A Functional Approach to Family Case Work [Reprint 2016 ed.] 9781512818956

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P E N N S Y L V A N I A S C H O O L O F S O C I A L WORK Affiliated with the UNIVERSITY

OF

PENNSYLVANIA

SOCIAL WORK PROCESS SERIES

A FUNCTIONAL APPROACH TO FAMILY CASE WORK

Previous Publications JOURNAL OF SOCIAL WORK PROCESS Volume I

THE RELATION OF FUNCTION TO PROCESS IN SOCIAL CASE WORK (Out of Print)

Volume II

METHOD AND SKILL IN PUBLIC ASSISTANCE (Out of Print)

Volume III

SOCIAL CASE WORK WITH CHILDREN (Out of Print)

SOCIAL WORK PROCESS SERIES I

TRAINING FOR SKILL IN SOCIAL CASE WORK Edited

by

VIRGINIA P. ROBINSON

PENNSYLVANIA SCHOOL OF SOCIAL

WORK

Affiliated with the UNIVERSITY

OF

PENNSYLVANIA

A FUNCTIONAL APPROACH TO FAMILY CASE WORK Edited JESSIE Pennsylvania

by TAFT

School of Social Work

UNIVERSITY OF PENNSYLVANIA Philadelphia

1944

PRESS

Copyright 1944 PENNSYLVANIA SCHOOL OF SOCIAL WORK

Manufactured

in the United States of America •

London Humphrey Milford Oxford University Press

FOREWORD UNDER the impact of two great social crises of the past decade— economic collapse and world-wide war—family case workers have confronted extremely difficult problems and unusually exacting demands upon their professional clarity and skill. At the same time, partly in response to these pressures, they have undertaken most interesting experiments and adventures in new kinds and ways of service and in new relationships. These problems and some of the resulting tensions and conflicts, as well as accompanying trends in scope of service and in method, were brought under discussion in seminars and round tables of the Summer Institute of the Pennsylvania School of Social Work in June 1943, where they were examined from the viewpoint of functional case work and its contribution to professional practice. Many of the papers in this volume were presented, and much of the case material here assembled was used, in the Institute, which thus gave the occasion for this first organized presentation of the functional approach to family case work. It is offered now as a timely contribution to the growing technical literature in this field, through which significant differences of viewpoint and method must be clarified and evaluated, if the outcomes of varied experience are to be utilized for further professional development. KENNETH L . M .

Philadelphia May 1944

PRAY

CONTENTS Page FOREWORD

v

Kenneth

Pray

INTRODUCTION Jessie

Taft,

1 Editor

P R O B L E M S O F THE PRIVATE F A M I L Y AGENCY IN WAR T I M E Elizabeth

H.

16

Dexter

S O M E P R O B L E M A T I C ASPECTS O F FUNCTION IN THE F A M I L Y AGENCY AS REVEALED IN TWO CASES Rosa

A SOCIAL AGENCY APPRAISES ITS WORK W I T H REFUGEES Sarah

28

Wessel

S.

78

Marnel

DISCUSSION Helen

89

Wallerstein

T H E USE OF F E E IN THE CASE-WORK PROCESS IN A F A M I L Y AGENCY Frances

97 T.

Levinson

T H E S P E C I F I C NATURE O F F A M I L Y CASE WORK M. Robert

Gomberg

T H E RELATION O F CASE-WORK HELP TO PERSONALITY CHANGE Grace

111

148

Marcus

A DISCUSSION O F TWO CASE RECORDS ILLUSTRATING PERSONA L I T Y CHANGE Virginia

P.

Robinson

162

CONTRIBUTORS Jessie Taft, Associate Professor of Social Case Work, Pennsylvania School of Social Work Elizabeth H. Dexter, Secretary, Family Service Department, Brooklyn Bureau of Charities, Brooklyn RosaWessel, (Pennsylvania School of Social Work, 1936) Assistant Professor of Social Case Work, Pennsylvania School of Social Work Sarah S. Marnel, (Pennsylvania School of Social Work, 1936) Case Supervisor, Family Service Division, National Refugee Service, New York City Helen Wallerstein, (Pennsylvania School of Social Work, 1912) Supervisor of Case Work, Jewish Welfare Society, Philadelphia Frances T. Leoinson, (Pennsylvania School of Social Work, 1936) Assistant Executive Director, Jewish Social Service Association, New York City M. Robert Cornberg, ( Pennsylvania School of Social Work, 1941 ) Case Consultant, Jewish Family Welfare Society, Brooklyn Grace Marcus, (Pennsylvania School of Social Work, 1943) Special Consultant, Bureau of Public Assistance, Social Security Board, Washington Virginia P. Robinson, Associate Director, Professor of Social Case Work, Pennsylvania School of Social Work CONTRIBUTORS OF CASE MATERIAL

Marcia A. Leader, (Pennsylvania School of Social Work, 1943) Formerly student case worker, Jewish Welfare Society, Philadelphia; now case worker, Jewish Family Welfare Society, Brooklyn viii

CONTRIBUTORS

ix

Roberta M. Wilson, (Pennsylvania School of Social Work, 1943) Formerly student case worker, Home Service, American Red Cross, Philadelphia; now medical social worker, Valley Forge General Hospital, Phoenixville, Penna. Else Jockel, (Pennsvlvania School of Social Work, 1937) Supervisor, The Family Society, Wilmington Ruth Fizdale, (M.S.S. Smith College School of Social Work, 1922; Advanced Curriculum, Pennsylvania School of Social Work, 1940) District Secretary, Jewish Family Welfare Society, Brook-

INTRODUCTION Jessie

Taft

volume on A Functional Approach to Family Case Work, which it is mv privilege to introduce, marks the culmination of an effort of many years on the part of the case-work facultv of the Pennsylvania School of Social Work, to clarify for itself, for its students, and for its training agencies, as well as for the profession, a point of view regarding the practice of family case work about which it has conviction and on which it undertakes to train students. This effort was necessary because within the last ten years there had gradually emerged between the classroom teaching of this School and the philosophy and practice of some of its training agencies in the family field, a difference of approach whose implications for student training could not continue to be ignored. This difference was evidenced primarily in our emphasis on the importance of the social agency and its particular function as a determinant of the case-work process, in contrast to a tendency to allocate to the case worker himself greater responsibility for determining and meeting the need of each individual client. THIS

The first volume of the Journal of Social Work Process in 1937, entitled The Relation of Function to Process in Social Case Work, had brought out clearly what the functional approach could mean in the practice of case work with children. At that time, the material on which we were learning about the importance of agency function as a much needed source of control in case-work method was drawn chiefly from the work of the child-placement agencies of Philadelphia. The deepening comprehension of three major child-placement agencies in our community regarding the nature of their service as one long, sustained process of establishing and maintaining the functional relationships on which a child's placement depends, provided a rich stream of case material on which to learn and to teach. We had also drawn heavily upon the evidence of process as presented in the practice of the Philadelphia Child l

2

FAMILY CASE WORK

Guidance Clinic. There was, however, only a limited opportunity in Philadelphia to examine the effect of this new understanding of function on actual case-work results in the family field. This lack was obscured, but also emphasized, by the almost unlimited possibilities which were opened up in the area of public assistance in Philadelphia, where supervision for the first time was being separated out and analyzed as an essential and unique process in social work, related to case work but differentiated from it by the very difference in its task and in the relationship to agency service.1 Because of the necessity for functional definition, both of the service and of its supervision, the public assistance agency in Philadelphia became for a time another proving ground for this new conception of function and its determining relation to any process, including case work. It was natural, therefore, that in 1938 the second volume of the Journal, edited by Mrs. Rosa Wessel should be devoted to Method and Skill in the Practice of Public Assistance. It was inevitable, also, that the interest of our case-work teachers in the operation of this new and important function should sharpen their awareness of the differences that soon became apparent in case material from this source and that brought in to class at the same time by students from the private family agencies. While students were impatient with the limitations of the often too rigid public-assistance policies, they were correspondingly alert to the lack of clarity and direction so often characteristic of a family casework situation. They were quick to face the private agency student with a challenge as to his function. No amount of understanding and open-mindedness on the part of the teacher could prevent the ¡conflict introduced into the work of a student thus subjected to criticism by his peers, no matter how warmly the School might be related to the training agency involved. When to this dilemma was added the teacher's mounting interest, positive though it might be, in the possibility of applying this new concept of function to the problems of family case work, it is evident that unless the training agency was equally interested, an insoluble conflict was in the making between student practice in agency and school training in the classroom. 1 Virginia P. Robinson, Supervision in Social Case Work, Carolina Press, 1936.

University of North

INTRODUCTION

3

As our conviction regarding the applicability of a functional approach to family case work grew firmer, our teaching became correspondingly clearer and at the same time more difficult for the students in the family agency to reconcile with their field-work experience. There were valiant attempts on our part, as well as on the part of those family agencies whose practice was most at variance with the School's teaching, to bridge the gap, to minimize the practical differences, to make it right for the student. Acceptance of the difficulty of reconciliation came almost simultaneously to our teachers and to the training supervisors of one important family agency when we faced the fact that the problem involved not only a difference in case work, but in supervision itself. The difference actually went all the way. It seemed clear to us that for these supervisors student supervision meant an almost indefinite period of freedom for each student to unfold in his own time and on his own terms, without the pressure of school requirements or of the crisis precipitated by the possibility of failure to meet them. For a professional school organized on the basis of requirement and achievement within a limited time, this is obviously an untenable concept of supervision from a purely practical standpoint. Furthermore, psychologically, in terms of student learning, it fails to comprehend and hence to utilize the dynamic afforded by the very nature of the training process, with its self-chosen goal of professional competence, just as, in case-work practice, it forfeits the control and direction provided by agency function and policy for an anomalous personal freedom. While a school of social work has its own professional practice and carries the responsibility for a training process based on classroom teaching and individual advising, it must depend for its immediate contact with agency case work on the field work of its students and the case material presented by them in the practice classes. In those areas where the social agencies were pioneering for themselves on a functional basis, the work of second-year students reflected truly a developing method and case-work understanding which could be sustained by supervisors and teachers alike. Such a connection between agency and school is vital and mutually effective. Each learns from and is influenced by the other through the dynamic of a training process which depends equally on both. Where there is no such common basis the relationship

4

FAMILY CASE WORK

between school and agency loses its living force and ceases to be a source of learning for those concerned. To the keen regret of the case-work faculty, this vital connection between the School and the family field seemed to be seriously impaired until, in 1939, the situation was saved for us by the introduction of a full-time program with field work, in the recently instituted Advanced Curriculum. This brought into the School senior case workers and supervisors from a wider geographical area, our own graduates as well as graduates of other schools, and some workers without full technical training but with experience and qualifications beyond the regular student level. Through the freedom of these responsible, mature students to try out the new functional approach with the backing of their agencies, the School again achieved a broad working contact with family case work on a level that has made teaching and learning in that field dynamic and sound. One might well ask why the family field rather than any other should become the focus of difference in viewpoint. Some of the reasons for this are obvious. The family agency is truly the generic agency from which specific services have sprung. Its practice has set the pace for professional achievement in this country, while to it we owe much of whatever theory we possess today. Other fields, important as they are practically, have not been so significant theoretically, as far as case-work method is concerned. For example, no important theory regarding case-work method had ever come out of the children's field, to my knowledge, before the publication of our first Journal in 1937. The daily practice in this field has seemed to be the answer to all theoretical problems. Agencies have children to place in foster homes or something equally emergent and real. Even today, significant differences of opinion regarding fundamental principles in the area of fosterhome placement are difficult to find in the literature. Not until the Child Welfare League of America began to include technical case material in its Bulletin in 1940, was there even a regular medium for publication in that field. That the presentation of any new method in social case work should meet formulated difference of opinion chiefly from leaders who represent the method and theory that have been developed out of family agency practice is, therefore, to be expected. Because

INTRODUCTION

5

these leaders are usually not interested in family case work as a specific service, but in family case work as something generic—not so much as a method of giving a service, as a form of psychological treatment—thev tend to challenge the functional point of view in general theoretical terms, without reference to the concrete material on which the theory rests. For instance, one of the criticisms most commonly expressed is that the functional theory is unscientific. No one to my knowledge has ever tried to show specifically that the practice on which this theory relies is lacking in helpfulness to the client in obtaining the service for which he applies, nor that this helpfulness, where it seems to be demonstrated, is not connected with an understanding of the process involved and with a conscious, consistent use of that understanding. If by "scientific procedure" one means not so much the complete reliance on a deterministic causality as the recognition of a universality based on verified comprehension of the nature or law of the particular process in question, then this approach is scientific. Since in our eagerness to repudiate all connection with a rigid, mechanistic conception of causality, we have allowed the epithet "unscientific" to go unchallenged—in fact, have asserted the unpredictable nature of the case-work process, as far as the client is concerned—this may be the time and place to declare publicly that the functional theory of social case work, far from being unscientific, seems to us to constitute the one approximation to a scientific method ever to come out of social case work itself. Since the "law of the process" underlying case-work help can be isolated and understood, provided the conditions under which it can occur are given and are subject to reasonable control on the part of agency, it is as open to observation and generalization as any other living process, when the social worker is as ready to accept the conditions inherent in his role as is the laboratory scientist in biology. T h e fact that the social worker, by definition, is there to help, while the primary purpose of the scientist is to observe or experiment, should give us pause in our efforts to relate social work practice too closely to scientific procedure, but it need not prevent us from understanding and relying on whatever is universal in the process for which we are responsible. Perhaps the lay origin of social work, its original lack of professional freedom, of professional training, and of professional re-

6

FAMILY CASE WORK

sponsibility, all of which persist to some extent into the present, account for its readiness to see in psychiatry and psychoanalysis, a way of helping that is better defined, more scientific, and therefore more desirable than anything social work can hope to offer of its own. The resulting tendency of social workers to rest upon the authority, even to utilize the supervision, of this more firmly grounded, better trained, legally sanctioned profession, in order to fill what seems to be a void in their own, has been the source of much confusion as to what, if anything, is indigenous to social case work. It has also often blinded both agencies and workers to' the nature and potential value of their own task. This leads to the further point which is usually raised against the functional approach—that it merely substitutes Rankian therapy for Freudian psychoanalysis. To many of the writers who present this argument, only a psychology based on the work of Freud may claim affiliation with science, and to them the charge that the functional method is unscientific appears to be substantiated authoritatively on this ground. With the same stroke, it is clear, social case work as such is again denied and only a form of psychotherapy remains. To escape from this dilemma is indeed difficult, for no answer meets the objection of the social worker to whom Freudian psychology is essential and psychoanalysis the only fundamental source of help. The advantage given to those of us who have learned from Rank lies in the fact that, although his own professional practice was therapy, he did uncover the universal nature of the human being's problem in taking help and he supplied us with a psychology and philosophy of helping that can be used independently of therapy. But it was only when we realized that it is the function and structure of the social agency that differentiates the helping that belongs to social case work from the helping found in therapy, that we were finally freed from the necessity to confuse the two modes of helping and could concentrate on learning to use with skill the particular process for which we are responsible. Deep as is our acknowledged debt to Rank for his insight into the nature of professional helping, apart from psychotherapy as well as within it, it is no longer necessary to depend on his experience rather than on our own. Through using the differentiation and control provided by the nature of social service and by the determining differences of specific agencies with specific functions,

INTRODUCTION

7

we have located and described repeatedly in our published material what seems to us to be a method of helping peculiar to social case work. It follows then that this method, which is generic, will underlie all case material that records any particular instance of its utilization. Perhaps this is the answer to another criticism commonly made against the functional point of view, namely, that it is a point of view, not eclectic or ambiguous but unified and consistent in every piece of case material, to the point of monotony. One can only reply that this consistency is not, in our opinion or to our knowledge, due to blind identification or slavish imitation on the part of students and others, but it rather bears witness to the scientific validity of the hypothesis on which we work. To say that the recorded experience of case workers who work functionally is not to be trusted, is to cast doubt upon all case recording and all casework experience. As to the danger of the case-work process becoming dull or repetitious because of its generic base, it seems to me that there is more reason to fear the complexity and infinite variety which the case worker is expected to meet skillfully, when, as in functional case work, only the nature of the process and the function of the agency remain stable. The client, on the other hand, is free to be or to become himself, in his own way, with the help of the worker and under the challenge of the new possibilities opened up by the agency. As long as clients retain their uniqueness as individuals, no point of view can ever make case work mechanical or merely repetitious. Perhaps what is feared is that the case worker will not be equally free, and this is true. Only the client remains on the level of personal freedom. The worker is necessarily limited by professional responsibility, but within those limits no boundary is fixed for the development of his skill and his human understanding. Closely related to the reproach that functional case work is unscientific, is the further charge that it has abandoned diagnosis and its resultant plan for treatment. This is true in so far as diagnosis and treatment are concepts taken over bodily from medicine or psychiatry, for they represent an attitude toward the client which seems to us fundamentally antagonistic not only to functio*nal practice but to social work itself. The client, in our belief, is not a sick person whose illness must first be classified, but a human

8

FAMILY CASE WORK

being, like the worker, asking for a specific service. He, no less than any other human being, finds it painful to put out a need that he can no longer meet independently, and to subject his will, however feeble, to the possibility of unwelcome control in obtaining what he seeks. The functionally trained worker does not take upon himself responsibility for knowing the complete personal history of every client who requests a service, but he does expect to follow every client through the conflict which he experiences in trying to use help, as well as to get all the information regarding the client's situation or previous history that bears on the giving of this service. The functional approach demands of the worker a fundamental understanding of change and growth, a deep comprehension of what it means to take help, derived from his own training experience and from a conviction that only the client can determine in and of himself what he will utilize helpfully from the services available. We understand diagnosis, then, not as a categorizing of the client's make-up, with a resultant prescription for his needs, from the viewpoint of an adjusted personality, but an attempt on the part of worker and client to discover whether client need and agency service can be brought into a working connection that is mutually acceptable. The diagnosis is made when worker and client arrive at a plan for continuing or finally terminating the contact. Diagnosis in this view leads not to treatment but to a working relationship, set up under certain determining conditions, with a purpose or plan worked out by the client and accepted as a tentative arrangement by agency. There is here no secret labeling of the personality of the client by the worker, no unshared intention to treat "a fundamental emotional problem," but a practical judgment reached through an application process in which the client has an equal responsibility. The worker carries full responsibility for agency service, for the knowledge of the problems this very service can create for the client and his family, for understanding the universal human resistance to being helped, no matter how great the need, and for the skillful utilization of time in the client's interest. But no worker knows, or should presume to try to control, the vital process through which a client experiences change in his use of agency. Nor can any worker, however skillful, determine or foresee the exact nature, direction, and depth of such

INTRODUCTION

9

change. Herein lies the freedom for creative utilization of help that escapes the foreknowledge or diagnostic acumen of the helper, however scientific his attitude, and goes beyond or even against any treatment plan laid down in advance. It is not for the sake of widening or deepening these theoretical differences, but rather in the interest of working on the problem which the family agency presents to the functional approach, that this volume is offered. There is no ready answer to the challenge of a social agency whose purpose can be defined generallv but whose specific services cover a wide range and leave uncharted such an area of increasing demand, for instance, as that which is often called "counseling"—a term that unfortunately obscures the confusion and uncertainty into which the average family case worker is thrown when deprived of the support and control inherent in defined services and practical procedures. That his uncertainty is justifiable is evidenced by the border-line character of many of these requests for help, which seem to be purely personal and psychological. The case worker who tries to meet this demand is caught in a two-way fear, with respect to his service—either that the client will not return, an indication of failure to help, or that the client will return and bring the worker face to face with the possibility of a worker-client relationship which feels more like therapy than case work. There are family agencies so closely affiliated with psychoanalytic psychiatry that they do not hesitate to meet this type of application with a modified form of psychoanalysis, for which a psychiatrist may take a nominal or an actual responsibility. As this obliterates the essential difference between therapy and case work,2 we of the functional persuasion are not content to accept as insoluble the undeniable problem of family agencies today, with2 Although case work and therapy are alike in that both are methods of helping based on an effective relation between a professional helper and a person seeking help, they differ essentially in the degree to which the world of reality is continuously respresented. T h e psychoanalyst and his patient tend to retire into a world of two, in which even the psychiatrist as second person seems to exist largely for the sake of the patient, except for the realistic restrictions of fee, time, and place. In social work, on the contrary, the client, however understanding the consideration he receives from an individual practitioner, remains always in a threedimensional world, represented by the conditions and limitations of agency service and by the agency's responsibility, not only to the single client, but to the family and community in which his problem is expressed.

10

FAMILY CASE WORK

out an effort to locate a specific function and a case-work method, even in this area of so-called "counseling." In the first paper of this volume, Miss Dexter presents without apology the dilemma of a family agency that is unable to find a statement of its function general enough to cover every form of service yet specific enough to identify the family agency and to afford a control and support to the case worker no matter what the nature of the application. That Miss Dexter herself, despite her long experience and readiness to work functionally, finds no one satisfactory answer to her own question, indicates how real and widespread must be the uncertainty in a field that was once the rock bottom of case-work method. As long as there is some tangible service which the client seeks and the agency offers, however slight it may be as compared to the psychological help he receives in obtaining it, the worker seems to be freed, equally with the client, to engage in a genuine helping process. While there is no doubting the personality change effected in every case presented in this volume, it is also clear that neither worker nor client departed in any instance from authentic casework practice. This is determined, it seems to me, by the pervasive presence of agency, as a background, which holds both worker and client in a larger reality. However, without actual reliance on the focus provided by some concrete service, through which agency is expressed, it is difficult for them to gear their relationship to a social case-work medium. It tends to approximate the commonsensefriendly or the professional-therapeutic. The functionally trained worker becomes uneasy in either situation, as it soon deprives him of the role which he can carry with skill and leaves him as unsure as the client, whose fear is enhanced by any attempt to internalize his problem but whose projection of it upon others gives no practical possibility for solution. In Mrs. Wessel's paper, which discusses, with the understanding of an old family case worker, the complicated problems arising from the ever-changing encroachment of new agencies upon the family-agency preserves, the Alberts case shows how surely and effectively a young student can sustain her helping role, when she uses not merely herself but her agency, and its responsibility to the supporting community, in order to condition the client's request for temporary financial aid while he is qualifying for a job. That

INTRODUCTION

11

this reliance on agency can become an escape from helping and is frequently so utilized by beginning students and unqualified workers, no one will deny. The fact remains, however, that, without it, psychological sensitivity and genuine feeling for what the client experiences in taking help lose their dynamic, which, as Miss Marcus has demonstrated in her paper in this volume, on "The Relation of Case Work Help to Personality Change," lies in the possibility of a new and creative relation to reality limits, as represented by agency requirements, limits as real for the worker as for the client. In Mrs. Wessel's second case, the Fletcher family, we have a perfect illustration of helping which is almost purely psychological even in its content—nothing but a series of interviews held to a limit in time by the reality of furlough and held to the function of the Red Cross Family Service by the interstate involvement and the soldier's feeling of claim on this agency. True, there is some financial assistance, and a use of hospital for the wife and institutional shelter for a child, but the worker's helpfulness lies primarily in her ability to focus the soldier's conflict around an effort to clarify his own attitudes and to hold him to the necessity of coming to a meaningful decision regarding the next step. That this decision is no final solution is clear, but it is also clear to me that the work of this young student contains the very essence of family case-work helping, a process that would have been impossible for this worker or this man outside of the family service sustained by the Red Cross function and without the limits inherent in the reality problem of the soldier. To say that the man's fundamental marital conflict is untouched is beside the point and may or may not be true. All a social worker can know is that the worker has used himself and his agency in the interest of community and client to the limit of his skill, in order to help the client to effect some releasing change in his own situation. There is no need to question the validity of the help unless the problem continues to be reflected in an attempt to use agency irresponsibly. How deep case-work help may prove to be, if measured by results in the client's adjustment, is brought out impressively not only in the Alberts' improved marital relation but in the Marks and Lee cases, which Miss Robinson compares. It is evident that "depth" is dependent less on the particular helping medium than on the dy-

