F., "Changes i n the Theory of Relief-giving", pp. 267-279, Proceedings of the National Conference  of Social Work. New York: Columbia University Press, 1941. pp. 787. Sapirstein, 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 Client's Needs as i t i s Conditioned by the Equipment of the Worker", pp. 53-64, Differential Approach in Case Work  Treatment. New York: Family Welfare Association of America, 1936. pp. 64. Stamm, Isobel, "Understanding the Total Personality i n Treatment", Journal of Social Casework. 26: 323-329, January, 194o"T Sytz, Florence, "The Development of Method i n Social Casework", Journal of Social Casework. 24: 83-88, March, 1948. Voilarid, Alice 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 Principles Defined. OMIT ( 2. Guiding Principles Applied. (3. Importance of the I n i t i a l Interview with ( the Unmarried Mother. (b) Specific References Austin, Lucille N., "Trends i n Differential Treatment i n Casework". Journal of Social Casework. 29: 203-11, June, 1948. Bergler, Edmund, The Basic Neurosis. New York: Grune and Stratton, Inc., 1949. pp. 353. 82 j Blenkner, Margaret, "Predictive Factors i n the I n i t i a l Interview in Family Casework", Social Service Review, 28: 65-73, March, 1954. Burlingham, Susan, "Differential Diagnosis as a Basis for Selection in a Family Agency", pp. 1-11. Diagnostic  and Treatment Processes i n Family Social 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 for the degree of Master of Social Work i n the School of Social Work, (Vancouver, B. C.) The University of Bri t i s h Columbia, 1951. PP. 119. Coleman, Jules V., "Distinguishing between Psychotherapy and Casework", Journal of Soeial Casework. 30: 244-251, June, 1949. Deutsch, Helene, The Psychology of Women. Vol. I, New York: Grune and Stratton, 1944. pp. 308. Dollard, John and Neal E. Miller, Personality and Psycho- therapy: An Analysis in terms of Learning. Thinking and Culture. New York: McGraw-Hill Book Company, Inc., 1950. 488 pp. Flesch, Regina, "Treatment Goals and Techniques in Marital Discord", Journal of Social Casework. 29: 382-388, December, 1948. Futterman, Samuel and Philip B. Reichline, "Intake Techniques i n a Mental Hygiene C l i n i c " , Journal of  Social 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 in Psychiatric Practice. "Collaborator: Margaret Sommers. International Universities Press, Inc., New York: 1954. 423 pp. Hamilton, Gordon, "Helping People - The Growth of a Profession", Journal of Social Casework. 29: 291-299, October, 1948. Hamilton, Gordon, Theory and Practice of Social 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 Hollis, Florence, "Environmental (Indirect) Treatment as Determined by the Client's Needs", pp. 19-28. Differential Approach i n Case Work Treatment. New York: Family Welfare Association of America, 1936. 64 pp. Hollis, Florence, "The Relationship between Psychosocial Diagnosis and Treatment", Social Casework. 32: 67-74, February, 1951. Hollis, Florence, "The Techniques of Casework", Journal  of Social Casework. 30: 235-244. June, 1949. Kage, Joseph, "Ego-Supportive Therapy with Displaced Persons", Social Casework. 31: 65-70. February, 1950. LaMar, Helen, "The Intake Process i n a Growing Community", Social Casework. 34: 167-173> April, 1953. Lowry, Fern, "The Client's Needs as the Basis for Differential Approach i n Treatment", pp. 1-13. Differential Approach i n Case Work Treatment. New York: Family Welfare Association of America, 1936, pp. 64. 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 Pacific Northwest Regional Institute. Family Service Society, Spokane, Washington, 1950. Preston, Malcolm G., Emily H. Mudd and Hazel B. Froscher, "Factors Affecting Movement in Casework", Social  Casework. 34: 103-11, March, 1953. Richmond, Mary E., Social Diagnosis. New York: Russell Sage Foundation, 1917, 511 pp. Rogers, C. R. Counselling and Psychotherapy. Boston: Houghton M i f f l i n , 1942. pp. 450. Rogers, Carl 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 Social 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 Under-lying Social Casework Practice", Social Casework. 31: 311-18, October, 1950. Towle, Charlotte, "Factors i n Treatment", pp. 179-91. Proceedings of the National Conference of Social  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, Super-intendent.) 1940. Witmer, Helen L., editor, Teaching Psychotherapeutic Medicine, an experimental course for general physicians, given by Walter Bauer and others. New York: The Commonwealth Fund, 1947. pp. 464. 

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