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UBC Theses and Dissertations

Family diagnosis and treatment in a children's psychiatric clinic: an assessment of the case-work focus from the recording Peterson, Joan


There have been many changes in the focus and direction of social casework since Mary Richmond published Social Diagnosis in 1917. Casework in her day emphasized the socio-economic aspects of the family's adaptation to society. With the advent of psychoanalytical concepts, the focus shifted from the family's social reality to the individual's subjective response to it, as one way of understanding the client's maladjustment to his life circumstances. In agencies and clinics, office interviews with individuals replaced home visits to the family. Consequently, the caseworker's knowledge of the day-to-day social functioning of the client and his family was often incomplete. Caseworkers and psychiatrists in Child Guidance Clinics learned that the child could not be helped with his emotional difficulties unless the parents were included in the treatment process, since the child's maladjustment so frequently stems from unhealthy relationships with his parents. While the focus was upon the child and his family, the emotional aspect of each parent's adaptation was emphasized. The interplay between family members' personalities and the problems for which they were seeking help was still too complex for full understanding. The search for helpful concepts is still in process. Current casework emphasis on the client's social functioning is attempting to integrate psychological and social concepts in casework theory. Role theory, combined with psychological concepts, holds the promise of providing a method by which the caseworker can diagnose and treat the problematic aspects of the individual's and family's adaptation. In order to understand the individual, it is necessary to know how he interacts with family members, they with him, and his group with society at large. This study is an exploratory assessment, from casework recording alone, of the extent to which psychosocial diagnosis and treatment has been adapted to casework practice for families with disturbed children in the Children's Clinic of the B.C. Mental Health Centre. Twenty cases of disturbed children were selected: between the ages of five and ten years living with their own parents; capable of attending public schools; and not suffering from physical handicaps. Most of the children had siblings. They were active cases in which treatment had proceeded a substantial distance. Two rating scales were: (a) the child's emotional and social adjustment and (b) parental and family relationships and strengths. These pointed up the areas of information obtained by the caseworker for the psychosocial diagnosis of the child's family, and also made it possible to compare the child's adaptation with that of his family's. The evidence is that the social functioning of the family as a unit is not apparent from the recording, that most emphasis is upon the mother-child relationship, and that the child's relationships with other family members are not sufficiently explored. The Casework contributions to the diagnostic study of the child's problems are largely in the area of the parents' (particularly the mother's) emotional adjustment, and the child's particular development. The original intention was to measure the child's and parents' social functioning between two points in the treatment process, but the recorded data was insufficient for this purpose. Only descriptive comparisons are possible, also a descriptive evaluation of the outcome of treatment in relation to the casework focus. The recording which described the greatest improvements in family relationships, and in the parents' and child's social functioning, was oriented, in the treatment phase, to the client in his family, even though this focus was not evident in the diagnostic study. Those cases which showed the least movement emphasized the emotional adjustment of individual members of the family. The main reference point in the former cases was the client's interaction with people and situations in his current life circumstances; in the latter cases, the worker's efforts were directed towards helping the client with his emotional conflicts, which stemmed from his early life experiences. This is an exploratory study of areas highly significant for family casework in the Children's Clinic. Although the conclusions require repeated research to verify their validity, they nevertheless suggest that a casework focus on the client in his family holds more promise of helping than a focus which emphasizes the client's emotional adjustment alone. Such an orientation contributes to the definition of the casework function, and distinguishes the caseworker's role from that of the psychiatrist. It has contributions to make also, in the task of integrating theory and practice in family casework.

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