12

FAMILY CASE WORK

namic granted to helper and agency through the vital significance of the conflict brought to them by the client's election at a point of crisis, without which even the therapist is impotent. It is only the skilled case worker who can use the client's projection of his problem on agency, conscious or unconscious though it be, to the limit of its potentiality for helping. Miss Jockel took full advantage of Miss Lee's unequivocal acceptance of agency as the sign and symbol of a new life for herself, while Miss Fizdale with equal sureness helped Mr. Marks to throw off the agency that had come to symbolize his own immaturity and failure. What could one ask more of any helping than that an individual should find it possible to live again or to begin to live for the first time? Yet in these two cases, there is no shadow of doubt that the setting which made help available was the social agency, and that both workers, skillful as they were in meeting the psychological problem, depended for their surety in helping upon their awareness of agency support and agency sanction. Mrs. Marnel and Miss Wallerstein, in their presentation of the refugee client and the two methods of helping him—the one through a specialized agency, the other by a development of family case workers beyond the necessity to treat the problem of the refugee as essentially different from that of other family agency clients—agree both in their understanding of the psychological problem likely to characterize the refugee client and in their reliance on agency reality and responsibility not only to the community but in these cases to the entire country, as a conditioning background for case-work help. Despite the clarity achieved in these papers just referred to, the core of the conflict which absorbs the family agency at this moment has not yet been touched by them nor by the functional method. Indications of this core and of efforts to come to grips with it are to be found in the papers by Miss Levinson and Mr. Gomberg, both responsible and experienced leaders in family agencies. From Miss Levinson's important and penetrating analysis of the effect of fee on client and worker, we are justified, it seems to me, in concluding that when a family agency finds its case load decreasing because financial help has ceased to be the prevalent need, and because the increasing demand for counseling service is hard for workers to sustain without the customary relief structure, there

INTRODUCTION

13

will eventuate naturally a movement toward the payment of a fee by the client, not only because he should pay for agencv time if he can, but because it adds an element of structure and procedure which helps to reestablish the lost control. Although it may embarrass the worker at first, it ends by giving her, as well as the client, a greater security. While to some this reversal of familyagency tradition may seem to break down the last barrier between therapy and case work, in my opinion it actually serves as a truly differentiating factor. It undoubtedly makes the worker's assumption of professional ability more conspicuous, both to herself and to administration, thus increasing individual responsibility, but at the same time it removes from her all personal share in setting the basic condition of service—in this case, the fee. The client knows that he pays agency, not the worker; that he must take the worker appointed by agency and may not choose for himself; and that the fee scale set up by the agency is one that the worker has no power to change. Thus, through the establishment of a consultation center, one family agency at least has injected itself firmly into the structure of the counseling service on a case-work basis, as far as this service is offered to those who can pay. The problem that remains to be solved presents itself as twofold. First, how can agency make itself felt in the "counseling" cases where there is no fee to carry its presence and no tangible service, with requirements and procedure against which the client can test himself? Must such cases, which today form the bulk of applications in some agencies, become the graveyard of the family case load, because individual workers lack the skill and training to carry such cases personally and hence lose more cases than they keep? Or do we give up family case work as such and insist upon some form of psychoanalytic or psychiatric training and supervision, which will use the agency merely as a center for non-medical practitioners, working on their own responsibility or under the protection of the psychiatrist in charge—a form of socialized psychiatry for those who cannot reach the psychiatrist? That the latter alternative is one the community has a right to choose, provided the profession of psychiatry agrees, I would not dispute, but the problem we are facing here cannot be solved by this form of escape. If there is any reality in this process we call case-work helping, as such, and differentiated from therapy, we have to find

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FAMILY CASE WORK

its place and its functional determination in the family field. In my opinion there is one other source of control which is comparable to fee but which, because its importance has never been realized in social work, has been left to the judgment of individual workers. That source of control is time, and the possibility of sustaining the individual worker through formulated agency policy regarding the time it gives, where there is no other clear practical or realistic limit in the situation. The family agency has learned to take responsibility for the effect of money given to the client, not only upon him but upon his family. As yet no family agency to my knowledge has ever tried to consider its responsibility for the effect of time upon the client and his relationships, as well as upon the helping process itself. Nor has any family agency held itself accountable for the value of limited or unlimited time consumed in contacts except, perhaps, to the extent of limiting the individual interview in advance, through the necessity of the appointment calendar. The utilization of the time structure when other practical content fails is outstandingly illustrated in Mr. Gomberg's case material, but not every case worker can be expected to carry personal responsibility for time so skillfully and surely. The actual value to agency of the worker's time will soon become evident where fee service is involved, and once its meaning for helping is understood there, the social agency will have discovered another way of taking from the worker a burden that only the therapist should be asked to carry, that is, the personal responsibility of setting the date for ending contacts. 3 The Pennsylvania School has long since learned the value for the student of the impersonal predetermined time limit as given in the conventional quarter or semester. If the social agency can decide arbitrarily or by some objective standard to parcel out time, just as it decides on a fee scale, it will have taken a long step toward keeping a consultation service well within the area and capacity of social work. There remains the second, and in my opinion the fundamental, aspect of this central problem of family case work, which constitutes the unanswered question in Miss Dexter's paper and provides the challenge that Mr. Gomberg meets squarely. Is there anything definitive about the purpose of the family agency, apart from 3 Jessie Taft, The Dynamics of Therapy in a Controlled Relationship, The Macmillan Co., 1933, Part I, "The Time Element in Therapy."

INTRODUCTION

15

specific policies and procedures, which can be so stated that it actually limits or determines for an individual worker the direction, extent, and boundary of his work with a client, no matter what particular service is requested? Mr. Gomberg believes that theie is and has succeeded in describing an operating principle acceptable to his own agency, which would bring all services under the direction and control of a dynamic yet definitive concept activating the general purpose which all family agencies acknowledge. Perhaps the family agency will have to face the necessity of eliminating something, of finding some boundary beyond which it will refuse to go, if it wishes to retain a specific identity; but unless that boundary is admitted and its definitive, determining quality embodied in a general statement of function, such as Mr. Gomberg has found, which affects because it permeates its every procedure, the family agency in its struggle to hold every "outpost," may lose a unique opportunity to develop the very service that its name implies in a world that has never been more in need of help for the family. In this volume, the case-work department of the Pennsylvania School has put together evidence, which has come to it through the last five years, of the applicability of the functional approach to the family field. On the basis of the results for case-work helping in situations where the agency purpose and policy give sanction to the service, we believe that we are justified in our expectation that the problematic area of "counseling" will yet be clarified and either eliminated or restored to authentic case-work status within a function peculiar to the family agency.

PROBLEMS OF THE PRIVATE FAMILY AGENCY IN WAR TIME Elizabeth

H. Dexter

THE problems of the family agency in war time differ in degree but not in kind from those it faced before war occurred. Then as now, the fundamental problem of the family agency was that of identifying and establishing a particular function of its own in meeting community needs. The necessity for such definition is greater, today, both because of the additional confusion about family agency function created by the rapid expansion of the Home Service of the Red Cross and also because of the compelling evidence that large numbers of people are vainly searching elsewhere for the services the family agency is equipped to give. The family agency's avowed purpose of conserving and strengthening the values of family life is a general one which it shares in large measure with all social agencies and which therefore gives no hint of the special and characteristic ways in which the family agency undertakes to serve this aim. This lack of definition has exposed the family agency to a disturbing buffeting under the winds of change; it has troubled us in relationship with other agencies, with clients, and with the public. In this brief attempt to examine a persistent problem I do not assume to know the answers. I venture only to present one view of a perplexing problem, one appraisal of some of the efforts we have been making to overcome it, and some questions and suggestions about the principles w e mav observe in our search for a solution. The difficulty of defining the family agency's function has pressed upon us for at least ten years. In the pre-depression years the major function of the private family agency was recognized as the meeting of needs for maintenance and supplementary relief, The family agency operated on a philanthropic basis and therefore did not provide community-wide coverage; but for all its shortcomings, its relief-giving function was clear enough to be 16

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17

understood by the public. In the early 1930 s the sudden and rapid expansion of public relief confronted the private family agency with a major crisis, one which called for a thorough reexamination of purpose and a reorientation of program. A period of fumbling for function was inevitable. With its maintenance relief function swept away, was the family agency still an essential community agency, and if so, what was its basic, distinctive function? The struggle for function precipitated by the development of the public relief agency at first naturally centered around reliefgiving. There was an initial resistance to accepting the fact that only the public agency could meet the responsibility for community coverage of maintenance needs. For a time this resistance took the form of clinging to segments of the public program and competing with the public agency by insisting on the superior skill of the private family agency. During this period the family agency duplicated the public relief function to some extent by accepting cases in which the public agency appeared slow to act, and by giving maintenance relief to people who had previously enjoyed economic securitv and who sought escape from the supposed stigma of going on the public relief rolls. The early confusion, which gave rise to these practices, was gradually worked through, and private family agencies arrived at agreement on the basic principle that responsibility for maintenance needs rests with government. A few family agencies questioned whether there was a legitimate need and use for relief in a private family agency and attempted to give up their relief function entirely, in expectation of reaching a new clientele whose problems would not include financial need. But most family agencies found that the giving of money was still essential to the family-agency program. The shift that took place during this phase is reflected in family-agency statistics. The sharp decline in case loads that occurred from 1932 to 1937 was the direct result of the transfer of maintenance-responsibility to the public agency. An upswing began in 1937 and by 1939 family agency case loads had returned to a size approximating that of the pre-depression years, a fact that indicates that the private family agency had found new areas of usefulness, whether or not they could be defined. In the majority of family agencies, non-relief cases predominated and the small amount of relief, per relief case,

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FAMILY CASE WORK

was evidence that the maintenance relief function was no longer in operation. Although disagreement and variations in relief practice were to continue among family agencies, they succeeded in identifying a relief function in distinction to that of the public agency. The result has been that competition and duplication have been replaced by a cooperation between public and private family agencies that makes integrated service possible for families carried simultaneously by both types of agencies. The agreement on the retention of relief-giving marked an advance, but it did not dispose of the more fundamental questions. For what distinctive purpose was the private agency to dispense relief and how was the relief to be used to forward this purpose? Sharp differences have characterized the directions taken by family agencies in determining their answers to these questions. Many family agencies have used the giving of money for the therapeutic purpose of allaying anxiety and of treating the personality and behavior problems of their clients. This concept of the relief function involves the indirect use of relief, for ends other than the solution of a financial problem. In distinction to this practice some family agencies have come to conceive of the giving of relief as a service per se and, like any other service within their function, to be granted for a limited period to families and individuals who seek help in bringing about a change in their circumstances that will improve their family and social life. For these agencies the essential criterion for service is the desire and the ability of the client to use financial assistance to effect constructive change. The relationship between the worker and the client lies in working together around the problem experienced in the giving, accepting, and using of relief, and the relief service is regarded as a distinctive service in itself. I have noted that the problem of the private family agency's function was clarified, in part at least, by differentiation of its use of relief from that of the public agency, but this was only one of the questions in relation to the public agency that clamored for an answer. Was the family agency to exist primarily to fill gaps in the public program, or was it to perform services which were an integral part of the public agency function but for which the public agency staff lacked the time or the skill? Was its basic purpose to be that of promoting the full development of the public agency

FAMILY AGENCY IN WAR TIME

19

program by providing service beyond the present limits of the public program until such time as this service could be incorporated into the public program? Was it, for instance, to be a testing ground for more effective methods of relief administration, in order that the public agency could have the benefit of its experimentation? In short, was the family agency to be an adjunct to the public agency, or was it to exist to serve purposes oriented to other specific community needs and to perform a function distinctly its own? That the family agency has always to some extent served clients who either were not in financial need or were receiving assistance from other sources, and that in recent years the number of such clients has noticeably increased, indicates that it has purposes to fulfill which are independent of those of the public agency. The problem of defining this area of need accurately and intelligibly is still unsolved, and it remains a major obstacle to the understanding and use of the family agency by the public, by clients, and by other social agencies. In its effort to embrace its multiple services in a single statement of function, the family agency appears to offer a program which comprehends everything and yet commits the agency to nothing. The flexibility of the family agency has the value of allowing for shifts in program to meet changing community needs, but this particular fluidity also permits an unsteadiness in program which adds to the problem of establishing its own distinctive identity. For example, in recent years family agencies have placed case workers outside of the agency, in such settings as day nurseries, public schools, courts, and now in welfare offices of unions and personnel departments of industry. I believe the continued development of these "outposts," as a recent publication of the Family Welfare Association of America calls them, presents problems of the gravest nature. If family case work is a service that can operate through a network of activities carried on within other organisations, then the identity of the family agency becomes more and more obscure. It is of vital importance to determine whether these scattered activities result from a natural, healthy growth or whether they are no more than a grafting on other institutions in an effort to gain new and added strength. If the latter is true, the development of outposts is part of a struggle for survival through a colonizing of other agencies. An uncritical expenditure in outposts jeopardizes two basic principles: 1 ) that a social agency

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FAMILY CASE WORK

should exist only so long as it has a basic function which meets recognized social needs; and 2) that it should operate under its own distinctive auspices and on its own defined responsibility. A serious danger to which the outpost exposes us is that of taking over the function that inherently belongs to another organization or institution. The worker lent to the church may presently be performing the services of the church visitor; the worker in the school may become a visiting teacher; and the worker in the personnel department of industry may become a substitute personnel officer. If such is the case, the worker is performing tasks which the other institution has been set up to perform and the family agency is in effect subsidizing the institution or usurping its function. The attempt of a worker to administer a service in an institution to which administratively she does not belong is equally questionable. In the case of day nurseries the argument is advanced that the family agency can provide supervision to day-nursery case workers who, if they were not attached to the family agency, would be obliged to work alone, in isolation from professional case-work direction. Although case-work skills may be generic, their use becomes specific in relation to the function of the agency. Therefore, can the supervision of day-nursery case workers, whose task is a highly specialized one, be soundly lodged in the family agency, which serves a different purpose and operates administratively according to methods that serve that purpose only? Is it a service to the day nursery to delay its recognition of the problem, which it must accept, of integrating within its own organization and administration the personnel it draws from different professional fields? For the limited purpose of demonstration, the outpost can be a useful device. In order to safeguard this purpose the outpost must be set up on a carefully defined plan and not on a speculative basis. Outposts can be constructively used for limited periods for specific purposes. We know that today many people are going elsewhere for services the family agency can offer. In situations of that kind the outpost can be used for the study of these requests, in order that the family agency may learn in what ways these relate to services the family agencies are now performing or could properly perform. The family agency could identify the problem, gain a better understanding of it, and work out ways of channeling back to the family agency whatever service appropriately belongs there.

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21

Another valid purpose of outposts is that of helping another institution to recognize the value of referrals and to equip itself to make them to other community agencies. The outpost may also be used to demonstrate to an institution the need and value of a casework service within its own framework, on the understanding that if the demonstration meets certain minimum requirements the institution will inaugurate its own service. The outpost should be a temporary arrangement and its purpose clearly understood from the start, both by the family agency and the other institution. The family-agency worker must remain closely oriented to the specific function she has come to perform and must avoid taking over established functions of the other agency. If her purpose is that of demonstrating the value of a case-work service, which the institution will take over after the demonstration period, it is essential that she become an administrative part of the institution during the demonstration period, because only in such a situation is she demonstrating and fulfilling the function of that institution. An interesting use of the outpost is illustrated by the placing of trained case workers as volunteers in the Selective Service boards of New York City. The volunteer is placed with the board to assist the members of the board to carry out their Selective Service function. The family case worker draws upon family case-work skills, not for the purpose of performing family case work but solely as this equipment is useful in fulfilling the Selective Service function. These case workers are administratively a part of the agency whose function they fulfill, an arrangement which gives validity and soundness to the plan. There is not here the question of subsidizing another institution, inasmuch as the case workers, like the members of the Selective Service boards, volunteer their time. That the family agency, far more often than any other social agency, has made use of outposts is significant. Does an agency with a clearly defined function, set up to meet recognized social needs, have the need to move beyond its own immediate area of operation? Does the promotion of outposts represent a dangerous avoidance of its own domestic problem, which the family agency ought squarely to face, if it is to be more than a chameleon? Among some family agencies the effort to find the agency's place in a shifting scene of community services has taken a direction very different from that of posting workers in other organizations. This

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FAMILY CASE WORK

second trend is by no means dominant, but it is my belief that it is related to the basic problem of the private family agency. The relatively small number of family agencies which have engaged in this effort have concentrated on strengthening the distinctive identity of the family agency and have undertaken to do so by trying to arrive at a more precise definition of the basic function of the private family agency and of the service required to fulfill that function. The inherent difficulty lies with the multiple services the family agency renders and the problem this creates in yoking these services to a single defined purpose. The agencies that have worked on this problem have evolved a concept of function that may be stated as that of making counseling and relief service available for limited periods to persons who have a problem that threatens the integrity and adequate functioning of the family and who wish assistance in improving their situation. The requirement that distinguishes this service from that of the public agency is the emphasis on the client's individual desire to better his condition. The statement is, of course, still vague. It represents merely a preliminary stage of definition and does not really meet the social agency's obligation to make known to clients and community in intelligible and practical terms the specific service it offers. It is an effort, however, to state the distinctive purpose of the family agency and to make clear wherein it is different from that of other agencies, which have clearly defined functions. Unfortunately we have not yet reached any agreement in the field of family case work about the importance of function and therefore no agreement about how the problem of function can be attacked and solved; nor are there organized channels ready to sponsor joint and concentrated effort to explore the lack of agreement and find a ground for objective study of the issues buried beneath it. If we accept this analysis of the dilemma of private family agencies we can see that at the point where the present war started, the basic problem of the family agency was still unanswered—that of a definition of its peculiar function. The family agency had emerged from the confusion resulting from the development of the public agency but, before it had advanced into a positive clarification of its specific responsibilities, the coming of war faced it with another acute problem of defining its service. With the rapid expansion of the Home Service Division of the Red Cross the fam-

FAMILY AGENCY IN WAR TIME

23

ily agency appears again to be threatened and its position disturbed in ways as severe as those experienced during the rapid extension of public agencies. There is danger that in attacking the problem of relationship to the Red Cross certain attitudes may arise out of the past to confuse fundamental issues. We may again conceive of the family agency as properly having a monopoly on skilled personnel and claim the special privileges of the superior competitor. The family agency may thus hope to win concessions from the Red Cross and to induce it to allow the family agency to perform some of its services for it. The result may be nothing more profitable than a struggle for jurisdiction, in which responsibility to clients and public may be lost to view. On the other hand the Red Cross may resent any question calling for clarification of its services and be reluctant to engage in a process through which the responsibilities of the two agencies can be defined, for the importance of the expanding agency often seems to dwarf that of the static or contracting one. The jurisdictional conflict can only be resolved by mutual recognition of the difficulties with which the Red Cross and the family agencies are contending, and by working together for a clear understanding of the specific and necessary function of each. There is no dispute over those Red Cross functions that have to do with communication and information, reporting and claims. The confusion arises in the area of home service to the serviceman and his family. According to the Red Cross statement: "The primary responsibility of Home Service is to assist servicemen and ex-servicemen and their families in meeting those needs which arise from the man's service in the armed forces." This statement has much of the same vagueness and lack of specific definition that have made the private family agency's statement of function unsatisfactory. The essential first step is more sharply defined policies on the part of both agencies. This is not simple. There are innumerable problems arising in families of men in service, and the connection between them and the fact of service is not always subject to categorical description. The dividing line can only be discovered as policies are developed which make a clearer distinction between the problems arising directly from the conditions of service and the problems to which the military service of a member of the family is merely a contributing factor. We can be sure

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that in many instances the difference will be one of degree, not of kind. The family agency may seem to have more at stake in this confused situation than the Red Cross. In its anxiety to maintain case loads and to sustain its traditional role, the family agency may be inclined to accept whatever the Red Cross refers and in so doing may lose the direction of its own function. The Red Cross is overwhelmed with work and quite naturally may be tempted to use the family agency as an extension of itself and to refer cases not on the basis of policy but because it lacks the staff to perform services within its function. In accepting cases on this basis the family agency may substitute the Red Cross function for its own, as earlier it was inclined to take over the function of the public agency. To the family agency it seems clear that the Red Cross can make legitimate use of the family agency in the area where the man's presence in service is merely an additional complication in an existing problem of civilian living. If referrals are made or accepted on any other basis than that of policy, confusion in function between the Red Cross and the family agency can only mount. If the Red Cross and the family agency are willing to recognize a mutual problem of responsibility to clients and to the public, they may be able in exploring it together to reach an understanding of their fundamental differences in function and to agree to policies which can be used as a basis for referral. The first step in such an understanding demands a resolute effort to dispose of any alienating attitudes of superiority or competition and a willingness to pursue a policy-directed course, whether or not this results in smaller or larger case loads and in greater or less prominence in the community. As the family agency succeeds in differentiating its services from those of the Red Cross it may reach another milestone in learning how to examine the problem of function and may gain new conviction about the need for a definition of function as the essential guide in the development of its program. Closely related to the family agency's whole problem around function is the necessity for making its services known and understood so that it can render to the community its full measure of usefulness. That many people are turning elsewhere for the services the family agency has to offer is evident from the large number who are seeking "counseling" service from Selective Service boards and personnel officers in industry, as well as from Mr. Anthony and

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25

various other sources. The impact of the war has so thoroughly disturbed social relations and family life that more people than ever before are turning eagerly for help wherever it can be found. That they frequently do not recognize the family agency as an appropriate resource is again due to the lack of clarity in definition of the family agency's purpose and services. This lack, for which responsibility rests with the professional case-work staff, creates a serious publicity problem. In our efforts to reach larger sections of the community, we are very much handicapped by our money-raising publicity. Many of our publicity people, deprived of clear definition from us, strike one note with the supporting public, while the case-work staff strikes another with the clients. On the basis of much of our money-raising publicity the new group which the family agency is trying to reach does not recognize family-agency services as appropriate to their use, for they do not see themselves as economically inadequate and they do not want charity in any of its forms. On the other hand, the publicity addressed to potential clientele, while it has succeeded in giving a more accurate description of family-agency services, is still too vague and comprehensive. It is evident, therefore, that the family agency is confronted with a serious problem of interpretation, one of the many which arise from failure to clarify its own basis of operation. Among those who might wish to avail themselves of the counseling services of the family agency are the families or individuals who are able to pay for such service and who today either do not know it exists or whose use of it without payment of a fee would invalidate its effectiveness. The development of a fee service would not only extend the usefulness of the family agency, but from a technical case-work point of view would introduce a factor that has important value as a dynamic in the helping process. Although experimentation in this area is limited it is likely that during the next few years there will be development of the fee service. Another large group which provides potential clientele for the family agency is that of workers in industry. Here the obstacle is not only lack of information about the family agency and its services but a prejudice against the charity motive traditionally represented by the private agency. It may be that the small group of family agencies whose statement of policies includes the conditions of eligi-

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FAMILY CASE WORK

bility for agency service may be in a somewhat favored position in making clear to union members that agency service is given as a social right to those eligible for it, and is not largesse from one group in society to another less fortunate group. Labor's suspicion of philanthropy is long standing and the efforts of the family agency to remove misconceptions of the basis on which it operates today may not immediately succeed. An experiment in this direction is at present being tried out by the seven family agencies in New York City. These agencies are conducting a joint program of interpretation addressed to workers in industry. A leaflet describing the services of the family agency and listing the names, addresses, and telephone numbers of the seven family agencies, has been approved by the Labor War Chest of the C.I.O. and A.F. of L. Through the channels of labor and management over 100,000 copies have been released to employees in industry. It is too soon to judge the effectiveness of this undertaking, but it illustrates an effort to reach people who may need and wish to use the services of the family agency. The challenge that faces the family agency today, as I see it, is to identify the central base, the raison d'être for the family agency. Family case workers have no doubt of the validity of family case work, for they see at first hand the deep meaning it has in the lives of their clients. Discovering the core concealed within its multiple services will be achieved as the professional responsibility for doing so is more clearly recognized and as more concerted effort is expended in the search. Unpredictable social needs will arise in the transition period from war to peace. The whole social-work structure may undergo rapid change and the problem of the family agency's position among community services may become increasingly complex. In the face of these dilemmas I think we need be unafraid if we follow the course dictated by certain basic professional principles. These are: ( 1 ) The family agency cannot seek survival for survival's sake; ( 2 ) As any other agency, the family agency exists to meet a currently recognized and defined social need and is under an obligation to its supporting public to use its services for the intended purposes;

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27

(3) It cannot exist to supplement defects in the skill and facilities of other agencies; (4) The family agency is under an obligation to define its services so that the staff, those who are in need of its services, and the general public all may know what it is the agency does and does not do; (5) The family agency must continuously test its case-work method, or the method itself may lose validity and purpose; (6) The agency has an obligation to make known what needs it is not meeting, so that the supporting public can, if it so wishes, take measures to provide the necessary additional services. This precludes maintaining a status quo and allows for the flexibility necessary to keep an agency's services vital and related to changing social needs. If these principles are generally followed we shall not lose our way in the natural confusion that still persists about the function of the family agency and its position in the community. We shall avoid the danger of having no central purpose and shall arrive at an understanding and definition of the distinctive services of the family agency that the community will support for the welfare of its citizens.

SOME PROBLEMATIC ASPECTS OF FUNCTION IN T H E FAMILY AGENCY AS REVEALED IN TWO CASES Rosa Wessel THE family agency, which has weathered many social and economic crises in its comparatively brief existence, is today meeting on many sides, from social workers as well as from lay groups in the community, the sharpest challenges with which it has yet been confronted. Serious though the problems of survival are, it is unnecessarily pessimistic for family case workers to fear that the private family agency may be a casualty of the war. Out of my own early experience in family case work, and from more recent experience in teaching and advising students who are receiving their field-work training in family agencies, I have developed increasing conviction about the unique contribution which the private family agency has made in the past and the contribution it can continue to make, in service and method, now and in the future. This conviction impels me to try to find some answer to the insistent question: Has the family agency a valid basis for asking continued support? Does it serve a legitimate purpose in our society? In other words, has it a function? The immediate interest underlying this paper springs directly from an experience in teaching a course, called "The Moving Focus of Social Work Today in Services to Families," in the 1943 Summer Institute of the Pennsylvania School of Social Work. There were some fifty students enrolled in this course, all experienced social case workers who were holding positions of supervisory and executive responsibility. Most of them were either working in family agencies at the time or had had some experience in family case work. Among them were graduates of thirteen schools of social work, and they came from twenty-two states. The Institute covered only ten days in actual time; but working as intensively as this brief time necessitated, with students who brought 28

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29

such rich diversity of experience and background, afforded an unusual opportunity for the examination and clarification of my own conception of the function of family agencies. Again and again one was forced to recognize that the professional problems with which all family agencies are now faced have a significance which extends well beyond any local scene, however particularized each agency's problem may be. In discussing some of the problematic aspects of the function of the family agency in our Summer Institute, the two pieces of case material which follow proved to be peculiarly valuable; for between them they deal with almost every point of controversy with which the family field is today beset. They are presented here in complete details as they were used in the Institute, because the validity of function cannot be established except as one is able to view each case in its entirety, thus revealing the agency in its continuing relationship to other resources for help in the community, as well as to the client from the beginning of his experience through to the ending. It will be necessary for the reader to make himself quite familiar with both of these cases, even at the cost of considerable effort, for I shall refer to them frequently and specifically, to illustrate or illuminate a point under discussion. These cases were used originally to bring out the technical problem of the meaning and use of focus in case work as a factor in process and skill. While they are not handled from that angle in this paper, but are used rather to present a point of view as to the nature and scope of family case work, it is evident that point of view and technical skill are closely connected, the former being implicit in the latter. Though the emphasis here is on a concept of the task at hand, the reader who is looking for demonstration of skill in the "functional method" of case work, will be able to find it in both the Alberts and Fletcher cases. This case material has been lifted bodily without abridgement, from the theses submitted by two able, sensitive young students in "partial fulfillment of the requirements for the master's degree" in June 1943. The content deals with the problems which clients are bringing to agencies for help at this very moment and it therefore raises questions which are current and timely. The first case, the Alberts, is set in the Jewish Welfare Society of Philadelphia, a private family agency. It represents the culmi-

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nating experience of the student's second year of training in family case work, in an agency which operates with a function defined as follows: "To help with problems affecting family life and personal adjustment by offering financial assistance and other services to those people who show a desire and an ability to use such services responsibly, so that some constructive change can be effected." A classical "family-agency case" for which only a few years ago there would have been no question of the appropriateness of the agency's function, it now opens the family agency to challenge from several sources, particularly from the public agency. THE ALBERTS CASE

1

The Alberts family consists of Mr. and Mrs. Alberts, both in their middle thirties, and their two children, Selma, eight, and Jimmy, four. Mr. Alberts, a sheet-metal worker by trade, had always been able to support the family on his earnings, which averaged about fifty dollars weekly. Two years ago he suffered a severe heart attack, developed diabetes, and was hospitalized for a short period of time. He then returned to sheet-metal work. About ten months ago he again collapsed and since that time has been unemployed. The family exhausted all of its resources, pawned various possessions, and even borrowed sums of money which they were unable to repay. Finally, in September 1942, they had to apply to the public relief agency for assistance and Mr. Alberts returned to the hospital. He was discharged about two months later. There followed a frantic search for work, each time ending either in a collapse or a job refusal because of his precarious condition. Mr. Alberts was referred to the private family agency by the hospital, which he had also tried to enlist in his search for work. He was told that we might find him a job and help him secure glasses which he badly needed. When Mr. Alberts came to the agency he presented these two requests, and was given an appointment for January 14, 1943. He did not keep it but arrived later in the day, explaining that it had been necessary for him to see the doctor that morning. He was given another appointment that afternoon, but when the application worker was ready to see Mr. Al1 Excerpt from thesis, "The Use of a Specific Family Agency Service to Effect a New Balance in a Deteriorating Family Relationship," Marcia Leader, Pennsylvania School of Social Work, June 1943.

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31

berts, he was gone. She learned that he had suddenly become ill and left the office. Mr. Alberts returned two hours later, explaining that he had gone to a near-by hospital for emergency treatment. He was obviously nervous but seemed anxious to see the worker. He carefully described his illness, outlined his work history and then requested that the agency help him find a job. The worker briefly described how the agency could help him with a plan for securing work, including supplementary financial assistance. He would have to secure a statement from his doctor that work was consistent with the doctor's recommendations. To this Mr. Alberts replied, "So you won't give me a job; you want me to take charity." Although the worker made several attempts to explain the agency's policy in giving help and that the choice to consider this was his, nevertheless Mr. Alberts stressed a sense of being forced by the worker to take help. However, he did finally say that he would want to think over the matter of applying for temporary financial help, and asked that a worker come to his home. He would like to have his wife included in the discussion, and because she was not verv well it would be difficult for her to come to the office. The application worker accepted this, stating that a district worker would let them know when she would visit them. On January 15,1943 the case was assigned to me. I wrote to Mr. and Mrs. Alberts introducing myself as the district worker and stating that I would visit them on January 20 at 4:30, to discuss their application for help. 1-20—43 Visited the home of Mr. and Mrs. Alberts by appointment. Mrs. Alberts, a woman of huge and misshapen proportions, opened the door. Her face bore a fixed smile, and before I could introduce myself she said she knew who I was. With quite a flourish she led me into the living room. Mr. Alberts, a well-built and pleasant looking person, sat appearing very downcast and extremely uneasy. He was poorly and carelessly dressed. A nod was the only recognition he made of my presence. Mrs. Alberts burst into conversation like a well-wound phonograph, breathlessly reciting their difficulties. They were terribly up against it, having exhausted all their resources. Their only income now is an ADC 2 grant, and of course I would know that it was impossible to keep a family and run a house on that amount. 3

Aid to Dependent Children. Department of Public Assistance.

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She had thought of working herself or even taking in foster children again, but Mr. Alberts was simply too nervous to stand anything like that. They feel terrible about having to come to the agency for help. I said I did know about their difficult circumstances and Mr. Alberts' illness. I had come to see what they wanted to do and whether or not the agency could be of help to them. Mrs. Alberts, pointing to her husband, said, "You'd never know it to look at him, but that man is really half dead." Mr. Alberts looked very annoyed and smiled with forced effort. Mrs. Alberts continued with an account of his illness dating back two years, and ended by saying what a horrible experience his having gone to the agency office to make application had been. I knew this must have been difficult. I asked Mr. Alberts what they had in mind to do now. Moving nervously to the edge of his chair, he stated with considerable firmness that he wanted a job. That had been his purpose in coming to the agency. He did not want "charity." I explained that we did not find jobs for people, although I could refer him to the Employment and Vocational Bureau, a Federation agency, if this was consistent with medical recommendations. Mrs. Alberts broke in to say that he was not ready for work now. It was foolish for him to think of it, although they were very hard up. I commented that it might be possible for the agency to give them financial help for a limited time, until Mr. Alberts was ready for employment if they were interested in this kind of assistance and if Mr. Alberts were ready to carry out the prescribed treatment. Mr. Alberts bitterly replied that he would not think of it. All his life he had worked and earned a good living. He was not going to take "charity" now. I replied that it had been pretty tough, after having had a good trade and supported his family for so long, to find himself in this spot. He nodded and said, "You bet." Mrs. Alberts made several attempts to smooth things over, repeating that he should not be ashamed about asking for help now. Mr. Alberts angrily shooed the children into the kitchen. With mounting rage he turned to his wife, repeating that he did not want "charity," then asked me again if I could refer him to a job. I stated again briefly the conditions under which this would be possible. At this, Mr. Alberts burst forth with a withering blast. If he listened to the doctors he would stay home for the rest of his life. They were all crazy; he would not listen to any of them. I said I knew that it was no fun sitting home month after month, and added that no one could make Mr. Alberts do what he himself was against doing. His anger was evident as he turned to me saying, "How would you feel if you had to sit here all day and see them (referring to his wife and children) starve?" I said that it certainly was a pretty terrible prospect, but perhaps it was even

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more difficult for him to believe that he really had a heart condition that limited what he could do. He brushed this aside. He wanted a job now to support his family. I could certainly see why he wanted to do that, but I thought that he, too, knew the consequences of such a step. Mr. Alberts winced slightly as if warding off a blow. He sat with his head in his hands. What was the use? If he couldn't get a job now, he was just no good and might as well commit suicide rather than go on living this way. I said that if he wanted to do this, and felt there was nothing left for him, that was a way out; and perhaps he had the power to do it. Mrs. Alberts quickly commented, "See, those moods come over him. It's nothing." I thought that it seemed like a pretty serious matter. Mr. Alberts talked into space. It was either getting a job immediately or ending it all. No, he would not take "charity." There were several moments of tense silence. Mr. Alberts, attempting to assume an indifferent attitude, turned to Mrs. Alberts with this remark, "It's up to you, Sally. If you want to take charity, okay. I won't have anything to do with it." By this time Mrs. Alberts was thoroughly bewildered. I said I did not think this would be possible, though I realized that it would be much easier on Mr. Alberts. If they wanted our help, he counted in this as much as Mrs. Alberts. What he planned to do was important, too. But I wondered if we were getting anywhere. I felt that he was fighting me and I didn't think that I could be of any help if that was all he wanted to do. Mrs. Alberts again tried to cover this tense moment with more recounting of Mr. Alberts' illness, emphasizing the hopelessness of his condition. I realized that all these things were terribly important to her, but I didn't think that any of us could do much about what had already occurred. I was here to talk over what they wanted to do and whether they wanted to use our help. Now I was questioning seriously whether we could get together. Mr. Alberts lashed out at Mrs. Alberts, telling her to "shut up and stay shut up." He then impulsively asked me if I could tell him just how the agency could help him. It was as if he hadn't heard what I had said up to this point. I mentioned financial assistance, employment referral, and how these were related to a feasible plan for their becoming independent. This would involve several things—first, securing a medical statement, and then, Mr. Alberts' willingness to accept these recommendations. He shook his head sadly. He didn't think that he would have to come to this, to start all over from the very beginning. I guessed that it was going to be a pretty big job for him and wondered if he felt ready to take it on now. Mr. Alberts began to talk rather eagerly about his last visit to the doc-

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tor, who felt that he was showing progress. He spoke hopefully about the possibility of securing some kind of sedentary work. I acknowledged this as a possibility, but I would first want a statement from the doctor about his condition. I asked if Mr. Alberts were willing to secure this, since a short while ago he seemed to think that all doctors were "crazy." Mr. Alberts recounted several unpleasant experiences with many doctors, but he did have faith in Dr. D., who was currently treating him. He could get a statement from him. He readily gave permission for me to talk with him as well. He thought Dr. D. was sincerely interested in helping him. Mr. Alberts paused, and as though summoning his courage asked, "Can you help us for just two months?" I thought this would be possible on the basis I had just described, and asked why two months? He replied that he would not stay home any longer. He thought that this would be sufficient time for him to regain enough strength to return to work. I could accept this if it did seem realistic to the doctor too. This was agreeable to Mr. Alberts. He thought he could get to see Dr. D. by the end of next week. I offered to send him an office appointment for some time after that. He assured me that he felt well enough to make the trip to the office. Mrs. Alberts sat smiling and very much relieved. She was eager to come to the office to work out the family budget, and I explained what verification of expenses and income would be necessary. I commented that our hour had gone by. It was now near their supper time and I had not planned to stay more than this hour. Mr. Alberts smiled and said he would be waiting to hear from me. He was very careful to open the door for me and managed to say good-bye calmly. A week later I talked with Dr. D. Mr. Alberts had held a lengthy discussion with him and was eager that Dr. D. tell me about it. Dr. D. explained that Mr. Alberts did have a rather serious heart condition. There was little hope of any great improvement, but with restricted activity and medication he would manage to get along. Right now Mr. Alberts needed more nourishing food, and Dr. D. felt that within a month or two, after he had gained more strength, he could hold a sedentary job. In the past he had found Mr. Alberts to be a very difficult patient, but commented on his recent willingness to carry out recommendations. I sent Mr. Alberts an office appointment for 2-1-43. I had written Mrs. Alberts that I could see her on 1-27^43. 1-27-43 Mrs. Alberts arrived at the office on time for her appointment. She was neatly dressed and spoke quietly, at times a little uncer-

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tain and faltering. This was in marked contrast to her compelling manner in the previous interview. I commented on her having come in such bad weather, but Mrs. Alberts quickly assured me that it was all right. She wanted to talk about several things. In fact, Mr. Alberts was eager to come with her but she would not think of it because it was cold and snowing out. It was difficult for her to get into the business of the interview, although she immediately showed me the verification of income and expenses she had brought. With profuse tears, she expressed how badly she felt about their having to ask for help after all these years of independence. She even had to borrow money from a neighbor to come here today. Mrs. Alberts seemed very much weighed down with concern over Mr. Alberts' health and their uncertain future. Things wouldn't be so bad if he weren't so moody. She nearly goes out of her mind watching him mope around the house. Sometimes he just sits and cries for hours on end. In response to my expressed appreciation of how these difficulties affected her, Mrs. Alberts was able to state that she had also come to ask for help for herself. She wanted to do whatever she could to help the family get back on its feet, but she needed special medical care for her obesity. This involved considerable extra expense which they could not meet with their present income from the Department of Public Assistance. It was difficult for her to ask for specific help and she expressed uncertainty about beginning treatment. Because of all the difficulty with Mr. Alberts, she could think only of him and the children. She sighed and said she didn't count. I remarked that she could certainly feel that way about herself, but I thought she was as much of a person as the others and perhaps she did have a right to want something for herself. Mrs. Alberts was then able to state her determination to go ahead with medical treatment, and outlined her plans to contact the doctor for an examination. She realized the difficulties she might encounter in treatment, but seemed eager to carry it out with the assurance of help from the agency. I said that on the basis of the physician's findings we could both consider the recommendations, and perhaps she would then be better able to decide whether she wanted to go ahead with them. W e then computed the family budget, Mrs. Alberts taking quite an active part in this. I explained when they could receive their allowance and the conditions on which its continuation depended. I said that it would still be necessary for Mr. Alberts and me to settle more definitely, if we could, the basis of our continuing to work together before the grant could be established on a regular basis. Mrs. Alberts expressed

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her gratefulness with sincerity and directness. She felt that it was the beginning of something different for them. She made some effort to inject a personal note into the conversation, as she expressed surprise upon learning that I was married. I commented that being married did carry a lot of added responsibilities. Mrs. Alberts sighed in agreement. She left more at ease and promised to get in touch with me after her visit to the doctor. 2-1—43 Mr. Alberts came in about twenty minutes early for his appointment. His appearance and manner were noticeably changed. He was neatly dressed, seemed at ease and beamed a greeting to me. As soon as we were seated he eyed me closely as he burst forth with the fact that he had just secured a job as a crew dispatcher at a railroad terminal, which paid $147 a month. He would not begin right away, but would have to train for one month without pay. With almost boyish exuberance he rapidly went on to explain the details of the job, pointing out its advantages—good hours, adequate pay, light desk work. He was almost ashamed to say that it was a "lazy man's job," not like sheetmetal work. He talked on rapidly, apparently trying to keep control of the conversation. He had already tried out the work for one day, and could not begin to describe how much better he felt already. All he needed now was only one month's assistance from the agency. I shared some of his enthusiasm about having secured work so quickly, and what it meant to him. I said that I did not want to throw cold water on his achievement, but his taking the job did raise a problem in my mind. I would have to know from the doctor whether this was the right job for him in his present condition before deciding about granting financial assistance on a regular basis. Mr. Alberts tried to dismiss this, stating that at the end of the month he would be examined by the railroad physician anyway. I asked how he knew that he would be able to pass this exam? Mr. Alberts became very annoyed, and flippantly added, "I should think that you would be glad to get rid of me." I smiled, saying that it seemed as if he was trying hard to get rid of me. He grinned and made no comment. I added that perhaps he could not let himself do what was involved in taking help, even for that one month. Mr. Alberts had secured a statement from Dr. D. about his employability, but he didn't think he was going to tell him about this job. He hadn't told the railroad about his heart condition either. He only indicated vaguely that he had been sick. I again commented that in view of his present physical condition he would have to have this job verified by his physician before we could help him. I knew that it was no fun having to go back to the doctor now,

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after all he had been through. He still didn't see much use in going through with all that. He had the job and that's all there was to it. I said that I certainly wasn't telling him that he should continue with the job or leave it; that was up to him. But if he did want help from the agency, securing a doctor's statement to that effect was a requirement he would have to meet. Mr. Alberts looked very uncomfortable and asked, what if the doctor said "No"? I thought that would be hard for Mr. Alberts to take, but then it would be up to him to decide whether he wanted to go along with such a recommendation and use the agency's help until he could work out another job plan, or to continue on his own responsibility. Though I realized the spot that would put him in financially, the agency could not help him without medical verification. I did care about helping him become independent, but I had to have some proof of the reality of such a plan in terms of his health. Mr. Alberts mobilized all of his fight around this point, forcefully trying to present the advantages of the job, the improvement in his whole outlook as the result of it. He talked earnestly of all the difficulties he had gone through up to now. His firmest emphasis was on the fact that he was now requesting help for only one month. I realized how much the job meant to him, and that now, after all that, he was confronted with the problem of whether or not he would go back and discuss it with Dr. D. He nodded uneasily. I thought he seemed frightened over the prospect and said I could see why. Without hesitation he burst forth with, "That's it." He was just plain scared to death to face him. He had already taken several jobs against his advice and Dr. D. was pretty disgusted with him. I guessed he was wondering whether he would see things differently this time. Mr. Alberts then soberly said he was facing a different kind of a "test" now. He felt certain that the job would be all right and he would not think of taking help for any longer than one month. I said I still wasn't sure whether or not we would be able to work together even for that month. After a pause, Mr. Alberts replied that he would talk it over with Dr. D. He had an appointment with him this afternoon. He asked if he might call me today after he had seen the doctor. I said that he certainly could, and told him when would be the best time to reach me. We went over the budget for the family, Mr. Alberts expressing considerable interest in this. He said that they had received their first check, and in a lowered voice added that it really had helped them a lot. He mentioned the necessity of his securing glasses, the need for a special diet, and some other expenses important to his working. I said he could get help with these but that financial assistance beyond this week would depend on whether he wanted to work along with the agency on

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the basis of the doctor's recommendations, or try to manage on his own. Although we seemed to have finished, Mr. Alberts made no move to go. I asked if there was something else he wanted to talk about, for we still had some time. Mr. Alberts self-consciously replied that it was funny, but he had not planned to talk about so many things today, or even tell me about the job. He wasn't sure what I would say about it, and was a little scared too. I remarked that this was natural. He quickly added that he wasn't nearly so scared as when he had first come. I said I could see why it was so for him; he had no way of knowing what getting this help would be like until we had talked these things over. Perhaps after he had thought this over and talked with Dr. D. he might decide that he did not want to continue with it. Mr. Alberts said that he really didn't know, but he was glad he had told me anyway. He repeated his promise to call me this afternoon. I did not hear from Mr. Alberts that afternoon, but on 2-4—43 I received a call from Mrs. Alberts. She began by telling me that Mr. Alberts had secured a statement from Dr. D. who felt that he could take the job in a month if he carefully restricted his activity. When I commented that I had been expecting to hear from Mr. Alberts himself about this, Mrs. Alberts quickly added that he had gone to the hospital clinic today for an eye examination and was lying down because it had tired him out. She assured me that he would get in touch with me. She also wanted to talk about herself. She had gone to the doctor, who prescribed a special diet and an abdominal support. She planned to discuss the latter with her DPA visitor to see if she could secure the appliance through the Public Assistance medical program. If not, could we help her? I thought this would be possible. She would let me know how she made out. Mrs. Alberts ended the conversation by saying that things were beginning to go a lot better at home and acknowledged the receipt of their first check. Mr. Alberts called me on the following day. He had been to see Dr. D. and was eager to talk over his recommendations with me. Because the doctor had been ill, he had not been able to see Mr. Alberts the day of our last appointment. He referred also to his eye examination and requested an appointment. One was set for 2-8-43. 2-8-43 Mr. Alberts was in the office promptly for his appointment With considerable animation he remarked that things were going along

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fine. I thought that a lot had happened since we last talked, and wondered where he wanted to begin. Immediately he mentioned the eye examination. He needed glasses very badly in order to continue with his job training. We worked out the necessary arrangements for securing the glasses. Mr. Alberts felt that this would be a big help to him, and with much directness expressed his appreciation. With evident satisfaction, he said that not only had he been examined by Dr. D., but he had also managed to talk over his job with the doctor at the hospital where he goes for monthly check-ups. Both indicated that the job was within the limits of his ability. I asked where he thought he and I stood now in terms of our working together. Mr. Alberts proudly commented that from all indications he would be through his learning period in about ten days. He was learning much faster than he'd anticipated and was really in a hurry to get this thing over with. I did know how much he wanted to get back to being on his own, but wondered why he felt he had to hurry so. Mr. Alberts replied with a grin, "If you want to know the truth, I would like to get rid of the help from you." I recognized that we were both interested in his eventually becoming independent, but I had some question if this was really the way to achieve it. Mr. Alberts did not refer to the doctor's restrictions, but pridefully pointed out what a wonderful "break" he was getting in this job, and he simply had to make the most of it. He painted a very bright picture of future possibilities. While recognizing these, I commented that I was concerned with what he was doing right now and how we were going to work together from this point on. Mr. Alberts guessed he did get over-enthusiastic, but everything was at stake now and he simply had to make a go of it himself. I said it seemed hard for him to think that he could not do the whole thing immediately and all by himself. He returned to discussing Dr. D.'s statement, and as though arguing with himself, but finally stated that he was ready to abide by it. I added, "But how about the restrictions?" Mr. Alberts then admitted that he had put in several extra hours in an attempt to learn faster. He just had to start earning money for the sake of his wife and kids. They were the ones who were really suffering. I thought that he had done some suffering himself. He admitted this with a nod. Maybe it would be too much for him to comply with the doctor's recommendations. He tensely repeated that he was going to do whatever Dr. D. told him. I commented that it might not be easy, for already he found himself working extra hours and hurrying the whole thing along. Mr. Alberts said it was so hard to hold himself back, and I agreed that it could be. I could not deny his wanting to work and earn a decent living. That's what a man with a family

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usually wanted to do, but I still had some question about whether he could really let himself take help from the agency to the extent that was necessary to achieve this end. With much feeling Mr. Alberts said he could not ask for things. He needed shoes and a suit very badly. All he had now was a pair of "relief pants." He especially needed clothing for the job, but added, "I don't want to be too much trouble to you." I asked if it was really a question of being trouble to me, or of his own feeling that made it seem so. No, he just couldn't ask me. I wondered how this was different from regular financial help or getting the glasses we had just talked about. Mr. Alberts told me with mounting emotion how badly it made him feel to come to somebody else for help. He had never done it in his life before. It was just hard to take. I could appreciate the spot he was in, and maybe it was just too hard for him to take. Mr. Alberts said he knew I wasn't there to force help on him, but his having to ask me for everything somehow made him feel "queer." "A big fellow like me sitting here telling you how sick I am and how I need things is no fun." Of course it wasn't, and I felt that it took real courage on his part to say so. He guessed I knew how he felt without having to tell me. I said I could not make it feel right for him, but he was also telling me that there were some things he could and wanted to do for himself. He smiled, saying thoughtfully that it was some of both. Mr. Alberts then quickly turned to ask about help with clothing he would need when he took the job. I explained how it was possible to help with these, and Mr. Alberts offered to shop around. He also listed some other expenses, which I added to the family budget. He computed the regular supplementary allowance which came to $10.65 weekly. Mr. Alberts reconsidered the length of time he thought it would take him to complete his training. He stated that he would need an additional month's help, for he would be paid a month after he was taken on the payroll. As we figured out the approximate date on the calendar, Mr. Alberts remarked that his first pay might be for only part of a month. He wanted to know if the present plan of help could be extended until he got a full month's pay. I said that it could, and explained how we would decrease their grant as his salary increased, until he was getting his full pay. I did point out that right now neither of us knew whether Mr. Alberts would successfully pass the examination, but the agency was willing to continue assistance if he could accept the limits of his activity. He soberly said that he would. He guessed it was going to be like one partner working to get rid of the other, but quickly added, right now he needed the other one. Our time was up; Mr. Alberts asked

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for another appointment to discuss his plans, and one was set for 2-15-43. Mr. Alberts rose to go. He guessed he had "explained everything." He wanted to tell me so that we would know just "what was what." I did appreciate that, but didn't think that up to now he had been so anxious to let me in on all of this. Mr. Alberts smiled and nodded. He guessed he didn't have to tell me how rotten things had been and what he thought coming here was going to be like. I felt that Mr. Alberts was a little overwhelmed by what he had said; and he hurried out with a quick good-bye. I saw Mr. Alberts again on 2 - 1 5 - 4 3 when he came in to discuss his efforts in pricing clothing. He had shopped in several stores and with evident satisfaction said he had succeeded in locating some good values, which were within the limit of the agency's allowance. H e was now going to Dr. D. twice a week regularly for checkups. W e also completed arrangements for Mr. Alberts to secure his glasses. Mr. Alberts did not express the same urgency about getting through with his training, and excitedly he told me how much he was learning about railroads. He felt that within a f e w weeks he would be ready for the examinations. If he completed these successfully he would be glad to bring me job verification, and I would give him twenty-nine dollars for the necessary clothing. Mr. Alberts showed great concern about Mrs. Alberts, who h a d suffered a gall bladder attack and was confined to the house. She wanted to talk over "some business" with me, and sent a message with him that she would like an appointment. I told him that I could arrange to visit her at home, since she was not well enough to come to the office. Later that day I wrote Mrs. Alberts that I would visit her on 2-19-43. 2-J9-43 Visited by appointment. Although it was fairly early in the morning Mrs. Alberts was neatly dressed and had the house in order. I could tell that she was waiting for my arrival. She began the conversation in a pleasant chatty sort of way, but soon got down to talking about herself. She described in great detail her visits to Dr. D. and outlined the prescribed treatment. I commented that it certainly sounded

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like an ambitious program, and Mrs. Alberts proudly announced that she had already lost four pounds. She seemed to have some difficulty in requesting financial help with some special medicine. There was considerable discussion in which Mrs. Alberts expressed sincere uncertainty of the outcome of the treatment and the length of time involved. I felt it took something on her part to want to go ahead with it on that basis. She felt that it was about time that she did something about her health. She has gone two years without really attempting to remedy it. For the first time she expressed some self-consciousness about her size. She wanted to look more like a normal person. Why, she couldn't even care for the house, her husband, and the children decently the way she was. She became quite absorbed in a discussion of her feelings and did not bring Mr. Alberts into the conversation at all. We worked out the necessary details for securing the special medicine. Mrs. Alberts had already talked with her DPA visitor about securing the surgical belt through that agency. To date she had received no definite answer and was concerned about what she should do. I commented on this in relation to the length of time she had done without it. Mrs. Alberts laughed, saying that once she was able to bring herself to consulting the doctor, she wanted to hurry things up. She guessed she could wait awhile longer. I explained how it would be possible for us to help her with this if she could not secure it through DPA. Mrs. Alberts spent some time discussing her management of their household expenses. We were interrupted by Mr. Alberts, who had just awakened and come downstairs. He seemed in high spirits as he greeted me warmly. He was wearing his glasses and promptly called my attention to them. Without any hesitation he eagerly turned the conversation to himself. His training was nearly at an end, and now he had only to wait for permission to take the examinations. Mrs. Alberts seemed content to let him talk about this. She beamed with pride as he outlined his progress; and she commented on the contrast between this and his previous jobs, which involved heavy physical labor. She mentioned the fact that he was having some difficulty with spelling, and she was trying to help him. He brought work home and they went over it together. Mr. Alberts said he had had very little formal schooling and she praised him for what he was able to do now. Mr. Alberts seemed to enjoy this very much. He showed me a small dictionary which he carried around with him and studied at odd moments. There seemed to be quite an exchange of positive feeling between them as they discussed this. Mrs. Alberts said that I could not imagine what a great difference this work had made in Mr. Alberts. As though catching her breath she

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commented, "Why, you can talk to him now just like anybody else." He replied with an embarrassed nod, indicating his agreement. I thought that it had made a big difference to both of them. Mr. Alberts replied that things were certainly different since the last time I had been at the house. I acknowledged this and what they had each contributed to the change. Mrs. Alberts turned the conversation in another direction by talking about their renewed interest in having some children placed in their home. He nodded his approval and there was some lively exchange of comments about this possibility. I remarked that we had already used up all of our time. Mrs. Alberts said she would let me know how she was getting along with treatment and how her arrangements for securing the belt through the DPA worked out. Mr. Alberts said he hoped he would have good news in a week or two. He felt confident of being able to pass the examinations. He knew the job thoroughly, and Dr. D. had remarked on the unusual improvement in his health. He would call to let me know. I said I was interested in knowing how he had made out, and guessed he was finding the waiting hard. He readily admitted this with a smile. Jimmy, who had been bouncing up and down on Mr. Alberts' lap, self-consciously announced that his daddy had promised to take him to see all the big trains. Mr. Alberts, in a whispered aside, explained that the kid was very excited about his new work. I guessed Mr. Alberts was as excited too. He laughed and agreed. He mentioned that one of his duties would be to decide on applications for railroad passes and he would handle some of the payroll, too. At this, Mrs. Alberts said, "Say, Joe, that makes you a real boss now, doesn't it?" We all laughed, Mr. Alberts, the heartiest of all. This time Mrs. Alberts accompanied me to the door, repeatedly asking me in a stage whisper if I had noticed the change in him. 3-1-43 Mr. Alberts phoned. In a clear, loud voice he announced, "I called as soon as I could, to tell you that I passed both exams and am starting on the payroll today." I was certainly glad to hear such good news. His voice sounded all smiles and I told him so. Mr. Alberts laughingly agreed and added, "Say, I want to thank you for the coal. It was the biggest ton I ever saw." He asked for an appointment and we decided on 3-3-43. 3-3—43 Mr. Alberts came in one half hour late for his appointment. He looked tired, was unshaven, and carelessly dressed. He did not apologize for being late, but explained that he had had to work overtime unexpectedly the previous night and so had overslept. I commented that we could have arranged our appointment for another

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time. He assured me that it was all right. He had made the appointment and wanted to keep it. In spite of his fatigue he began excitedly telling me about how the whole job had finally worked out. He smiled, saying that he had also turned down two better-paying jobs the railroad was ready to offer him. These would have involved longer hours and more difficult work. He did not want to do anything that would impair his health. He knows now that he will have to take it easy and cannot rush into things so quickly. Before the examinations he had finally told his boss the truth about his heart condition. It nearly scared him to death to do this, but he wanted to be straight about it. He was a little skeptical about his ability to pass the physical examination and after discussing it carefully, Mr. Alberts went back to Dr. D., who assured him that he had made sufficient progress in his health to pass. I thought all of this had taken some courage, for it was something he hadn't been too eager to be straight about, even with himself. He readily agreed, adding, "It's even hard for me now to believe that I have heart trouble, but, boy! I really do." He seemed anxious to talk about all the various details of the job. There was a lot of "head work" to it, not like sheet-metal work. He had never believed that sitting in one place could be called work, but he explained how complicated and vital his job was. It meant making substantially less than he had earned as a sheet-metal worker, but Mr. Alberts added, "That's part of the past." To him this was like taking his very first job; and from now on he would really be a "railroad man." He spoke of his responsibility for other men and related one incident in which he had first said "No" to a man's request for time off, but had then given it to him. He didn't feel ashamed of what he had done. Smiling, he commented that it was funny—he found it hard to be too firm with the men. However, he was willing to take the responsibility for this. I guessed he could afford to be a little "soft" now. He agreed with a wise smile. We arranged about securing the money for his clothing needs. In his haste this morning Mr. Alberts had left his job verification home. However, he did have his railroad pass. I gave him a check for $29, the cost of a suit and shoes. In considering his additional work expenses, Mr. Alberts said with much firmness that that was something he would not want any help with. He'd manage somehow, and perhaps meet them when he got his first check and ended with the agency. I said that his telling me this made me wonder about something. I was really puzzled, and asked Mr. Alberts if he could bear not being able to say goodbye right now. He replied that when the time came he's sure he'll be

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glad to, but he still needed this help. Quickly he began to think back about how much better things were for him now. I thought he had been able to come through a lot, and it hadn't all been easy for him. He quickly remarked, "Yes, especially the taking part." Mr. Alberts began to say something about his taking the money for the suit and how it would feel to show up on the job decently dressed. Some of the men had already made remarks about his shabby clothing. His face suddenly turned red and he sat staring hard at the floor. Slowly Mr. Alberts' eyes filled with tears. At first he tried to hide them by glancing around the room. Finally he gave way and sobbed quietly for several moments. After some time he softly commented, "I'm acting just like a big baby now." I said that was all right. I added that it was probably what he wouldn't let himself do before. Mr. Alberts didn't seem to be in any hurry to dry his eyes. He continued crying. Finally, after another lapse of silence he wiped his eyes, smiled, and said that he was "okay" now. He made several halting attempts to start a sentence, but couldn't seem to get beyond the word "thanks." The color returned to his face as he stumbled over words, finally commenting that he couldn't say much. I knew what he felt and guessed that he didn't have to put it into words. Mr. Alberts then asked if we might figure out how much longer he would be needing the allowance and we computed his additional expense. He couldn't quite figure out exactly when he would get paid, but thought it would be some time around the end of the month. He would let me know. He did not seem at all anxious to leave but continued talking eagerly with me about his future with the railroad, about his plans for fixing up the house, and buying some new clothes for his wife. They were ready to go ahead with plans for securing another foster child. I had to remind Mr. Alberts that our time had already passed. He assured me that I would be hearing from him by the end of the month and we agreed to let things stand that way. I wished him luck in his new job. Mr. Alberts shook hands firmly, accepted this warmly, and added, "I want to thank you." 3-31—43 Mr. Alberts phoned to tell me that he had received his first pay check of $88.47 for fifteen days work. He sounded quite elated about this and asked for an appointment to "wind things up." I suggested that perhaps he would want to make this our last time and he agreed. We settled for a definite time on 4-2-43. 4-2-43 Mr. Alberts in by appointment. He looked a little tired, but nevertheless seemed in good spirits. He was wearing his new suit and shoes and appeared to be very much at ease. Immediately he showed me the stub of his paycheck, carefully pointing to the place where the

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amount of his earnings was recorded. I guessed he was proud of that. He nodded, and I added that he certainly had a right to be. We talked for a little while about the job and how he was finding it. I asked about his health, now that he was on a full work schedule. His eyes shone as he told me that his most recent check-up revealed a tremendous drop in his blood sugar. At first the doctor thought it was a mistake, but on rechecking found it to be true. He couldn't understand what had happened to Mr. Alberts. I asked him whether he thought some magic was at work, or was it something he had done? With a broad smile Mr. Alberts said he guessed the answer was his "mental state," pointing to his head. Mr. Alberts seemed eager to share with me all that had happened these past weeks, and got into quite a discussion of how he was going to maintain the family on his present income. He mentioned the fact that the first thing he bought with his check, even before he brought it home, was $25 worth of clothing for Mrs. Alberts. He planned it as a surprise for her, adding, "that poor woman hasn't had a thing these past couple years." He said he was very anxious to get many things that his wife and the children needed. I remarked that he seemed now at the point of taking things over pretty completely and perhaps felt ready to end with the agency at this time. Mr. Alberts hesitated a moment. He said he didn't quite know how he would really be able to manage alone. They have accumulated many debts during his unemployment and many items of clothing and household articles needed replacing. I felt there was some real hesitancy on Mr. Alberts' part at this point. I commented that I could see all of these responsibilities as real and weighing quite heavily on him now. He agreed to this. He could probably manage most of them somehow, but what really has him concerned is buying Mrs. Alberts' surgical belt. They were unsuccessful in getting it through the DPA. He was told it would cost him about $30. He explained how important it was for Mrs. Alberts to have it. I said that since it was something Mrs. Alberts and I had begun working on before Mr. Alberts' job came through, did he wish to consider further help from the agency for this purpose? As though weighing both sides of the problem, he stated that he was really the family provider now, but his earnings were not adequate to carry this additional burden. He was finally able to ask what arrangements could be made for help in securing the belt. I explained that although Mr. Alberts was no longer eligible for regular financial assistance, we would be willing to consider his present financial picture and work out some plan for partial payment, or repayment in small sums, for securing the belt through the agency's resources. I said it was entirely up to Mr. and Mrs. Alberts

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to decide whether they did want to start with the agency again at a point where they were pretty definitely moving toward independence. Mr. Alberts asked if he might consider this with his wife and they would let me know. We settled that if I did not hear from him by the end of the week I would know they were not interested in further help. If so, then today would be our last time. At this Mr. Alberts became quite serious and shifted the conversation more directly to himself. He began by talking about his illness. He had been so disgusted with everything that he didn't know which way to turn. He said, "Everything was running through my head until I thought I would go crazy. First I was thinking maybe Sally should go to work, but the more I thought about it the sicker I got. How could she work? I didn't want her to. Her job is home with the kids." He then began thinking seriously about going out of town—perhaps his chances of getting work would be better somewhere else. I said that that would have been a kind of running away, wouldn't it? He leaned over the desk and almost whispered that it was true, at one point he had figured on deserting the family. The way he saw it, Sally and the children would be better off that way. They didn't need him around. Not working, he wasn't much good to them. There were always agencies to take care of a mother and children. He then emphasized the struggle he had had in coming to the agency. "I didn't want to sink that low." I knew it had seemed like the end, but how did he feel about it now? Mr. Alberts replied that he had nearly "hit the ceiling" upon receiving their first check. I knew that what he was feeling at the time did not make it possible for him to take the agency's help, and recalled my questioning whether we could accomplish anything together. Mr. Alberts smiled in recollection and said he had the same question. "You did the most wonderful thing possible for a man." He added that a man doesn't want relief all his life. He wants a chance to work and support his family. He was afraid that he'd lose that chance if he took help from the agency. I thought that he had been afraid, too, of facing something in himself that might make him lose that chance. Mr. Alberts said he knew what I meant, his not wanting to believe that he was really a sick man and couldn't do the same kind of job that he had done before. He spoke of this with quite a feeling of accomplishment. His attitude toward the agency got into the discussion again. I guessed he could see now that we did have faith in a man's wanting to work for himself and his family. It was on that basis that the agency's services were available. He smiled and said, "Well, you sure done a wonderful job." I commented that we had done only part of the job, Mr. Alberts had something important to do with it

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too. He beamed. Nothing was said for several moments. There was evident sincerity in all that he had just said. Our time was nearly up. I asked Mr. Alberts if he was ready to say good-bye now or would he like another time to decide? Smiling, he replied, "Oh, I'm not saying 'good-bye,' I'm saying 'so long' now." I agreed that it could be "so-long," for I did want Mr. Alberts to know that he could return at a future date if he again felt the agency might be of service to him. He thanked me. He rose to go, saying that he would talk the matter of the belt over with his wife and if they wanted to discuss further the possibility of using the agency's help with this she would get in touch with me. I acknowledged the possibility that they might prefer to end right away. After a moment's hesitation he finally walked toward the door, and as he turned around offering to shake hands with me, there were tears in his eyes. He did say, "So long," and I wished him lots of luck.

DISCUSSION

It is scarcely possible to discuss the problematic aspects of the function of the family agency as they appear in the Alberts case without examining first the more general question of w h y there has been greater resistance to the concept of function among family agencies than among the more specialized fields, such as child placement and medical case work. Since the family agency was the parent stem of all case work, traditions have become settled upon it which are difficult alike for the lay and professional groups in social work to question or move. One of these traditions, which tends to impede the professional development of the family agency, is the tradition of the total and generic. Family agencies, originally created for the specific purpose of the practical handling of problems of poverty and dependency, have developed steadily by adding new, varied, and more professionally sophisticated services. As their awareness of the multiplicity of problems of family life developed, they widened the area of their interest in, and responsibility for, problems of family adjustment. For years they were the apex of all professional social work, and no social worker, whether practicing with individuals or groups, felt her training adequate unless she had had some experience in family case work. It is understandable that family case workers now experience greater difficulty than workers in other areas of social case work

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in defining a specific focus for their activity. In their resistance to the concept of functional limitation, there is a natural fear that this narrowing of their scope of operation may mean a diminishing of the family agency's effectiveness, as well as a lessening of its importance. The Alberts case portrays a family agency operating with a defined function that has in it no assumption of total coverage, either in analysis of problem or in service. It has limited itself to meeting only certain lands of need and only under certain conditions. It has committed itself to work directly with a client's direct request, at the point of engagement with the problem he presents. To appreciate the full professional dignity of such limited help giving within a family-care agency, requires a knowledge of the pervasiveness of the help-taking, help-receiving experience. In its simplest terms, in the Alberts case, a man with a cardiac condition is referred to a family-care agency by the social service department of a hospital for a job and for help in securing glasses. He is accepted for this specific help. He brings his own focus. He has decided at what point he can bear to put out the effort it costs to live. Around his focus of job revolves almost every individual and family problem one could enumerate—his position as head of his household, as husband, as father, as provider. His whole future is at stake. In the truest terms, physical as well as psychological, it is a matter of life and death; the kind of job he takes can shorten or lengthen his days. The practical request he makes has the permissive quality of his own sanction of the referral made by the hospital social service department. It is evidence of his real involvement in an experience of powerful importance in a critical moment in his life. To take help around this point of finding a job cannot fail to affect every aspect of balance and imbalance in his life. If this is rightly understood, the case worker cannot ask for a spot of greater strategic value. She can only be humble before such awesome responsibility, and be grateful that the social agency in its definition of function, as an expression of the contributing community's intentions toward its clients, has protected both her and her client from the full potential of the impact of their powerful personal feelings as they work together on this seemingly simple, specific request—a job and a pair of glasses. The reader will see how frequently she is required to use her function, to maintain for him a

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balance between his impulse to stay and work responsibly with a help-giving source, and his impulse to take only as little as he can bear at the moment and then to run away in shame and fear. Some family case workers have a tendency to ascribe to function a rigor and an inflexibility which are neither necessary nor desirable in good case-work practice. Traditionally the givers, whether of funds or of understanding, they are fearful that a defined function requires such specificity that it operates relentlessly at the intake desk to exclude all but the manifestly eligible for whom there are no other community resources. The Alberts case demonstrates quite the contrary, that an agency's clarity about its distinctive purpose in the community need not result in such uncompromising harshness to the client. Indeed, the criticism which this agency is likely to find itself facing is not that it refused, but that it accepted a case, and too easily. Rigid functional lines can be drawn to question the necessity for a family agency in this case, and the agency must be able, in reply, to relate its activity to its avowed purpose. In the preceding paper in this volume, Elizabeth Dexter, speaking as the case supervisor of a large metropolitan private family agency, has given one alternative statement of function for family case work which has a peculiar aptness for the Alberts' situation: "Relief and counseling service available for limited periods to persons who have a problem that threatens the integrity and adequate functioning of the family, and who wish assistance in improving their situation." 3 This may not be acceptable to all family agencies, but it corresponds closely to that of the Jewish Welfare Society. Why, then, must the family agency justify its acceptance of the case? The question is precipitated by the fact of referral. Mr. Alberts did not come to the family agency; he was sent by a hospital social service department. Since a job, which he needs and wants so desperately, was not directly available through the family agency but through the Vocational Placement Bureau, another constituent of the Federation of Jewish Agencies, why should not the hospital social worker have made the referral directly to the Bureau? Particularly, since it becomes increasingly clear that the crux of Mr. Alberts' trouble lies not in the need of a job but rather in his 3

"Problems of the Private Family Agency in War Time," p. 16.

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attitude toward his own illness, it does seem that the case need never have been referred to a family agency. It is quite conceivable that some perceptive medical social workers might have recognized this as a problem of a patient's non-acceptance of his handicap, falling well within their own case-work function. I have known medical case workers who could have handled this with consummate skill. And yet, in referring the case, the medical social worker may have understood the true extent of the precariousness of this man's whole situation, and have felt the desirability of offering the client the possibility of the services of a family agency as a community resource. The decision to go or not to go was always within his own control. To say that the family agency here merely supplemented, for lack of skill and resources available in the hospital, ignores the factor of the man's painfully hesitant but unremitting approach to a place already known to him as a help-giving source for the handling of family problems. The function of a family agency is seldom more desired and feared by a client, and seldom more applicable, than in the case of Mr. Alberts. His statement of focus as "job," has in it, broadly conceived, a permissive range of interest. It is only if one conceives of "job" from the point of view of "pin-point" focus, that the referral seems entirely inept. The case has a further complication, however, which is more difficult to reconcile in terms of function: The Alberts were already receiving Aid to Dependent Children from the public assistance agency. Why need they have been referred to a private family agency? Whatever their problem, was it not within the function of the public agency to provide some possibility of solution? Is aid in securing a job and glasses not equally obtainable through public resources? The private agency seems caught in a dilemma here. If these services are provided by the public agency, then we may charge the private agency, in accepting the case, with duplication of services, with no distinctive purpose of its own. If these services are not available through the public agency, the private agency may again be charged with "supplementation of defects in the skill and facilities of another agency." 4 For it seems a reasonable expectation that a public agency which is granting aid to a family because of the father's breakdown in health, should include in its services to this family such help as will enable the father to take * Ibid.

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over as much of its support as is consistent with his returning strength. This goes well beyond the usual original purpose of the public aid program, which was the determination of eligibility and the maintenance of certain kinds and classes of disadvantaged citizens. In Pennsylvania, however, in the last few years, since unemployment has receded, we have had a decided shift toward a broader and more generous interpretation of the purpose of our public assistance program. This resulted at the last session of the legislature, in an amendment to our original public assistance law, declaring it to be the legislative intent, . . that the purpose of the act is to promote the welfare and happiness of all the people of the Commonwealth by providing public assistance to all of its needy and distressed, that assistance shall be administered promptly and humanely with due regard for the preservation of family life, . . . and that assistance shall be administered in such a way and manner as to encourage self-respect, self-dependency and the desire to be a good citizen and useful to society." 0 In its generosity, this statement of intent is the very epitome of the undefined, and in its comprehensiveness it appears to do away with the necessity for the private agency where the public agency is active. An earlier amendment, the so called Rehabilitation Act, passed in 1941, has even more specific relation to this case. This legislation was the result of the community's genuine interest in having recipients of public aid helped to "go off relief." According to the law it is the duty of the public assistance agency "to promote the rehabilitation of persons receiving assistance. . . . " 6 The law lends itself to widely divergent interpretations, according to the various local county boards' understanding of the meaning of rehabilitation. It is not surprising that the law is conceived of largely in practical terms, and results in many cases only in the provision of a brace, a truss, a set of dentures, or an increase of budget for supplementary diet. What the public agency has not generally undertaken as its own responsibility is the considered, purposeful handling of the process that is involved in both terminals of its work 5 Excerpt from Legislative Act Number 1071, Pennsylvania State Legislature, 1943. 8 Excerpt from Legislative Act Number 181, Pennsylvania State Legislature, 1941.

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with people, the coming into and the going out of relief. This is not a criticism of our local public agency; it is a statement of fact that has a more general application. A public agency may, by the very category of assistance granted, precipitate new problems and intensify the existing problems within the family group. As proof of a family's eligibility for Aid to Dependent Children when the father is living, the man must have himself declared unemployable. This is an indignity which can scarcely be borne by many fathers, for whom earning ability is the mark of their manhood and the tangible confirmation that they are carrying their rightful role in our dominant family pattern. To Mr. Alberts, proof of his unemployability placed the seal on a doom which he had been trying to escape for several years. The deterioration of the family relationships was inevitable as he struggled alone with his guilt for the dependency of his wife and children. In accepting the Alberts family for relief, the public agency had set in motion a new phase in this family's experience, but it had not conceived of its responsibility as extending to the handling of the movement it had thus stirred up. Mr. Alberts' relation to public relief is such that he must ignore it as something in which his wife and children are involved, but not he. He has received public assistance but he has not been part of it. "There are always agencies to take care of mothers and children," he says later. He has been a client of the agency for four or five months, but he has had so little real connection with it that it does not even occur to him to explore its resources for his present need when he accepts the referral to the Jewish Welfare Society. Nor, we should add, does it occur to the medical social worker to refer him back to the public agency for the special services she believes he now needs. If the public agency has these services at its disposal, she has not been made aware of it. The knowledge of Mr. Alberts' physical readiness for a sedentary job after just "two more months of nourishing food" is information easily obtained from his physician by the private agency's worker in pursuance of her function in this case. But it would have been equally available to any worker of the public agency, had that agency conceived of its function as extending to include the process as well as the act of the client's giving up of relief. Here lies the difference between mere movement and process.

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The former is random; the latter involves a series of steps leading toward a culmination. The former can spill out explosively in all directions; the latter is held to form and pattern either by its own necessity or by the introduction of structure and focus from without. Case workers do often precipitate a process involuntarily and, unaware, live through it with the client to a successful eventuation. Often the client is his own precipitator, as unaware as we. We may be thankful that a considerable number of our clients often use naturally and constructively such attendant circumstances as time and season and place, which to the case worker may seem unimportant and even irrelevant, to hold the experience of taking help to one of direction and goal for themselves. When, however, a case worker can carry consciously her share in precipitating and sustaining a process through each successive step to its ending, she is operating with full professional responsibility. I have known few public agencies which take this kind of responsibility, and in these few notable instances, the public agency, interested in developing its staff for more sensitive performance, has usually set up a special district or project for experimentation and demonstration purposes. But I believe that we can identify here a difference in concept of job between agencies, rather than a difference merely in levels of skill. It is for this reason that it seems to me the Jewish Welfare Society can accept for help a man who is trying to "get off relief," without being charged with duplication of service or supplementation of inadequate skill. In these days of easy availability of jobs, I have known public relief clients who, after long periods of relief taking, have responded to the dynamic impact of a new visitor's relation to them, by flinging themselves off relief with a sudden reassertion of the impulse for selfresponsible living. Their plans are not always well considered, and are sometimes actually harmful to themselves and others. Before the visitor returns for her regularly scheduled visit, the damage may already be done. Indeed, there may be no return visit; for if a client notifies the public agency to remove his name from the rolls because he is now employed and able to support his family adequately, few public agencies would question his act or feel that they had been negligent of responsibility in not doing so. The private agency's response to Mr. Alberts' finding his own job illustrates this difference in the concept of function of the two agen-

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cies. Referred to the private agency for help in obtaining a job, he is offered the supplementary relief necessary to get himself into good condition to hold employment. In the first interview he himself limits the length of time he will accept this help to two months, but by the time he returns for his second interview ten days later, he has already found his own job and has reduced his original request for help by one-half, from two months to one. Any worker, and particularly a young student, might have been forgiven a natural human reaction of gratification at the rapidity of this movement and therefore an easy yielding to his altered request, especially since it asks so much less of the agency. Mr. Alberts himself is surprised at her refusal to accept his activity on these terms. "I should think you would be glad to get rid of me," he says. But such gratification is really a layman's typical reaction, which ignores the powerful negative factors in this behavior: the desperation of this man's fear of his future, his unwillingness to take help on the terms it is offered, and the denial of his predicament. Because she accepts her agency's functional requirement that its services be related to a feasible plan for becoming independent, even though she appreciates what it meant to him to have secured work so quickly, she is able to say "no" to what may seem to some readers a laudable and reasonable request. Although I have characterized the reaction above as that of the layman, it is frequently encountered among even the most experienced case workers, expressed as resistance to the resolute role the worker must play when she sets requirements for a client to meet as a condition of receiving help. Here it centers upon the worker's requirement that Mr. Alberts present evidence that his physician knew of this job, approved of it, and felt that his physical strength was commensurate with its demands, before help could continue. In identification with the client's weakness, some case workers faced with this responsibility would be inclined to say that the client's burden is already too great—how can they require more of him? Because they do not understand the process in which they are participating, setting conditions seems like a forcing of their own will upon the other, a form of "conditional relief," for which they feel so personally responsible that they mistrust it. Anyone who follows the history of relief-giving, from charity to social security over the last few centuries, becomes acutely aware

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that our current resistance to conditional grants grows out of that history.7 In reaction against age-old repressive attitudes and measures toward people in need, we have grown so accustomed to speaking of relief as a right, that we seem to have forgotten that a right is something to which one has a just claim and that responsibilities accompany it. Nevertheless, in public relief social workers have learned to work comfortably with conditions of eligibility, wherever the conditions are not capriciously or arbitrarily set, wherever they grow administratively out of a community's desire not to deprive people of their rights but to make certain that only those who have a just claim exercise those rights. It is the "plus" contribution of the skillful case worker's performance in administering eligibility for assistance that helps make this exercise of a right an experience of deep psychological value for the client. In a private agency the eligibility for help rests not only upon proof of a particular kind of need but, in addition, upon the client's readiness to use the help "toward a constructive purpose." The agency interprets this purpose as including both the client's personal welfare and the community's, as well. If, out of pity for Mr. Alberts, this worker had committed the agency to becoming a partner in his reckless plan, neither he nor the community would have been well served and the worker's act would have been not only professionally remiss but socially reprehensible. For the exercise of a right, as each of us can testify, carries with it an inescapable obligation of proper use of the benefits thereby obtained, and there is no more grievous penalty for misuse or default of such opportunity than one's own sense of guilt. What I mean to say is that Mr. Alberts is entitled to supplementary help from the Jewish community of Philadelphia, but if he takes it he must be willing to make a social accounting of it. This he cannot do if in desperation he uses the agency's money and its services to seize and hold a job through a false presentation of his fitness for it. I do not need to belabor this point, for it is obvious as one reads the case that it is this kind of behavior which has led to his several previous breakdowns, piling failure on failure, and thus compounding his anxiety. Part of the help he needs from this 7 Karl de Schweinitz, England's Road to Social Security, University of Pennsylvania Press, 1943.

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agency is a strength which he may use to protect himself from his own violent impulses and the inevitable guilt reactions. The personal and professional strength of this case worker is implicit in her every act, but the strength the client uses to work on his problem derives explicitly from his encounter with the conditions set up for the worker by the agency. If the agency, believing that one of Mr. Alberts' rights is the right even to refuse its help on the terms it is offered, stands firm on its requirements, then in struggling with his own confused intentions in relation to those requirements, he will be able to find his more balanced purpose toward himself and his family. When his decision is finally made, he will know that he is not caught or committed by any will but his own. It is very important for this man, whose most vital organ has betrayed him, to come to the realization that he can still be master of his own fate, that this is a right not conceded to him grudgingly by a social agency, nor to be fought for against opposition, but admittedly his. He could have no more poignant realization of this truth than that which he obtains from the worker's response to his threat of suicide —her simple acceptance that it lies within his power to destroy his own life. Again, when Mr. Alberts returns the following week, on February 8,1943, the worker is required to project a steadying factor into the situation, to put process into what is now haphazard activity. With independence so near at hand he is making a mad dash for it, revealing thereby fear and denial still operative. His compulsion to overwork, pressing time beyond his endurance, is evidence of his unwillingness to handle his situation with regard to his actual strength, which does not altogether promise well for his future. Again the worker holds him to the "constructive purpose" which is the only condition of their engagement. This involves his real acceptance of his limited physical strength, the necessity to yield to nature, rather than to override it in an exaggerated accession of strength which he would not long be able to sustain. This is what I mean by a worker's use of process, this deliberate, painstaking accompanying of the client step by step, holding the experience to a focus which gives it form, pattern, and meaning. I have discussed this point at some length in order to make it clear that in our present generally accepted division of responsibility be-

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tween public and private agencies, family case-working agencies can legitimately have a function which involves a supplementary service to public assistance clients. If ever rehabilitation is interpreted by public agencies in its deepest psychological significance, we shall have a new departure in public assistance which will require of its administrators a new kind of selection of qualified workers and a responsibility for the development of a new and more professional level of skill in case work. If this should happen in any community, the private agency would then find it necessary to retire from such activity, for there would then be truly a duplication of effort and services. I do not believe that this day will be hastened by the refusal of private agencies to give such service now, for, whatever social workers may hope to the contrary, this difference in function is rooted deeply in the community's conception of a difference, which it desires to have exist and is willing to support, between public and private services, the difference best expressed in the terms "public welfare and private social work." I have spoken earlier of the reluctance on the part of family agencies to work with the giving of a single direct service rather than a more comprehensive approach. Nowhere is there better testimony of this worker's acceptance of a limited function than in her handling of the deteriorating relationship between husband and wife. Of all the many problems within the family at the time of referral, this was one of the most critical. Mr. Alberts was later to tell the worker that he had even contemplated desertion as the way out. Are we then to explain the remarkably improved relations between husband and wife as merely coincidental with or a byproduct of her activity? The worker herself in her thesis gives the clearest possible answer to this question, and I shall quote a few sentences from it: As Mr. and Mrs. Alberts each used this agency service to achieve for themselves a redefinition of their separate roles, so they have used it to come together on a new basis. Mrs. Alberts' pride in her husband's accomplishments, her willingness to be a junior partner in his job venture, are all convincing indications of this. Mr. Alberts is now "the real boss"—which is the way both of them want it to be. Although Mrs. Alberts puts all of the change on Mr. Alberts, her contribution to it has been a significant one, involving real courage and strength on her part. The reorganization which both Mr. and Mrs. Alberts were able to de-

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velop in striving to recreate the balance of their original roles derived its impetus and direction from our focus on the specific and limited agency service they were using. Had I attempted to meet or even handle every problem they presented in their intensely personal relationship and for which they did not ask help, there would have been very little need for them to develop and test their own strengths in effecting a new balance. My willingness to provide this agency service as a social service, with each in turn as the center of interest, at the same time aware of the dynamics of the family constellation, gave each something they could use to rebalance their personal relationship by themselves." 8 Here is a fundamental belief in the strength of the individual to "move mountains" in his own behalf. If a worker has this faith in human beings she will not dissipate her energy or her agency's resources in doing for people what they can do with so much greater gain for themselves. She will be willing to trust the client to use her specific function with whatever psychological meaning it has for himself, if together they can agree on its applicability to the specific problem he chooses to define and present for help. The culmination of a process of help-taking is usually seen best in the ending phase of an experience. Here there is likely to be unmistakable evidence of whether the client has merely bowed more or less politely to external circumstances, keeping his internal organization intact and tightly locked against any real help, against the demand or opportunity for any new use of himself, or whether the client has truly participated by doing and by undergoing an experience that has made possible a new alignment and discovery of his own powers. The proof of Mr. Alberts' genuine readiness to leave the agency is not in his almost incredibly improved physical condition, nor in the family's financial stability, but in the new yielding to life. In his final interview, in reviewing with the worker all the agony of having had to come to terms with a damaged heart, he has abdicated from the negative position of power and strength which he had protected so fiercely against admission of human frailty. The real culmination of the process is in his willingness to say "So long" rather than a final "Good-bye," for this is an acceptance, without excessive fear or false pride, of the possibility of recurrent illness and consequent recurrent need. This must have 8

Marcia Leader, op. cit., p. 32.

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been rich reward for a young worker whose adherence to her functional responsibility in this case had so often required of her, even while she was deeply touched by the client's plight, an austerity that could well be mistaken for ruthlessness. Although he has still a remnant of fear at giving up the supporting strength of the agency and must, therefore, play with the idea of obtaining help a little longer, he has in fact already made his declaration of freedom. With his own first earnings he has made an extravagant purchase of clothing for his wife, spending on this "free willing gift" an amount equal to the cost of the surgical appliance for which he is now asking help and which he declares to be essential to her well-being! This is in essence his own emancipation. Once more and for the last time during this contact the worker places before him the functional limits of the agency. His request is one which the agency can consider, but only in the light of the family's new budget. In a calm and practical consideration of the meaning of continuing to take some form of help from the agency, Mr. Alberts' momentary impulse away from complete independence is spent, and the urgent desire to handle his own affairs reasserts itself. He has learned to take help but he can also give it up. The family agency need not be apologetic for its activity in this case. It is proof that the private agency plays a unique part in the life of the community, and that its uniqueness is not alone in the service offered but in the devotion to the development of professional method and process. o

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It may surprise some readers that the Fletcher case, the second case I am presenting, is not set in a so-called family agency but in the Home Service Department of the local chapter of the American Red Cross. In the case I have just discussed, the family agency was required to justify its own activity against possible criticism from competing interests. In considering the case which follows, the family agency may well play another role—that of the protagonist who makes the charge of invasion of its province. I have selected a case which illustrates the newly developing family services of Home Service, in order to discuss the criticism prevalent among family case workers of encroachment upon their estab-

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lished area of operation—indeed, in order to demonstrate the inevitability of this development. In this case, technically a Red Cross responsibility because of non-residence and an urgent time limit, a kind of service traditionally administered by family agencies is handled by the Home Service worker with a degree of skill comparable to that of the skillful family case worker. In her two student years in Home Service, in the period of its phenomenal expansion, this worker has not, to be sure, had the benefit of a clearly defined function to work with; but she has learned to value the kind of help inherent in a professional definition of service, and she is willing to take responsibility in large measure for setting that definition in each case. This is no easy task in an agency publicized as "The Greatest Mother in the World!" THE FLETCHER CASE

9

Early in December 1942 we received a letter from Mr. Fletcher, a seaman stationed at X, a distant naval base, asking if we could locate his wife and child. Aside from three names she might possibly be using, there was nothing to go on. About a week later a call from one of the local hospitals told us that a patient, a Mrs. Fletcher, wanted to talk to Red Cross. Mrs. Fletcher had been admitted following a miscarriage. She said she had come here from California in the fall and gave a hotel address on admission. It was the same family. I saw Mrs. Fletcher in the hospital on 1 2 - 9 - 4 2 . She wanted to discuss care for Tommy, fifteen months, and asked our help in locating her husband. Her older child, a girl of three, was with her parents in California. She was an attractive-looking young woman, twenty-one years old, quite self-possessed. When I returned to the hospital on Friday, 12-11-42, I found Mr. Fletcher there. He was a tall, pleasantly homely man of twenty-five. He had obtained a furlough in response to the wire I had sent on locating his wife. He wanted to go along with me when I went to get Tommy to take him to the public agency's shelter. After we had picked Tommy up and were getting into the car, he asked if he could talk to me somewhere. Later we went to the 9 Excerpt from thesis, "Offering Professional Help within the Limits of Red Cross Home Service," Roberta Wilson, Pennsylvania School of Social Work, June 1943.

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office, where he told me he wanted to ask about "having Tommy adopted." W e discussed this at some length. In this interview he expressed much concern over his wife's behavior since their separation in September, which had ended in her present hospitalization. This was a hard interview and a hard day for Mr. Fletcher, who stayed with Tommy until he was examined at the clinic and taken to the Shelter. He wanted to come back to the office to discuss plans, and we made an appointment for Monday. 12-12—42 Mr. Fletcher came to the office early this Saturday morning. He had been talking to his wife and she wanted to go back to X with him. She said she had learned her lesson; and he guessed they could make a go of it. I said he didn't sound very convinced. He shook his head and said with feeling, no, he really wasn't. She insists it would be different, and maybe he should give her another chance. He had tried before and it hadn't worked out. He didn't know why it would work this time. I said, wouldn't it have to be with them both going at it a little differently? How did it seem to her? Just as easy as that, he answered. "We just go to X and begin again as though we were just married." He knew it wasn't as simple as that. I said you couldn't get anywhere by just pretending to forget the past. He said he couldn't forget the past but wondered if in spite of it they could work things out. He spoke with little conviction. I said it would have to be with them acknowledging what had been bad, and still feeling they could go on. He thought they might be able to pull things together. I said that yesterday we had talked mostly about placing Tommy, but at the bottom of that problem was the question of whether he wanted to keep anything together. He said that was the main thing. He just didn't know whether it could be done. She insisted she had learned something. She had had long enough to. I said it wasn't how long but how real the experience. I guessed she might have had a pretty bad time. She'd had a bad time, he said. She had lived all around, and the fellow she came here to meet got married. It wasn't her fault entirely. She had never had any kind of home. When she was young she lived here and there. She never knew where she stood. I said I thought if they were to work it out together she would have to know pretty clearly where she stood in this. He could not do it all. He said he knew he couldn't; she would have to be willing to make it work, too. He wished I could talk to her. He thought perhaps I could see something more in it than he did. I said she had asked us to be in the situation because of placing Tommy and I would want to see her anyway. He was glad of this and thought maybe someone outside "sort of could see more clearly" than he.

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He talked on, saying she knew right from wrong, for he had spoken with her about this, not about themselves but about people they knew. But she got in with a bunch of girls that ran around, and so she ran around too. He had tried to steer her right. I said he was talking as though he thought of taking care of her as well as of the children. He said it was sort of like that. He wanted to help her, and he guessed he would give her another chance. But it would have to be a pretty clear understanding. He was going to talk to people at the different places she had lived. He looked at me questioningly. I said he might be "leading with his chin." Yes, he knew he was. I said that he might learn something pretty painful, mightn't he? He knew he was taking a chance on that, but he thought he'd better know now. Did I think he should? I did think if they were to try to set things up again, he'd want to know what he was dealing with, but I did not know whether he'd get satisfaction this way or not. He said again he knew he might not like it but he guessed he would. He started to go several times, but lingered on. I asked about the wire he had sent home for money and whether he knew that this was a service Red Cross offered, if he needed to take advantage of it. He did not know this was possible. I asked if he had had funds when he left. He laughingly said he had had $28 and spent $25 for his ticket. He admitted he was pretty low. I described the authorization necessary but said we could make him a small loan now, if he wanted. He guessed that would be swell. As he signed the voucher he said it "felt funny" and I asked him, laughingly, if he had never taken a loan before. Never under these circumstances, he said. I said I guessed the whole thing felt pretty odd. Yes, "kind of embarrassing." I said I knew it was a tough situation for him, wondering if he could make anything out of it. I said I remembered that yesterday he had said that with Tommy going into the Shelter, now was the time to place him; and now that the four of them were split up in four different places, perhaps this was an opportunity to reorganize the whole thing on a better basis. He took hold of this and said with more conviction than before, maybe he could; he thought they could. He paused. What did I think? I said I thought he really wanted a chance and was putting a lot into making it work. I did not know much of how she felt. He said she was hard to know. He was going to talk to her again pretty seriously, and he thought they could work this thing out. I asked if he would want to see me again and he reminded me that yesterday we had made an appointment for Monday. 12-14-42 Visited Mrs. Fletcher in the hospital. She was waiting outside the X-ray department in the hall. I asked her if I could talk to her

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somewhere. She wondered if we could talk here. I said I wanted to talk with her about plans for Tommy and thought we would have to find a place where we could really talk undisturbed. She thought she knew a place, and put her arm in mine as we walked down the hall. We found a little anteroom. I began by telling her a bit about taking Tommy to the Shelter, and said I wanted to discuss further plans with her. She started to tell me her husband wanted her to go back to X with him. I asked her what she wanted to do, and she said she wanted that, too. I told her I was interested in discussing this with her because she had asked us to help with plans for Tommy, which really depended on what he and she decided to do. She repeated she thought they'd go to X. I said I knew that they had had trouble before and I wondered how she thought it would work out now. She was willing at first to put the blame on inlaws and just to say it would be all right. I wondered what made her believe so. They had talked it over and would just forget the past. I wondered if this were possible, if this wouldn't be kidding themselves. She seemed to stop and consider this; then said she guessed they couldn't go back, but they could begin again. I wondered if that wouldn't be pretty hard to do. She said she did want to. She had learned something in the last few months. When you were hungry you really knew things. I said I knew she hadn't had an easy time. I remembered she had asked us before about getting back to California. I wondered if going back with him to X would be all easy, either. She guessed they'd have to get used to being together all over again. He was a swell fellow but he had done some things that annoyed her. For example, she told about baking a pie for him and then he wouldn't notice it. And he sometimes didn't show her much affection. She realized now she should have known he was probably just tired, working on the night shift and all. Then once in a while he'd bring her perfume, or admire her hair-do, and she would be so pleased she would just cry. Then she had been pregnant one time after another. He'd always played poker and he began going out at nights to play and so she started going out too. But she thought it wouldn't be like that again. I said it was a matter of how much each was willing to put into making it work. She said she was willing to put everything into it. I talked about how it might look like losing some things, in order to have others. She looked at me and said, "I know what you mean." She knew she had been flighty but she had had lots of time to think it over. He'd have to give up some things too, like that poker. She told of his talking this over with her, and he was so mixed up he didn't know what to do. He'd just sit there with his head in his hands. He was a swell

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fellow, she said again. And he was shy. They always got on together, but she had gotten tired of not getting attention from him. She did leave him finally. Then she described her life with her family and her antagonism to her step-father. If they went to X they would be away from people "butting in." I thought it wasn't only other people, but something between the two of them. She acknowledged this and said they had talked a lot about it and thought they would try. She wanted to have the children with her. Jane is his pet and Tommy is hers. I wondered if she had thought of taking Tommy if they went to X or placing him until they were established. She wanted him with her. He had been her mainstay, the last months. Later they could send for Jane. I said I would be wanting to know what they decided because we would have to arrange about Tommy. She said she would ask her husband to talk to me again. I said he too had told me he would want to do this. We walked back to the wards and again she put her arm through mine and took my hand. She thanked me for coming to talk to her, and thought they could work it out together. She wondered if I could get her some clothes. Eleanore (the girl she had lived with) had disappeared with all her things except a coat. I said we could get something for her. She could send me word if she wanted me to come after they had talked again. 12-14-42 Mr. Fletcher came to the office about a half hour early for his appointment. He had been to the public agency this morning and the worker had said the baby would have to go to either X or California, but she had said that if his wife took him to California, we could ask the Red Cross to meet her there and have someone keep an eye on her. He opened a box of letters he had with him, and wanted me to read them as he handed them to me one after the other. There were letters from her in which she was asking him for a divorce, planning to marry the man with whom she had been going after she left him. Then he gave me one from this man to her, which was very graphic about their affair. I read them as he handed them to me and I had to say he had an awful lot here to take. I wondered if with all this he felt he could possibly go on. He was very solemn as he said he wondered too. He couldn't unless she was sincere in saying she would be different. He looked at me and asked, "Do you know she had a miscarriage?" She had told him Saturday. "That's something else." I said it was one more part of the whole thing, and I knew it was just rotten for him. He said it was, yet he was glad he knew. Now he knew the worst and it was just as well.

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He asked if I had talked to her, and what she had said. I told him of seeing her this morning and that we had been able to talk quite seriously, alone. Even if I told him what she said, I could not tell how it felt between the two of them. He knew that. He just wondered if he could believe her when she said she wanted to come back. He asked, "Did she tell you she wanted to?" I said she thought they could get together again. I wanted to tell him she was sincere, but I couldn't know. He said, "No, you couldn't tell me that, but I can talk it out here." He said again he thought they could work it out in X. If she were in California he guessed he would have to get the Red Cross or somebody to check up on her. In X, he would be there. I said that was pretty hard on him to try to build something up with the feeling that he had to check up. He felt it had to work this time or not at all. I said, looking at the letters, that I could feel from all this what an immense amount he had put into finding her and trying to right all this. He acknowledged that that was true, he had tried everything. The thing that worried him was that it was not until she got stuck that she tried to reach him. I thought that was something hard to take. I asked, what did he really want for himself? He really wanted them together. He was fond of kids. That was what married life meant. He talked a little here about both the children. He asked about her transportation. He has a return ticket. I said we could probably arrange for that if they decided to go. He said he believed it would work out for them to do that. W e discussed how soon she would be discharged from the hospital. He tipped back his chair and said, "There it all is, in that box. The problem is what to do with the box. If I keep it, shell hold it against me. If I throw it away I said they weren't throwing away what was in that box; they were using it in building up something new. "Yes," he said, "That's so. And if there is a new case it would have a box of its own." He tilted back his chair once more and said, rather softly, "I guess I'll have to change a little bit too. I need to show her more affection." And cards—he used to play a lot of poker. He grinned at me and told me about having been in the Army before and learning to play cards there. Then in the Navy he had plenty of chance too. He and I laughed about this a little. When he got up to go he was looking very serious again and lingered a little as he got ready to leave. He said he would call me when he and his wife had talked again and were definite about what they were going to do. The following day Mr. Fletcher phoned me to say he and his wife had decided on going back to X together and when she was ready for discharge he would like to talk to me about her transportation. Within

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the next four days, however, the doctors revised their opinion and a diagnosis was made of pregnancy of four to four and one half months duration. Mr. Fletcher had kept in touch with me by phone and had come in once or twice. Then on 12-21-42 he came in after phoning for an appointment. 12-21—42 Mr. Fletcher came to the office a half hour early today. His face shows the strain of the last week. He began by saying he was back again. He guessed his plans had come unmade. I said there was certainly something new since he had made his decision. I thought he would want to know that I had talked to the hospital worker since Friday, and she had been able to explain the change in the hospital plans; they had decided Mrs. Fletcher was four to four and one half months pregnant. He had had a chance to talk with one of the chief doctors, and that was what they thought, but weren't even sure. He said he didn't think she was pregnant. She hadn't felt life. "She ought to know," he laughed nervously, "she's been that way twice before." I said there had been so much uncertainty in this. "There's another thing," he said, hesitating just a little. "I don't know whether it's my child. It could be; and then again it could not be. I don't know." I said that was a serious thing to wonder about. He repeated, "It could be mine." I said, "But you don't really believe it is." "No," he said earnestly, "I don't really believe it is." I said that was such a hard thing to take. I wondered if he felt he could ever go on. He didn't know. Maybe before, they could have put the past away, but it would be a difficult thing if there was going to be something always to remind them. I said it might be something he could never know about. He didn't think really she would carry this baby. The doctor had said when Tommy was born she probably couldn't go through with another. In a way, that would be for the best. I said, in a way it seemed so, yet he would still need to decide whether he could go on now, knowing this was how it was. He wondered whether the best thing was for her to go to California. The trouble was she couldn't go to her people, or she said she couldn't. She'd talked about getting an apartment, maybe with another girl. Then they'd be back where they started from. He would never be certain whether the children were all right. We had some discussion of how far Red Cross could go in following up the children's welfare if he decided that was the way he wanted it, and he said it might amount to that. I asked how she felt about it now. She still wanted to go to X. It still looked pretty easy to her; they could just go and start over. He didn't want to start again if she only wanted it temporarily, not unless she meant it to be permanent. He couldn't tell how sincere she was. I said

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no one could tell him that. He had talked to her a lot, but in the hospital it didn't feel as though she were herself and he didn't feel like himself either, with all those people coming over and breaking in. The one time he felt she was speaking sincerely was when they went to a little room by themselves, "where you talked to her." I wondered if she were discharged tomorrow, if his extension would mean they would have a chance to talk when she came out. He had not known the extension was granted. I said I was sorry I had not told him right away, I had presumed he'd received notice direct. I asked if this took a little of the pressure off having to decide right away today. This seemed a real relief and he thought they might be able to decide something. Maybe they'd go to a hotel, or they could have a room at the Y. He said he was going to stay over even if it weren't granted. He thought maybe he'd be going back to bread and water for three days, but didn't think they'd be too hard, because they knew why he was here. He was glad to know we actually had it in writing, though. I said he was covered by that. He thought they could talk it over again. He had to see that the children were treated right and he thought if he had them in X he would know. I said that all along it had seemed important to him to know, even though what he knew was pretty painful. He said he had experienced what it was not to know and he didn't like it. I knew what a lot of work he had put into finding out. He thought if she did go to California he might lose track of them again. Another thing she had talked about was just "disappearing" when she left the hospital. He knew that wouldn't settle anything. It would just all come up over again sometime later. I said we were talking of California as meaning letting things go between them. I thought perhaps feeling this way about her present condition he might really think it was too much to carry. Perhaps what he really wanted was to let things go. No, he didn't want to just let things slip away from him. I said for her just to go back to Cailfornia as before would not settle anything; it would not be an ending, as though there were a divorce. He said that would be different because then he wouldn't be responsible. Now he was legally responsible, he added, even for the new child. I said yes, he really was, and that might seem pretty heavy. Another thing she had thought of, was placing this child if it were born. He didn't know. It could be his, he said, and he didn't know whether he could take that chance. I said he was asking himself to do one of the hardest possible things and I wondered if he could do this if it were for the children's sake or for hers, unless there was something in it for him that mattered more than the badness in it. He said that one thing that made him feel there

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was something in it for him was some letters he had found in a suitcase which she had written to him in October but never mailed. He guessed she didn't because he hadn't answered her wire or her letter; but he hadn't known where she was. If it weren't for the letters he wouldn't think she meant what she was saying at all, but they seemed to say there was something with him she really wanted. I said there was something in it he really wanted. What he wanted was for them all to be together. After a pause he said slowly he really didn't know whether he loved her or not any more. He just didn't know. Maybe if things changed it might be different. Things were sure in a mess. I told him I knew they were in a mess, even after all the work he had put into them. I wondered if there were any basis on which they could get together. He said slowly, after all they had married. "You married for keeps." He thought it was better to try to save something. He had to express some doubts; she had only wanted him when she was in trouble and, in spite of what she said about wanting the children with her, she had left Jane and neglected Tommy. But perhaps they could try again in X if she wanted to make it work. I said it would take making. He realized it would be especially hard "maybe the next six months." He would have to go at things a little differently. He talked about playing cards "like I told you before and fellows would drop in and we'd go out for a bottle of beer." "Then," he continued, "we got to going out separately." Of course this time would be harder; there wouldn't be so much money. He had been making $70 a week. He had run the finances and paid the bills and done the marketing. He laughed and said his father had done this for his mother and he just always did, just like his father. I said she wasn't the same person as his mother, though. He thought, now, maybe that had been a mistake. She was jealous of Jane, too, because he paid her so much attention. He thought she needed it, but he would know how to be different about that now. He had gone to the hospital one day and found her making a budget. The figures were all "messed up" but she was making it. I said that seemed like one way of her working on their getting together. He said yes, he guessed it was and it didn't matter so much if the figures were wrong. This seemed to have real meaning for him. I said we had talked about its being different, but I wondered if it could possibly be the same. He said so much had happened, it couldn't be. He knew what he'd done that was wrong and she knew too. At least, she said she did. If he could only be sure. I said I couldn't make him sure. He knew nobody could tell him. He tried to understand from her. I said, "Perhaps she can't tell you in words." Perhaps one way she was different from him was in not being able to deal with this the same

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way he had to. I could feel how he was trying to think this out to the bottom. He was, because he didn't want to start anything again if it wouldn't work. I said it was a gamble in one way. Even if they started under the best conditions, no one could guarantee how things would work. He took this up and said that was true, even if they had started before when things seemed settled. He knew it would be harder, particularly if there was to be a reminder. But maybe it would be good for her to have a reminder. He was a little stern as he said this. It looked to me as though whatever he decided was with full knowledge of how bad things looked. He thought that was good because if he had to find them out later it would never work. He guessed perhaps they could go to X. "Do you think?" I said I couldn't tell him it would be all right. He said again, "I have to decide. I guess you wish I'd make up my mind." I guessed he wished he could, all this certainly must be tough on him. He was nervous. He drank twelve cups of coffee a day. I thought he certainly must be nervous, that the last ten days were pretty bad. He said he'd thought an awful lot about it. He would talk to her again, out of the hospital. Then he thought it would be all right. He got up to go, saying I must have other people to see. I said I had other appointments. He stood there a few minutes and then sat down in the other chair, nearer my side of the table. I guessed he must feel he'd like me to say "It'll be O.K.," that that might feel comfortable right now. He knew I couldn't tell him that, and he guessed he had something settled in his own mind. I said if it felt that way maybe it was a little settled. I couldn't tell him what to do, but I could try to help him see what he wanted to do. He said plenty of people give you advice but you just knew you wanted to do the opposite. He'd had plenty of advice lately. I said the people who gave advice weren't the ones who had to live it. He said with feeling, "If we get together this time, we'll really have something." I said, something he'd really worked over. He sighed and acknowledged he had worked. He got up once more, and again sat down in the first chair. He would talk to her when she got out of the hospital tomorrow. Then he would come here Wednesday. He wanted to know what time I would be free. He talked a bit about trains and reservations; he had found out about the fare. We talked about when they would need to leave, and were able to laugh a little over one or two things. He finally said he guessed he'd really better go. He looked pretty sober as he left. 12-23—42 Mr. Fletcher phoned this morning before I was in; and later came in. He thought it was really settled this time and they were going back together. He sat back and laughed a little nervously. They had talked it over last night. It seemed quite different when they were

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able to talk out of the hospital. He thought it was going to work out all right, "at least temporarily." I said the most he could do, was to decide what he wanted to do with the present. You couldn't handle the future. He said this was the thing for them to do now and "we'll try to make it work." I knew how much had gone into this decision and I thought that gave it a swell chance of working. He acknowledged it had meant a lot of thought. He hoped it was right. He knew it wouldn't be all perfect. It would be harder the next six months or so. I said I felt he knew today what he wanted to do. He thought he did and that what we needed to do now was to settle the details. He had phoned the railroad and had a Pullman reservation for her on the 2:15 train this afternoon. He had a coach ticket but wondered if this was good on the same train. The baby would need no fare. We planned how he would get Tommy from the Shelter. We also discussed how much money she would need. I had to explain the difference between our help to her, which could be as a grant, and the $3 we had given him which had to be as a loan. He commented on the separation of these procedures as "something else." Wc dccided how much she would need to carry her and the baby until he could sign a special payroll. I mentioned the Red Cross chapter in X as a possibility if they wanted further help. There was one more thing he had forgotten to ask about. He owed the blood bank at the hospital a pint of blood as she had had a transfusion. I wondered if he felt this had to be handled before they left, if he was wanting me to inquire about it. He thought he could write them and maybe give blood back at his station. They could send it and "it would be the same blood." I knew he had a lot of ground to cover and wondered if I could help him in doing any of these various errands. He thought he would have time but would call me if necessary. He did call later to say the Shelter was having to check up before they would let him have the baby, but he did not think I needed to phone. He would let me know if there was any hitch. Later Mr. Fletcher returned to the office once more. Everything was lined up now, and his wife and the baby were waiting at the hotel. He seemed to want to talk a little. He sat back in his chair and told about getting Tommy; how he had cried when he left; about the toys they had given him. Tommy would probably sleep most of the trip. He had no reservation yet, but he wasn't worried. He'd get on the train; and he laughed. I asked him if he would think it any help if I wrote the X chapter and he thought this might be 'like an introduction," if they needed it. I said

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perhaps he had had enough of Red Cross. He said this had been a tough time but if he hadn't been able to come here he wouldn't have had anywhere to go. I told him I knew how much he had had to do himself to reach today. He said once more he believed it would be all right. It had meant a lot of thinking. At last he thought he'd really better go. I went to the door with him and he tried to say thank you. I said sincerely I wished him the best of everything, and he left. DISCUSSION

The Fletcher case illustrates a problem of function so immediate and so current that we cannot speak of it with a conviction gained from years of actual experience, as we can discuss the differentiating aspects of public and private function. I offer my own fragmentary and inconclusive reactions to it, only as "grist to the mill" of a better understanding of the historical present of social case work. I believe that the recorded material is its own best advocate in giving a tentative answer to some of the perplexing questions of differentiation of function between Home Service and family agencies; for I learned from the reaction of the students in the Summer Institute that an impartial reading of this material can result in a wholly generous appreciation of the worker's activity in it, her creative use of her Red Cross function. In the light of it, one can no longer say that Home Service cannot produce skill adequate for so delicate a task as handling a problem in the area of family adjustment. Such questioning delays and impedes the training movement now under way in Home Service to produce skill equal to the full performance of its own job. The experience of the Pennsylvania School in training students in Home Service for the last two years has indicated that when students are held to the same standard of performance that is applied in other more stabilized agencies, they not only achieve skill in case work but they make a real contribution to the development of Home Service as a professional field. I do not mean to suggest that "adequate skill" is easily developed. Since my relation to this case material is also that of case-work teacher and adviser to the student while the case was in process, I know at what cost a worker in Home Service develops skill in an agency in which case loads are mounting by arithmetical progression month by month; in which clients' needs, fraught with life and death values, are insatiable and insistent; in

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an agency which is entrusted with expression of the humanitarian impulse in a world engaged in destruction. Some of the problems of maintaining a professional practice under these circumstances are those which we have already experienced in the period of mushroom growth of unemployment relief, and we are inclined to use these extenuating circumstances to forbear asking that an agency take full administrative responsibility for handling those aspects of practice which go beyond its urgent emergency tasks. If, however, family agencies are feeling more and more an obligation to state their purpose clearly to their communities, we shall have to place the same obligation upon Home Service, as a newly expanding part of the structure of social services in any community. Otherwise, our present confusion of function between family agencies and Home Service gives little promise of abatement, let alone of solution. The confusion comes in that area of Home Service which is officially described as "consultative and helpful activity directed toward meeting those family difficulties which do not require financial aid." 10 Small wonder that family agencies feel this to be cutting across established lines of responsibility carried by the private family agency. The Fletcher case, which in spite of the small expenditure of funds for travel might be considered as falling in this area of conflict, seems to give us a new departure for the consideration of whose function it is to deal with such cases, and a new basis for referrals from one agency to the other. There has been discussion of the availability of adequate skills, or the war connection of the problem, as basis of referral and allocation between the two agencies, but we have not sufficiently considered as a factor the readiness of the client to work on his problem with one agency rather than another. In the Fletcher case most of the worker's activity with the young seaman and his wife has the unmistakable quality, mood, and method of family case work. Take this young man out of uniform and you have a typical family agency problem, heightened by non-residence. You cannot say that the difficulty between his wife and himself is serviceinduced or war-connected, any more than any activity of this family would have its inevitable war connection, merely because 1 0 Joint Statement, American Red Cross and Family Welfare Association of America, on Services to the Armed Forces, June 1942.

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Mr. Fletcher is now in the Navy. Indeed, they both tell of their stormy few years of married life previous even to his enlistment. If you wished to determine the origin of their difficulty, the search would take you into a morass of problems in both their troubled young lives, which long antedate today's crisis. Nor can you find this origin, even if you would, for time is the essence of movement here. Mr. Fletcher has only between the eleventh and the twentythird of December in which to live through a momentous and tragic experience. The social worker knows that it is her solemn duty to help him live through it responsibly. She knows, too, that his future and that of his wife and children are to be irrevocably affected by what he can achieve for himself of courageous decision in that brief period of furlough. Of course, the non-debatable functions of Home Service, such as communication and reporting, are also involved here, and it makes for simplification and ease of operation that the worker is able to render help in extending the furlough, in granting financial aid and loan for travel. Almost everyone could therefore agree that it is more expeditious for Red Cross to handle this case, and could accept the technical propriety of Home Service function in the situation on that basis. Perhaps all could even agree that the family problem is "service-connected," because of the necessity of helping Mr. Fletcher reach a sufficiently satisfactory solution of his affairs so that he may return to service with some peace of mind. It is not so easy, however, for case workers to admit that the die was really cast by the two young clients themselves, each of whom, in pursuance of his own needs, called upon Red Cross for help. Stranded, outcast, and ill in a strange community, when Mrs. Fletcher was ready to ask for help for herself and child, her first appeal was to the Red Cross. Many hundreds of miles away, the young husband's first resource for help in finding her was the Red Cross. To both of them the Red Cross somehow represented a source of help which they had a right to call upon. It transcends state lines and railroads and residence restrictions. It belongs to all places and you belong to it, wherever you go, because you have a "service connection" whether you are the sailor or his wife. Both of these young people bring, therefore, a sharpened readiness to work constructively with Home Service on their urgent problem. It is probably the most powerful dynamic in the situation. This

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readiness might easily have been dissipated if referral to a "family agency" had been deemed necessary when the case-work problem became so clearly focused on helping the man to reach a decision which involved the very continuance of this little group as a familv unit. If we are inclined to enforce rigid functional lines, some children's agencies might well point out that the worker here even encroached upon a child placement function, in taking the baby to the Shelter and discussing at length the question of adoption with the father. In any thoughtful, objective evaluation of this situation, the needs of the family do extend well beyond the serviceconnected problem, and according to the agreement between the Family Welfare Association of America and the American Red Cross, would "call for the family adjustment service which the local family agency is especially equipped to render." Under such circumstances "there should be consultation between the two agencies to arrange for referral or cooperative service." 11 It would be regrettable if this agreement were to have a tendency to encourage uncompromising functional definitions. In this case the Home Service worker and her clients were able to define a focus of operation which ordinarily falls within a family agency, but it seems here appropriate beyond a doubt that Home Service should handle it. It should be possible for a family agency to yield some of the family adjustment function to Home Service, even at the recognized cost of some loss in potential case load—and to do so without fear of encroachment—if we recognize that in any helping process the client's will to be helped by a particular agency is a factor equal in importance to the agency's function. I accept that this consideration adds complexity to an already difficult situation, but I believe that agreements between agencies on referrals, however clear-cut, are invalid if they omit this factor, if the client's needs are considered but his will ignored. In the first case here presented, Mr. Alberts was sent to a private agency by referral, but he remained to work on his problem with all the force in him, because of his readiness to use the specific services of a private family agency. The Fletchers, on the other hand, themselves called upon the Red Cross in the midst of their distress, because of their conception of its help-giving function II

Joint Statement cited above.

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and its fitness for the problem they were facing. This conception is neither fantastic nor absurd; it falls well within the community's mandate to the Red Cross. Against many odds the worker presented Home Service to them in such a way that it fulfilled their expectations of help, but she did not have to create the agency or reshape it for them in terms of their need. The helpfulness she provided is inherent in the function. It is because she defined her help to them professionally—rich in understanding but limited in service and time, and focussed upon the problem at hand—that these few encounters with a young couple, estranged and in a city far distant from their home, could be for them an experience which profoundly affected their way of going forward to the next phase of their living together. No one is able to predict the outcome, and to some it may look dubious indeed; but could anyone doubt that Mr. Fletcher returns to his home port with new strength for the ordeal that faces them and new compassion for his wife? They will probably need further help, and it appears likely that as the occasion for it arises they will again call upon the Red Cross. There is an obligation upon Red Cross to have available for them the kind of skill they have already experienced in Home Service. No social agency can "stake a claim" in a field so vast as problems of family adjustment, without running into conflict and competition with many of the institutions which our culture is continually building up to "service" the family in all its facets. This case seems to ask of a family agency that it share a part of its traditional function with another agency, even accepting some duplication in service and method, but recognizing the other agency's distinctive purpose. Because we live in such critical, changing times, social workers are everywhere in a questioning mood about the social and psychological validity of the services they have been offering. Family case workers are openly questioning whether the family service function, having developed out of other social, psychological, and economic conditions, may be likely to find itself outmoded in a world of new forms of social security and opportunity. But I believe that few people could seriously doubt that in any social order, no matter how broad the coverage of security, there will always be many individuals who will need and seek help of one land or an-

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other for more adequate living, at points of crisis in family circumstances and relationship—help which is not provided through public auspices. I have a strong conviction that social case work, when it operates functionally in giving such help, is not evidence of philanthropic cultural lag; that it not only is compatible with "the democratic way of life," but is a development of technical process in social work which has evolved out of the contemporary culture. The family agency has a genuine right to a place in the community of social work, but only if it is willing to accept the responsibility for a clearly focussed task; and it can ask for support only if it demonstrates a method appropriate to this task. The focus of this task can, however, never be rigidly defined by social workers and supporting community alone, for the propriety and validity of a function derive in large measure, as well, from the individual for whom it exists—from the where, and how, and with whom, he is willing to work in his own behalf. If these factors are taken into consideration by family agencies in that continual readaptation of their function which is necessary in order to meet changing social conditions, family case work will be kept alive and related in service and method to current basic trends in our world.

A SOCIAL AGENCY APPRAISES ITS WORK WITH REFUGEES Sarah S. Marnel THE National Refugee Service, commonly thought of as a sectarian agency serving only Jewish clients, is by the terms of its incorporation, non-sectarian, recognizing in its charter that the victims of Nazi aggression would be drawn from every religious, racial, and social group. 1 It is true, of course, that the majority of the people who have come to the National Refugee Service for help are either themselves practicing Jews—in a religious sense—or are Jewish "racially," the latter group possibly made aware of its Jewishness for the first time by Hitler's treatment. Historically our country has from time to time opened its doors to people who were forced to emigrate from their own countries because of religious, racial, or political persecution, so that giving help to refugees of various generations was not a new experience for our government, nor was it a completely new experience for organized social work. Indeed, many of the sectarian agencies which were established in the nineteenth century developed and expanded their programs to meet the needs of groups of immigrants who had come to this country under somewhat similar circumstances. Up until the First World War there had been periodic waves of immigration to the United States which were first halted by the war and later by the new legislation which placed restrictions on the number of aliens admitted to the country annually. It was not until the advent of Hitler that there was a new mass-immigrant group which clamored for admission. The compelling reason which forced the migration of the twentieth century refugee from Germany and German-dominated countries is basically different from that which brought the earlier immigrants to 1 Actually the non-sectarian character of the agency is in practice primarily expressed through its specialized services (employment, re-training, service to physicians) which are used by the American Committee for Christian Refugees, and other sectarian agencies.

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the United States. They come from different countries and from different cultural and social levels than did the previous immigrant groups. Another difference lies in the totality of their rejection by, and ejection from, their homelands. Any attempt to examine the way in which organized social work has met the problem of helping this new group of refugees rtiust be related first of all to the changing volume of the job itself. From January 1, 1933 (the approximate date of Hitler's assumption of power) to December 31, 1942, there were 207,151 Jewish immigrants and non-immigrants admitted to the United States. (Nonimmigrants are people who have been admitted as temporary visitors, etc. Their status is more insecure than that of the permanently admitted aliens, since they must first be admitted as permanent immigrants before they can apply for citizenship, or before they have any permanent status in this country.) An analysis of these figures shows that the upward trend increased sharply, starting in 1933, when approximately two thousand Jewish aliens were admitted. The peak was reached in 1939 when 51,000 came to the United States. From 1939 the trend has been downward, although in 1940 and 1941 a substantial number were able to gain admission. When these new refugees began to arrive in the early days in 1933, their number was comparatively small and governmental restrictions placed on them were not very great. These early refugees were able to bring with them considerably more of their accumulated wealth than was possible for the group which left Europe in later years. Also, immigration figures show that they were young, which seems to indicate that the younger people, who were less deeply rooted, emigrated first. In New York City from April 1933 through June 1939, local family agencies, in accordance with their previously defined functions, took on the work of assisting refugees. These local agencies had distinct functional autonomy and developed their programs of service in accordance with their understanding of the needs of refugees. It is rather significant, I think, that throughout most of the country, the refugee clientele was separated into a special group and was handled by a staff especially assigned to this particular job. Many practical problems contributed to this practice of separating the refugee clientele from the rest of the agency's load.

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The rapidly increasing volume of the work involved in dealing with these new immigrants placed demands on the existing family agencies which exceeded anything the agencies had experienced in recent years. Also, since most American agencies had had very little experience in offering service to newcomers in the period between the two wars, it appeared to be a new problem. This practice of separating the refugee clientele into a special group represented the first response of the social agency to the emergency character of the problem and expressed its lack of sureness about the kind of help these new clients needed. As a result of a study made in the spring of 1939, it was proposed that work with refugees in New York City be centralized in one organization. These recommendations were based on the premise that "the present organizational structure is obviously not geared to the effective administration of a program which for the year 1939 may involve the expenditure of two and a half million dollars or more." Therefore in June 1939, the National Refugee Service was established as a successor to the several agencies which had been dealing with refugees up to that time. It was to be a national agency, created to help refugees in their economic and social adjustment in the United States. One of its major functions was to be the settlement of the new immigrants throughout the country, preferably outside of New York City, the main port of entry and therefore the locality of greatest concentration of refugees. The resettlement program which the National Refugee Service set up was patterned on a process developed more than a generation ago by such agencies as the Baron de Hirsch Fund, the Jewish Agricultural Society, the Industrial Removal Office, with the purpose of spreading the incoming groups throughout the country to avoid over-concentration in one city. The National Refugee Service established contacts with the existing sectarian agencies throughout the United States, who were asked to participate in this program of settling the newcomers in their own communities. In sections of the country where there were no established agencies refugee committees were set up on a local basis. In some instances these efforts to meet the needs of the refugees who were settling in those localities were actually the first social-work programs ever undertaken. The Intake Service of the National Refugee Service served a

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national as well as a local purpose. Those people who could immediately move out of New York, and who met the eligibility requirements set up by the various local communities, were prepared for resettlement by Intake. The remaining group, who, either for personal reasons or because they did not meet the eligibility requirements for resettlement, could not move immediately, were referred to the Relief and Service Department. The "Relief and Service Department" was the name given to the department created to meet the needs of those refugees living in New York City. Its function was to determine eligibility for assistance, to grant it where necessary, and to make available the other concrete services of the agency. The new department was to have a close relationship with the existing local New York family agencies which had been administering help to refugees. While a certain degree of responsibility for service was transferred to the new agency, it was definitely suggested that "cases requiring intensive case-work services" should not be handled by the National Refugee Service but referred to the existing family agencies. Because of the original intent implied in the setting u p of the agency, "to help the refugee in his initial adjustment to American life," and also because of the mass problem with which it had to deal, the Relief and Service Department in common with all the other departments of the National Refugee Service, directed its services toward- helping the refugee achieve a rapid economic adjustment. Back of this effort lay a deep sense of responsibility on the part of the Jewish community for the economic support and protection of this group of people, articulated in the principle that no refugee should need to seek assistance from public funds for the first five years of his residence in this country. It believed that its clients were "adequate people," who needed only a minimum amount of help while they recuperated from their recent experiences, and who, under their own steam, could be expected to make an adjustment in a comparatively short period of time. For those people who did not "move quickly" the local traditional family agencies would take responsibility. In working with this new group of clients, not only the National Refugee Service but the whole field of social work had much to learn. It might have been hoped that the experience gained from the depression years would have taught social work that mass

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catastrophe does not necessarily mean that the individual remains intact and that all he needs to function adequately again is the removal of the economic strain. The implication that more understanding and skill are needed in giving "intensive case-work help" than are needed in helping a person to use a concrete service dynamically is another fallacy which the field should have recognized from its experience in the early administration of relief. I think it is fair to say that this confusion as to what case-work skill involves in dealing with people who need help existed not only in the so-called lay community, but also in professional social workers, among whom there was little agreement and clarification of this confusion. Clarification must be accomplished if we are to avoid repeating the same pattern each time we are called on to work with new groups of people who need our help. For a time the National Refugee Service functioned under what can best be described as an "emergency" philosophy. In the years 1939,1940, and 1941, when the number of aliens admitted reached comparatively high proportions, there was a mass job to be done. Many thousands of people passed through the doors of the agency. By 1939, too, restrictions on people leaving Germany or Germandominated countries were much more severe than they had been for the earlier group of refugees, so that many reached the United States only after they had undergone long periods of deprivation and hardship. Under the impact of this mass problem, it is perhaps understandable that the agency in the early years put most of its emphasis on helping its clients achieve immediate economic adjustment. It is difficult, when dealing with a mass problem, to get past the mass nature of the problem to see the individual involved. Looked at in its mass aspects, the refugee group was a threat to us. They are particularly a threat to those of us who were identified with them through religion or through what Hitler has designated as "race." The feeling that "there, but for the grace of God . . ." was probably present for the contributing public, as well as for the agency's workers. In addition to the threat which was present for the religiously identified worker, there was something else new in this situation, which was also threatening. For the first time social work was faced with the task of making its skill available to a substantial group of clients who challenged any feel-

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ing of "superiority" that a worker might have about her own status. Many of these refugees brought with them in their backgrounds rich cultural and educational experiences. Many of them had enjoyed a social status which was superior to that of the worker who was in the position of helping them. The combination of the refugee's lack of experience in taking help, the threat it represented to him in further loss of status, the need to make someone pay for what had produced his need for help, plus the worker's own fear of this new type of client, often led to an unconscious fight for control. In this process the worker lost sight of the person, vacillating between periods of lavish giving and periods of rigid denying. Case workers had not yet absorbed their own concept, that each individual person in trouble will react to it individually and will need help based upon his own individual reactions, even though the trouble springs from "mass" trauma. These clients as a group have had one experience in common, the experience of having been rejected, made homeless, propertyless, and fearful of their lives, by a force bent on their complete destruction. That the majority of them had been able to live through such experiences gives one an added respect for the human will-to-survive. The capacity for adjustment and the force of the will-to-live is attested over and over again in the records of any agency that has had the opportunity of extending its services to refugees. Social workers did not, however, understand the difference between the force of the will-to-live, when one is being denied the right to live, and what this living costs when the struggle to escape that external force is successful and the individual must begin a new life requiring new energy. Social workers meeting this problem trusted too much to the strength the individual had shown in getting himself out of the situation in which he seemed so horribly caught, and they expected him to continue to operate with strength and courage without reckoning the price the individual had paid for this achievement. Early interviews in the National Refugee Service were so-called "diagnostic" in content. The client told his story and many times it was indeed horrifying. This was often a trap for the worker, because there was nothing she could do about the past. She could either try to deny the pain it represented, or she could pretend that she understood it. In either event, she was not entirely free to

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permit the client to have his past and to use herself and the agency to help him relate to what was different in his present. Yet this present represented the greatest threat to the client, and inevitably it was the point at which he needed the maximum of skillful help. Case workers only began to be helpful to refugees when they recognized that the refugee experience was not over with the landing of the boat and that the experience of flight can only come to an end when the individual can dare face making a beginning in a new situation. On September 16, 1941, the M. family, consisting of Mr. M., aged fifty-two, his wife, forty, Alice, eleven, and Peter, nine, came to the National Refugee Service for help. In filling out the application form, Mr. M. indicated two requests: "1. Aid and counsel in order to change my emergency visa into an immigration visa. 2. I kindly ask for material help." Behind this request lies the following history: Mr. M. had had quite a brilliant career as journalist and historian in Austria and Hungary, and had published a number of books on European history. During the short-lived Hungarian Republic, he had held an important position in the government. The period from 1933 to 1939 Mr. M. described as "the bitterest years of his exile." In 1939 his wife and the two children migrated, first to France and then to Geneva, where they remained for two years, finally leaving there to go on to Spain. Mr. M. was taken from France to a concentration camp in French Morocco, where he remained for a period of two years, until he was released through the intervention of friends. He obtained an emergency visa and joined his family in Spain. After a long and arduous journey, they arrived in the United States in September 1941. Four days later Mr. M. came to the agency for help. Although he had limited himself to two requests in his written application, in the actual intake interview and in subsequent interviews with the worker he showed great difficulty in focusing on any one problem. Although he verbalized the need for employment, for changing his immigration status, the emphasis of most of his interviews was on his past and his keen sense of loss of status. While he spoke constantly of looking for work and indeed made all kinds of compulsive efforts in that direction, everything he did

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operated to make these efforts ineffective. It was as if he could not admit that he had used his last strength in coming here. He indicated real difficulty in asking for relief directly and yet could not face agency limits in rental and food allowance. Even seeking an apartment became difficult for him. He asked the agency to bide its time before contacting his sponsors and relatives. His wife, too, seemed worn out and unable to undertake anything at the moment. In spite of their persistent statements of their desire to take hold, all of their activities seemed to deny this. Mr. M. "forgot" about filling out his extension of stay until the last minute. He made no effort to obtain work permission, had difficulty in getting affiants. In moments of great anxiety he had difficulty in hearing. As time went on he became more and more self-abasing and his wife more denunciatory of him. They both spoke of the children as being difficult, and each accused the other of using the children against him. Neither saw any solution to their problem outside of separation. Mr. M. wanted to wait until he could support his family but took no positive steps to do this, although he was always compulsively on the go. His wife talked of separation but expected the agency to set her up in a household and take full responsibility for that separation. At the same time the family seemed unable to live within the agency's budgetary limits. Their rent was far above the agency maximum. They splurged on clothing. This period seems, in retrospect, to be one of complete disorganization for the family. A suggestion that Mr. M. might use psychiatric help was rejected by him with the remark that the money might be better used for buying more clothing. So this period ended without any constructive help. In November 1942, a new worker took over the case and made a real start with the family. That her approach immediately felt different to them is indicated by their statement that the worker is a "very unusual person." They shared with her the information that they have always been told "not to rest on their past laurels." The worker pointed up the difference between resting on the past and using it to build on in the present and future. This evidently meant for the family a first acceptance of their past and the strength and status they had achieved, and permitted it to be connected with the miserable inadequacy of their present position. The worker suggested a time limit within which they might try to work out

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something different. During this period she would work with them to make available the agency's specialized resources. Their initial reaction to this discussion was one of fright, followed by a reliving of their previous contacts with the agency. The worker by accepting the validity of his feeling was able to help Mr. M. direct some hostility toward the agency, rather than turning all of it on himself and his wife. By the next interview he had taken sufficient responsibility for the time limit to say that he wanted the agency to give him six months' time and that this would be sufficient. He handled his plans realistically and recognized a relationship between the time element and a potential self-support plan. With the worker's acceptance and support of his strength Mr. M. could move ahead rapidly from this point on. He was able to secure affidavit signers and to send his documents to Washington. Within two months he had an offer and had accepted a job out-of-town with a foreign language newspaper at forty-five dollars a week. He and his wife worked out a plan of temporary separation and then asked the agency to continue to assist the family until the end of March, when Mr. M. would be able to send his wife money and take over full responsibility for the support of the family. Mrs. M. continued her contact with the agency, and she, too, with the help that the worker had given her, was able to make her own decision to move into an apartment well within the agency budget, because now these limits were related to her husband's earnings. She took real pride in her husband's success and felt certain that he would go on to even further achievement, while she herself found some part-time work in teaching students. Mrs. M. expressed a desire to take on more employment, and the worker left the opportunity open for her to return to the agency for help with this plan. In this situation we find that the original approach, which attempted to preserve the man's strength without recognizing the hardship of his present existence, served only to make the family more fearful. With this fear underneath and denied, any step toward change, even the securing of an affiant, was impossible, since it meant giving up the old security and facing the beginning of a new life. To do this would have implied a recognition on Mr. M.'s part of the fact that he was here to stay. To accept this had in it for him the fear that he could never recapture his previous status.

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Implicit in the approach of the second worker was her understanding of the traumatic nature of his experience and her comprehension of the necessity of admitting a separation from the past before the new could be taken on. She understood the importance of permitting the feelings, which such an experience of change precipitates, to be articulated. Above all she recognized the part the agency can play in helping an individual deal with these feelings if it is willing to carry the negative role for a client when he needs this, in order to get through to an active relation to present reality. The agency's early emphasis on immediate economic adjustment, which resulted often in adjustment on a minimum level, contributed to the feeling of unreality and temporariness which so commonly pervaded the refugee's experience of being uprooted and thrown out into a strange world. Only with time and experience have case workers learned how to help them deal with the essentially real, inevitable and permanent aspects of this experience. True, we found many refugees proving to themselves quickly that they could live and compete with other people. These individuals, through the pressure of their own psychological needs, forced themselves to make what appeared to be a rapid adjustment to life in the United States. Some are able to manage from this point on, but for others it leaves the real adjustment still to be made. Some of these latter ones come back to the agency with a request for help in working out a future plan. The client's plan, when analyzed, seems to be well thought out from the point of view of achieving better work opportunities as he now knows them to exist in the United States. At this point these people seem to be saying to us, "now we can risk putting down enough roots to think in terms of the future—a future based on America." Actually, through a slower, more independent process, these clients have achieved the ability which Mr. M. acquired with the help of the agency, to face a life in the United States which involves building anew toward a permanent goal, and they are now able to take the help they could not accept at first. Another large group of refugees has neither sought nor used any formal outside help. They manage to find their own way and to start again in this country externally, at least, to build anew and to recapture part of what they once had. It has been argued that

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the superior equipment of this group, plus their previous wealth, accounts for the quick adjustment they have made. But our knowledge of clients who do come for help indicates little relationship between their ability to make an adjustment in the new country and their previous educational, cultural, and financial achievement. Our experience points convincingly to the fact that a person's ability to make a new adjustment is dependent not upon superiority of equipment or resources but upon the availability to him of his own resources. This availability rests upon an emotional freedom to use his previous skills, his intelligence, and his experience in living, to develop new skills or adapt old ones for use in this country. We have seen numerous individuals, intelligent and well endowed, spend months of seemingly futile painful struggle until something could penetrate the barrier which walled off the old self and could release its resources for use in this new situation. We have seen unexpected and amazing results when that barrier has been penetrated and energy released for creative and constructive use in living. We have learned that until the person is free to use and develop the skill he has, no real adjustment is possible. In order for an agency to be helpful and to function responsibly, it must recognize that the decision as to the help the individual needs can only be made between the case worker and the individual client within the framework of the agency's structure. The worker must have available all the skills the profession has developed if she is to help the client in terms of his own capacities, experiences, and present attitudes. The decision as to the kind of help the individual needs and can use can only be made if the structure and philosophy of the agency allows for this individualized approach, rather than being predicated on the philosophy that a mass problem can be dealt with by a mass approach.

DISCUSSION Helen Wallerstein WHILE there are a number of points in Mrs. Marnel's paper that I should like to discuss or enlarge upon, actually I want to pick up at her concluding sentence—the "decisions as to the kind of help individuals need and can use can only be made if the structure and philosophy of the agency allows for individual approach, rather than being predicated on the philosophy that a mass problem can be dealt with by mass approach." I am doing so as a representative of one of the few agencies in the country, the only agency I think, that has continuously, from the beginning, carried refugees as an integral part of agency case loads. In this agency, the Jewish Welfare Society of Philadelphia, refugees have never been carried in a special department or by special workers, but on the regular case loads along with native clients. We have not, to be sure, been faced with a mass problem, such as that of the National Refugee Service, but we were one of the earliest agencies to handle refugees —I think our first refugee client came to us in 1935—and actually we have helped about two thousand different refugee families and individuals. Although from the beginning we had a conviction that casework techniques, as we had been accustomed to use them, ought to be applicable in working with refugees, there was, nevertheless, considerable uncertainty in our early work and we were conscious of many of the problems discussed by Mrs. Marnel. Workers here, too, were challenged by the social and previous economic status of these newcomers, especially the first newcomers. There is one point, however, that I think has not been emphasized enough, either by Mrs. Marnel in her paper or by other discussants of work with refugees. I refer to the fact that we had recently been through, or were, at the very time of the first refugee immigration, actually going through a somewhat similar experience of mass trauma in the United States, that is, the experience undergone by many 89

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persons who had been able to survive the first years of the depression but who had been forced to apply to the public agency and to private agencies during its last years. This group of clients came frequently from the same social and economic strata as did the first refugees. The catastrophe that they had suffered—and we must remember that it had taken place right here in the community where their lives had to go on—was for them a traumatic experience, though no doubt to a lesser degree than that experienced by refugees. The emotional factors in dealing with refugees were so great that I think we lost sight of this similarity where it might have been used more helpfully, especially with the earlier immigrants who had not known the terrors of wandering from country to country, of concentration camps, and the scattering of families to the four corners of the globe. These firstcomers were almost entirely from the upper and professional classes, and while the later group came more from the middle class and finally even from the laboring class, the preponderance was always from the white-collar group. In addition to this, those who came here were largely the most enterprising and able of any of these groups. Thus our depression experience was somewhat reversed and there was a meeting point —almost an over-lapping point—of which we had little awareness. Mrs. Marnel has spoken about the protective role of the agency. This is important to any family agency accepting responsibility for refugees. In Philadelphia and Pennsylvania, because of the state law which excludes non-citizens from general relief rolls, it has not been a matter for discussion or decision but a fact to be accepted. It seems to me that it is a point of special challenge to an agency working with refugees. Any agency, even a family agency working with refugees, must find a point of focus within its structure and the limits of its function, where agency and client can meet and work. This is no different in working with refugees, but perhaps even more essential, since these people need above everything a point of focus. The public agency has such a focus in its terms of eligibility. The Jewish Welfare Society found a similar term, if it is fair to call it such, in the necessity of contacting the affiant or affidavit signer. This proved a great help and a wise step, because much of the struggle that a refugee, like any other client, has to go through in accepting help could be focused on this one

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point set forth at time of application. We found that, except for unusual or extraordinary reasons, until a client was able to accept this necessity, he was not ready to accept the taking of help. Mrs. Marnel speaks of the problem that workers had in helping the refugee to separate from his past. The worker, she says, was "not free to permit the client to have his past and to use himself and the agency to help him relate to what was different in his present." I think there are several things involved in this to which we have not given enough attention. For one thing, in many cases, no matter how much the refugee client was able to orient himself to the present, he could not free himself from a past in which, often, his nearest kin were still caught. The worker had to learn to recognize this problem and to deal with the tendency in the client, especially the more unadjusted client, to use this involvement to resist the demands of the present. There is a further point that I find difficult to define, and one that I have not seen discussed, the gradual recognition of which has had a very important place, shall I say, in our development or growth as workers with refugees. Because of the total circumstances surrounding the coming of the refugee client to us, we as workers had a too complete separation from him as an individual. While we related him to a past, this was an immediate past, so fraught with emotion for him and us, that we were apt to forget or overlook an existence which he had as an individual in a setting familiar to him but completely unfamiliar, for the most part, to us. Even in an agency emphasizing individual work with refugees, and in the beginning with very small numbers, the identification was apt to be entirely with these clients as refugees, that is, as one of a group of persons who had had a common experience, rather than as an individual who had had an individual and separate past and who brought with him an individual personality. I know that in my own experience I reached a real milestone the day when I said to a worker with whom I was discussing a case that we had discussed many times before with little result, "the trouble with us is that we keep on talking about a 'refugee.' This man's problem is not that of a refugee, this is a man with a very serious personality difficulty." What I want to emphasize here again is that skilled case workers, given agency support as to their place in the situation and conviction about the function of the

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agency, found that they were able to work with refugee clients as they were working with native clients. Just as we did not think of native clients in terms of groups of problems but rather of each as an individual bringing his own special problem to the ageney for help, so the job with refugees was to help each client focus on certain problems on which he needed help and to work with him on these. To be sure, the worker had to learn new skills to meet special circumstances. She learned, perhaps somewhat slowly, to recognize when a refugee client's difficulty derived directly from his recent experiences or simply from his necessity to make a new start. She learned to separate this refugee from the client who was presenting problems which may have been accentuated or even crystallized by his experience, but which were not directly the result of it. This is what I mean when I say that we were hampered by not having lived in the refugee's past and not being at home in it. It is true that few, indeed, if any refugees, had known either social agencies or the meaning of case work, but we were not at first very quick to recognize him as a person who had, just the same, many experiences parallel to ours, to those of our friends, and to those of our own clients. I think I have used before the story of the client to whom the worker was attempting to explain what a psychiatrist was, so that he would accept psychiatric care, only to have him burst out, "Oh, I know what you're talking about; I went to a man like that years ago in Vienna." I will now go on to a side of the picture that Mrs. Marnel has not been able to give at all, since in resettlement cases she represents only the sending side. I want to talk a little about the clients who have been resettled, since my agency has been very much on the receiving end. It is hard here not to paint a glowing picture, because for the most part resettlement has been a very positive experience, in spite of the fact that there have been many failures and a number of resettled cases have returned to New York. The great majority of resettled clients, however, have themselves had a successful experience and usually, where there has been an inability to resettle or where resettlement has proved unsuccessful, the problems that have developed have been individual situations, neither inherent in the status of refugee nor in resettlement per se. Here, again, the skilled worker found that she had to develop new ways of working. When the refugee-client first reached town,

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he had only one thought in mind, a job. No matter how carefully it had been explained to him that this was not the plan, he still insisted that he was coming for a job. He may have been sent for re-training in the machine-operating project which had been set up, and he may have accepted resettlement on that basis. Just the same, when he got here, it was not re-training that he wanted, but a job. The case worker had to learn to meet this problem, not only because in most instances there was no immediate job, but because very often the client himself was actually not ready for a job and could not have held one if it had been waiting for him. Yet he did need some sort of activity. This activity could be focused on all the things that had to be done before he could get settled: finding an apartment; discussion of the budget, which was different from the budget that he had had in New York, if he had been there for any length of time; buying of furniture; getting children settled and in schools, when there were children; getting started learning English; and, finally, the hardest of all, helping him to a realization that he was not himself ready for a job until he was much more than physically resettled. Then, in addition, in the early years, he had to face the difficulty of finding a job, because we were still in the midst of a depression and one of the fallacies that all refugees brought to this country was that it was a land of plenty with a job for everyone. He might have been told in New York that there were no jobs there, but that meant nothing to him when he reached Philadelphia. Still, coming to a new community, to an agency ready to help him establish himself on a permanent basis if he wanted and was able to do so, held definite opportunity that often proved very helpful. I should like to give as briefly as possible two resettlement cases, since they seem to me to point up many of the things that we have been considering. The first—I admit it is my pet case—is a very simple and successful story, and yet I feel a fair example. Mr. G., his wife, and child had been in New York for about six months before they came to Philadelphia for resettlement. In New York, Mr. G. had been unable to find any work and had had a disheartening experience. We were somewhat hesitant about accepting this family because they were extremely orthodox and we questioned adjustment in an urban community. However, although in Europe Mr. G. had had

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a successful career as a schoolteacher in what would here be called a vocational school, and was a fine Hebrew scholar, he had expressed himself as interested in learning machine-operating and we decided to let the family come. Mr. G. proved very quick at adapting himself to this trade, liked very much the manual work entailed, and graduated in record time. Although at this period placement was not easy, he nevertheless was placed in a job at once. His income, at first, was not enough to support his family, and the agency supplemented it. Before very long, Mr. G. reported that he would need less money from the agency because he had secured some violin pupils. Next, he thought that he would be able to manage alone, because in addition to the violin pupils he now had some youngsters to whom he was teaching Hebrew. Shortly it was agreed that agency help was no longer needed. Mr. G. did occasionally write his worker, not, I think, because he was unable completely to separate from the agency, but because he was, humanly enough, a little proud of what he had been able to do. His last letter, which arrived as a New Year's greeting, told the final chapter of his story. He was moving to a larger house because he and his wife had taken two children, who had come from the same town in Europe where they had lived, to live with them. The story is not quite complete here, because their taking of these two children involved another refugee story. These children had been brought to this country for settlement. They had been placed in a city in the West and had been unable to make a happy adjustment there because they were so extremely orthodox that they did not fit into any available family setting. Since I am not a children's agency worker, I do not know just how this was arranged, but they were brought East to the G.s' home, with the happy result recorded. The second case took three years to bring the client to the point where, as Mrs. Marnel says, "he dared to face making a beginning here." Both Mr. and Mrs. P. as single individuals had migrated some years ago from Germany to France, where they had taken up permanent residence. Mr. P. had been a moderately successful salesman of textiles. They had known each other slightly as children. In Paris they met again and about two years before Mrs. P. came to this country they had married. Mrs. P., while a single woman, had applied for a visa and when her name was reached it

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was decided that she should migrate, since she had relatives whom she wanted to help bring to this country and, also, it was felt that her being here would make it easier for Mr. P. to come. Therefore, she came to New York more than a year ahead of her husband. When she arrived here, she found herself pregnant. She lived with a brother and made some money by sewing. By the time Mr. P. got here she was fairly well settled and spoke English well. About a week after his arrival at the port of New York this family was resettled in Philadelphia. In addition to the usual problems of resettlement, many others at once presented themselves. Although the P.'s had seemed to consent readily to resettlement and had relatives here, once here they showed great resistance. Getting settled and accepting the agency budget was a problem. In view of the fact that he had learned fluent French, it was significant that for many months Mr. P. was unable to conquer the rudiments of English and refused to take any steps toward learning it. This was tied up with the job difficulty. During the last months that he had been in France, Mr. P. had begun to learn to be a baker, since he had been told that this was something that would be useful when he reached America. Although his training was slight and he was totally inexperienced, he was throughout unwilling and unable to accept any suggestions for other jobs. This continued even after all efforts of the Employment Bureau and his union to get him work had failed. In one interview the worker noted, "he presented truly a pathetic picture and was clinging to his baking work as if it were life itself"; that is, baking seemed to him to be a symbol of all in the past that he was unable to surrender. We must remember, too, that although the P.'s were the parents of a child now two years old, they had never actually experienced family life, and along with all the other adjustments to be made they were only now undergoing the experience of adjustment to each other. On top of this, Mrs. P. again became pregnant. It was Mr. P. who reported this to the worker, expressing great unhappiness and conflict. What really seemed to disturb him most, he told me, was that his wife blamed everything on him. How could one person stand so much? Mr. P. spoke quickly, telling me about a brother of his who was in a concentration camp, about a sister who was in Sweden, and that he hadn't heard from either of them or any other of his relatives in Europe for so many months.

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Mrs. P., too, was reacting to this situation by putting undue pressure on her husband. Before the first baby was born she had done some sewing at home. She now refused to do any work, saying that she would not work so long as her husband was not supporting her; that was the man's job. I shall not attempt to go into all the details of the case-work process that brought this case finally to a termination. I do want to mention, however, that at one point the worker received great help from a relative of Mrs. P., who happened to be known to the agency, although not as a client. Through his discussion of his cousin's situation here, he was able to point out important factors in her cultural background; how unusual it was, for instance, for a single woman to have left a secure home in Germany and gone on her own to France; how completely foreign to the pattern of society in which she had been raised it was for her to have married in France a man little known to her family, without their consent and without going home first. These factors, which the worker was now able to recognize as the cause of much of the guilt she displayed, had been outside the familiar pattern of the American worker. Understanding them helped her, among other things, to accept the pace of these clients. "Although we assisted the P.'s," she says in her closing entry, "for a period of three years, the situation was never static. It did seem that the P.'s needed a longer period of time to work out things than the average refugee family known to us." Finally, Mr. P., who had failed in job after job secured for him, himself answered an ad in a paper for an assistant cook in a large chain of restaurants and secured the job, soon making a warm friend of his boss. As soon as Mr. P. was really working, Mrs. P. began to take in sewing and in the final entry in our record was reporting herself as doing quite well and telling the worker how glad she would be to do some dressmaking for her. Even in these brief summaries, I think it is evident that while there were special skills the workers learned to use as a result of long contact with refugee clients and growing sensitivity to the special problems of these individuals, the case-work process, except as it was shaped to meet individual need, was no different in these situations than in those of any other client of the agency.

T H E USE OF FEE IN T H E CASE-WORK PROCESS IN A FAMILY AGENCY Frances T. Levinson THE Jewish Social Service Association established the Consultation Center, a fee-charging division of the agency, with the following definition of its purpose and function: Consultation Center was to be an extension of the family case-work services of the agency to a group who could afford and who wished to pay for case-work help. F e e was thought of as a way of meeting the psychological need of people to pay for services received and of breaking up the identification of case work with its relief-giving aspects alone. I do not think we anticipated the extent to which fee-charging would affect the case worker, nor could we forecast its useability as a way of relating the client to his problem and helping him work toward a solution. In starting with the effect of fee on the case worker I have used the initial, often the extreme, reactions in our experience, since they illustrate not only the case worker's attitudes, which have to change before she can handle "fee" with any ease, but also the kind of supervisory help which is indicated. At Consultation Center, the staff had insufficient supervisory help and preparation at the outset. The experience was as new to the supervisor as it was to the staff, and instead of anticipating some of the attitudes and difficulties which might arise she did not recognize and handle these problems until they found expression in the worker's performance. There was one more complicating factor in the beginning. The demonstration was new in the family case-work field, and the workers themselves carried the burden of determining its success or failure. They were not only being tested by a new group of clients, who were determining the value of case-work help through this contact, but the workers were "on the spot" professionally, also. Either one of these factors was difficult to handle, and both 97

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would have been impossible for less mature and experienced workers. It is significant that as workers now join the staff, they do not have to go through the same experiences as these pioneers, nor do they feel as challenged by the factors external to the case work process. Although the Center is just over a year old, even this year gives it a history, and workers are no longer as threatened by its difference. They feel that there is a body of experience from which they can learn, and while study constantly changes the concepts and practice, workers feel that there is a structure to which they can relate. It would be well to look at the previous training and experience of family case workers to determine what differences client payment creates for the worker. Case workers are accustomed to being paid by an agency for a service rendered to an individual or a family. This service at times includes granting relief or making available other concrete resources as a way of helping the client change his situation. The worker is trained to understand the client's feeling about taking help and his fear of losing control because he is at the receiving end and has no way of repaying the worker directly for her help. In case work, the return from the client has been in terms of the client's ability to handle his situation more adequately or to respond differently to a new problem when it presents itself. Most clients do not feel free to verbalize the standard of performance which they expect from the worker, nor to set up controls for the worker's behavior, since they are not paying for service. On the other hand, the agency which pays the worker does hold her to known standards of performance, and indicates, through supervision and formal evaluations, the worker's ability to meet and maintain the quality and quantity of work which it expects. Unconsciously the result of these unique transactions is the development of a feeling on the part of the worker that she is granting a free benefit. There are many factors which play into this feeling on the part of the worker. Case work is an exacting profession and one which makes constant and serious personal as well as professional demands on the worker. The client's attitude, plus the kind of responsibility a case worker takes for another human being, combine to give the case worker a feeling of nobility, which includes a sense of dignity as well as a sense of power. This is an almost inevitable concomitant of the necessity to perform at

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such a responsible level and to have to continue in the pursuit of greater skills. Payment by a client for service, even if this is just a token payment, interferes with the free play of these feelings. In a fee agency, payment is made by the client for the service which the worker renders to him within an interview. It follows from this that the first concern of the workers could easily become not what the agency expected of them in this new experience, but what the client had a right to expect for his money, even though he would, of course, have no idea what is involved in the case-work process. While this is also true of clients who come to a non-fee agency for the first time, case workers have developed through experience a security in interpreting free case-work service and a conviction about its usefulness which enables them to handle the clients' questions and doubts about the value of case work as a way of helping. I do not think we have appreciated the extent to which our security in handling this has been vested in our feeling about the hold we had on the client because the service was free. I do know that the workers' first fears in the fee set-up related to the amount of control the client would have if he paid. There was even a question as to whether we would not have to render our service differently, as a way of helping the client to accept contact. I also know that through this period the validity of case work was more questioned and tested by the workers themselves than any client could ever have dreamed of testing it. The worker was caught between her identification with the client who had come for a tangible service, which he could almost package and carry away, and her identification with the case-work process which she had used successfully in the past. The identification of the worker with the client's expectations had a positive as well as a negative effect on the worker. The negative aspects are obvious. There was a block, in the beginning, in the transference of the worker's previous experience to this new experience. Fundamental concepts and ways of operating seemed to desert the worker, and her approach was characterized by extreme self-questioning. What could she give a client that was worth his money?—this in spite of the fact that she had in the past given a service which she and the agency felt was fully worth the client's time and energy and the community's funds. This uncertainty was

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reflected in the worker's inability to inject any control into the contact. In intake interviews the worker followed the client, and when she tried to inject anything new or different her effort to give the client a feeling that he was getting a concrete immediate return led to awkward fumbling. Out of this came a recognition that if the worker were to relate only to the fact that a fee was being paid and that the client expected a crystal-gazer's solution to a problem, she really could not help at all. Throughout this struggle, we were learning something about the meaning of payment and how payment could be used in case work. Gradually as payment began to take its place in a process, it became something the worker could use as an integrated part of the process, rather than as a control of herself and the client. This eventuated in a greater security in the use of case-work skills, since the worker was freed to help the client and to utilize positively the fact that case work is a different way of helping from any experience the client has known. Finally, recognition that the very use of a fee could itself be a way of helping, supplied the first real freedom we knew. The worker could now take hold of the problem seriously, test the client's willingness and desire to use case work toward a change for himself. She could now bear the client's right in contact, the client's inner right,—not only because he was paying for what he received,—to accept or reject another person's way of helping. And as a result, the worker now felt free to accept or reject the client on a case-work basis, rather than on the basis of his willingness to pay a fee for contact. It may sound contradictory to say at this point that in a casework contact the client's payment of money does not really change the worker's role. If the client is to be helped, it is essential that the worker remain related to the client's feelings about taking help and to the fact that these feelings do not change radically because he is paying. Nor can the worker turn over to the client complete determination of the conditions under which he will take this help because he can pay, any more than she leaves it to the non-paying client to determine the conditions on which agency help may be obtained. In the experience of Consultation Center, few clients have come with any knowledge of the case-work way of helping. The name of the service is itself misleading, since the word "consultation"

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does have an existing meaning. "Consultation" is understood to mean a process whereby an expert's diagnosis and advice are sought. It is generally assumed that the seeker will be given the best thinking of the expert but that the expert will in no way assist in carrying out the recommendation. The participation of the person seeking the advice is usually limited to his description of the problem and its history. In some fields the applicant may have to submit to examination or tests. In practically no other field does the client have to play such a vital part in determining the solution. Seldom does the applicant have to prove his willingness and ability to use constructively the "advice" he is going to receive. The specialist who is consulted may have a professional and personal stake in having his recommendation carried out, but he will not hesitate to make it, nor does he feel he has the right to refuse to make it, because it is apparent that the applicant will not use it. There are many situations in which applicants to Consultation Center come with a clear-cut request, for which a specific recommendation can be made. A young man about to be inducted into the service wishes the name of a good home for the aged where his mother can be placed. A young divorcée wishes the name of an adequate boarding school for her youngster. A young woman wishes to move from her parents' home and wants help in determining the relative merits of various living arrangements. A woman wishes to leave her husband and is unclear about her legal rights. But the case-work way of helping involves more than knowing the client's verbalization of the problem. It necessitates knowing whether the client has given an accurate picture, and if not, the worker has to determine what emotional needs color the picture. It involves knowing what a best solution would be, not in abstract terms but as it relates to the client's emotional and practical ability to carry out the plan. It also strives to enable the client to attain that best solution. In a few situations the client coming to Consultation Center does not have to change his original concept of the service. That is, he comes in, tells us his problem, and secures a specific piece of information for which he pays a fee. He may know that he received careful, individual attention, that he feels more comfortable about his plan, and that the case worker injected some new ideas by

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which he could test the validity of his plan but, by and large, nothing too unexpected happened to him. These situations are usually those in which the applicant is clear and has a good plan, but either doesn't know the resource available or needs the approval of some outside force to feel free to go ahead. While the worker has answered her case-work questions through the interview, in order to know the validity of the plan and the client's ability to carry it out, she has not needed to set up for the client any new definition of taking help or working on his problem. Here fee makes little difference to the worker. For the client it makes possible taking a service which probably would not be socially acceptable to him on a free basis, and it makes available to him a more thoughtful, rounded way of evaluating a solution. The content is very different where the client and his relationship to his problem indicate to the worker that there is a need for change in the client's use of himself in relation to his problem. Here the worker injects into the intake interview a preparation for a continued case-work contact and undertakes thereby to give the client a new understanding of our service. The use which the client makes of fee in this discussion gives us an immediate indication of his ability and willingness to make some change. Miss R., an attractive librarian in her middle thirties, came to the Center presumably to make a plan for an aged mother. It was obvious that her real problem was her inability to assert herself or take the responsibility of creating and carrying through any plan which she might feel would make her happier. This was true of her social contacts, her career, her living arrangements, and her way of handling her money. By the end of the intake interview, she knew that advice about homes for the aged would not answer her need. She also knew that continued contact at Consultation Center meant that she would be participating differently in determining her own destiny. The fact that she was quite clear as to what contact meant was indicated by her reaction when she was given a choice at the end of the interview as to whether she wanted to work on a plan for her mother or whether she wanted to determine what she was going to do about her poor vocational adjustment. Her replv was that it would be more honest to face her own problem; if she ever did, then a plan for her mother would result naturally. The intake worker did not know the extent of Miss R.'s conflict about taking

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help until fee was discussed. The client participated in this discussion actively and then in arranging time for payment (clients are given a choice of being billed once a month or paying weekly) she asked to be billed at the end of the first month, after which she would pay weekly. There was a practical reason for this, which she might or might not have used, depending upon how she felt. Actually she put into her response to the time arrangement for payment of fee her whole question as to whether we could help and whether she could take help. When the case worker realized this, she was able to help the client verbalize her questions. If money had not been involved, I do not think the worker would have been able to make apparent Miss R.'s question about herself and her distrust of the experience. Payment here also met another need. Miss R.'s life philosophy is that she should be able to manage without the help of another person. While she is learning t o take help, payment lessens the guilt and resistance which would increase as a rolling snowball if there were no outlet for the need to give as well as to receive. Both the client and the worker needed something concrete and fixed in this situation around which to test the client's willingness to take a chance on herself. She was actually putting it in terms of paying at the end of a test period. The case worker continuing with the situation had something to take hold of in her contact and could use the client's relationship to pavment as a gauge of her ability to work on her problem. While in the experience where fee is not involved, the client can use lack of time as a way of expressing his fear of contact, it is not as easy to take hold of, nor as intelligible to the client, as his reaction to fee. If Miss R., in the continued contact, had expressed inability to go on and had attributed this to the cost, as has happened in other situations, the skillful case worker would be able to use this for clarification of the underlying attitudes. The worker can use it also to express her own difference and her role as the helping person. The client who is paying has more freedom to accept or reject the case worker's thinking here than in cases where no payment is involved. The case worker's time and skill are not being given to the client as a gift, and the client can make a choice as to how she wants to spend her money. Also the worker puts a new value on her own time, which is worth money and not to be expended lightly or to no end.

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There are many other ways in which the client uses fee at the outset, which are an indication of his attitude toward contact. There is the client who wishes her husband billed for contact, or who insists, because she is paying, that she has the right to'switch appointments every week; or the man who expresses his fear by maintaining his importance through calling only an hour in advance for an appointment and offers to pay more because special service is involved. All of these manoeuvers not only express attitudes toward taking help; thev also give the worker a real indication of the client's usual way of handling his problems. Probably if we worked on the client's use of fee alone, as an indication of the way he is relating to others, a change could be effected. We have, however, made fee the focus only where that seemed the best way of getting into the problem. In the illustration of Mrs. A., who wished her husband to pay for her contact, we have a woman who comes because of a bad marital situation. Her husband is completely indifferent to her and she has become a housekeeper in the home. Contact revealed that she has always used him as a financial resource and had never given him anything of herself. Here again she planned the same set-up. She would come to the Center for help, he would pay, and she would remain uninvolved in contact. In the regular district of the agency, if she had ever come, which possibility I doubt, it would have been very difficult to clarify with her that this had to be her contact. To her, her very coming physically and spending an hour in an interview would have parried that statement. At Consultation Center, on the other hand, contact could be clarified in terms of its being only her problem with which we were willing to help. To make it truly her problem meant to use her own money, from her own allowance. At this she thought very seriously about the advisability of making another appointment, although previously in the interview she was all set to go on. The very fixing of the fee, since we have a sliding scale, gives some clients an opportunity to clarify their feeling about attempting any change. Mrs. L. was very upset by her inability to secure any help with her eighteen-year-old daughter. She had tried everything—boarding schools, private camps, psychiatric treatment— all to no avail. Yes, she would be interested in seeing if we could help her but unfortunately she could not afford our service. It was

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only when the worker pointed out that Mrs. L. did not know anything about the fee, that they had not yet discussed fee, that Mrs. L. was able to gain a beginning in understanding of her fear that someone would help her in relation to her child—that she might actually lose her problem, not that she might fail to obtain help with it. Factually, Mrs. L.'s income made it necessary for her to pay the maximum fee, and again she protested. The worker handled her protest realistically, in saying to Mrs. L. that only she could decide whether she wanted to work on the problem and what it was worth to her. We could only make working on it possible bv setting up the facilities and determining the case cost. We could not even say that her payment of a fee would mean that she could be helped. We were not sure. Mrs. L. decided to continue contact. Throughout the contact, she put her feeling about changing her relationship to her daughter on the pavment involved in contact. She even went so far as to try to have interviews over the phone, which meant that she wouldn't be paving. It was through the worker's handling of her attitude toward money and giving up money that a change in relation to her daughter was effected. Throughout contact, the client may continue to indicate his relationship to taking help and whether he is being helped, by his use of payment. After four interviews, the case worker learned that Mr. B. was paying for his interviews in advance. Mr. B. was coming to Consultation Center to make a plan for a twenty-year-old son, who had been under private treatment for schizophrenia for eight years. The father had created a private institution in his home for the boy and devoted all his time, energy, and money to his care. He had refused to accept the psychiatrist's recommendation or diagnosis but knew that he was breaking under the strain. The case worker had been unable to inject anything which made any difference to Mr. B. He continued his same arrangements and refused to think in terms of what he was doing to the boy and himself. It was only when the case worker challenged the way he was paying, and when both were able to recognize that his advance payments were a way of insuring the fact that we, too, would make no difference, that any movement toward taking help was started. It is significant that payment itself does not take care, even superficially, of the question of some clients as to whether they are entitled to help. Miss E., a clerical worker, who had been exploited

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by a woman employer with whom she had established a relationship similar to the one she had had with a domineering, competitive mother, came to the Center for help in changing her job. At the beginning of the second interview, she sat fearful, huddled in her coat and obviously afraid to go on. Miss E. explained that she must not stay too long, after all she was only paying the minimum fee of one dollar and was not entitled to much time. In handling this the worker was handling the client's whole question about herself, how much value she had and what she would dare to invest in herself. While payment carries with it the socially acceptable way of securing service, and gives the client greater freedom, it also carries a good deal of pain for some clients. Mrs. M., a professional person in her forties, came in to discuss her marital situation. It was apparent, in contact, that she was threatened by her husband's popularity, his ability to establish good relationships without effort, and his easy acceptance by others. She had always struggled and had to pay for anything she got. Contact was hard for her. She had difficulty in accepting the worker's difference, and continuously projected on to the worker her own lack of freedom and distrust of herself. After the seventh interview, however, she finally found herself comfortable with the worker and able to talk about her husband's qualities as assets. Although she had rigidly paid for each interview previously, this time she left the Center without paying. In handling this later, it was hard for the worker not to give the interview to the client as a gift and yet it was only in the client's ability to face her debt and admit in the paying that she had gotten something money could not pay for, that we established any difference in her relationship to her problem. Only when this client could pay for something and not feel that the paying destroyed the value, could we trust the fact that a different organization was taking place. Regardless of his pattern, the use which any client makes of the fact that he is paying is of extreme importance. Many clients want to use payment as a way of purchasing a solution instead of working on their problem. They are delighted with the fact of a fee and frequently suggest that it is too little to pay. Mrs. F., a personnel worker, came to the Center because she was losing her job. Within a short time the worker learned that Mrs. F. always lost jobs. She

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was separated from her husband, and her four-year-old daughter was placed with a friend. Mrs. F. wanted to use contact to tell in dramatic fashion of her many accomplishments and to present fantastic plans for quick success. She told the worker that she was paying for the opportunity to present herself accurately and it was for the worker to present her with a solution to her problems. The worker permitted this to go on for three interviews while the client became more and more unrealistic in her ideas. Finally the worker handled directly with the client the fact that this contact couldn't be worth her money. The client rightfully answered that it was. The worker then injected the additional fact that, even so, it wasn't worth the worker's or the agency's time, when she was unable to be helpful and as a matter of fact was abetting Mrs. F. in evading her problem. The client used this sharp differentiation to test the worker further and, finding her steadfast, finally began to use the contact to handle realistically the confusion she was in on her job. It took a number of interviews before any marked change was perceptible in her way of relating to her job responsibilities and there was much moving back and forth. When, finally, she was told by her employer that she seemed more relaxed and better able to carry through the firm's procedures, she was quite proud and talked in the same interview of the fact that while she was paying for her daughter's care, she had begun to feel that this did not end her responsibilities as a mother and maybe she had more to give than money. The worker expressed her belief that Mrs. F. did have more to give than money, once she could relinquish her old habit of using it "to pay her way" because she felt that she gave so little of herself as a human being. Another illustration is Mrs. S., who came because of a problem with her ten-year-old son. Mrs. S., a divorcée, was supported on a very adequate level by her parents. She had never assumed any responsibility for herself or her child and it was obvious that the youngster's negative behavior was an effort to force her into the rôle of a mother. Mrs. S. tried to strike a bargain in contact. She would pay if we would change the youngster and leave her out of it entirely. This arrangement was the only relationship she knew how to establish. Even her parents paid her for the privilege of treating her as a child. She was rather indignant when we said that payment was only a part of contact, that she herself would have

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to create the situation which would enable her youngster to change and that all we could do was help her make this possible. The worker realized that Mrs. S. was indignant just because she understood exactly what was meant and that she couldn't "bargain" with the agency. She could only decide whether she wanted to continue with the purpose and payment which using agency service would require. Meeting conditions set up by another person is a new experience for Mrs. S. and if she can continue to relate to it, it may prove to be the first one in her life which does not permit her to buy her way out, although she pays a fee. Another serious problem on which we have been working at Consultation Center is the determination of the ending of contact. While this does not relate to the fee aspects of the service alone, having a case load which is completely devoid of relief-giving and in which many of the cases have no concrete plan which will determine the ending, has forced us to think in terms of some external factor to which both the client and worker can relate. I am not discussing here the situations in which the effective carrying out of a plan determines the ending, such as in helping a client accept psychiatric treatment or complete a vocational plan or secure a position which uses more of his ability and training. I am referring to those situations in which we are helping the client change his relationship to a marital partner, an employer, or a child. Possibly the very skillful, sensitive worker can depend upon being sufficiently attuned to the client to know when as much change as the client can take at the moment has been accomplished. She can then interpret to the client his impulse to end and help him to leave agency so that his gains are ensured. This is difficult to do and hard for the client to take, particularly the fearful client, who, while he wishes to be on his own, nevertheless likes the security he has attained with the worker and the feeling that he is not entirely on his own. The client says, rightfully, "I have made so much progress in this period of time, why can't I go on and see if I can do even more about my situation?" The fundamental question in this is at what point does the case-work process lose its value as professional helping and become "a way of living for the client." There is always room for improvement and by the same token always a reason for contact. We have thought of case-work contact as a means by which the client can learn what is realistically possible as a way

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out of his difficulty and as a method of attaining this. At some point it has to be said that "this is as good as it can be now." The experience of having the case worker say to the client "You have given the solution as much as you can" has value, not only in the client's recognition that he has met his existing problem, but in his attitude toward new problems as they occur. He now has a new organization which enables him to make a beginning with new problems as thev occur rather than to let them grow until they throw him. This maturity also enables the client to know that living consists of meeting and handling problems and that growing up is learning how to work with your situation so that it won't destroy you. It is working toward this ending to contact which makes taking help positive rather than a symbol of inadequacy. Recently, we have tried to handle this by saying to the client that we will go on together for a specified period of time and determine at the end of this time, two or three months, the difference which case-work help has made and how much longer contact is indicated. This grew out of some experimentation we were doing in intake interviewing. Clients showed a good deal of fear about going on in contact at the same time that they obviously welcomed the possibility of being helped. In some cases we, too, were uncertain of either our ability to help in the specific situation or the client's ability to take our help. In order to meet the client's question and ours, the intake worker suggested the possibility of trying contact for a few interviews to determine whether case work would be helpful to the client. W e found that this allowed a greater freedom to establish a relationship, while at the same time it put a purposefulness for the client as well as the worker into these first interviews. A final ending is more difficult to handle since it brings out the client's real ambivalence about going on alone; his fear of leaving and his guilt for being able to leave. Clients test the worker and themselves acutely in relation to separation. For some it calls forth every original symptom as proof of a need for more help. With some clients the inability to face a fixed ending forces the client to withdraw an interview or two before the planned time. The client explains this by telephoning or writing that he feels strong and able to go on alone, and it is only with great difficulty that the worker is able to help the client come in again and end with rather than away from her. Some clients do not return then

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but come in months later, saying that they want to tell the worker how they have managed. It is as though they didn't dare to end until they had tried themselves this new way, and having proven that they could manage they dared to face a discontinuance of contact. It is the client's relationship to ending and the worker's handling of it which really determines the helpfulness of the service. It is here that the worker through her ability to keep the client related to using contact, although it must stop eventually, really helps him secure from this experience a different organization of himself. While those workers who have been involved in the experience do not feel that we have defined or know all the differences which fee creates for a worker and client, we have conviction about a few essential points. Fee allows for the retention of more freedom on the part of the client. The bargaining power which it gives the client allows the worker more ease to use the client's strength for his own benefit. It has case-work value in its effectiveness as a point around which the worker and client can come together to work out the client's willingness or resistance to participating in his own destiny. Above all it preserves the client's independence and his right and need to pay for help received in concrete, socially acceptable terms.

THE SPECIFIC NATURE OF FAMILY CASE WORK M. Robert

Gomberg

it is possible to discuss the specific nature of one or another of the services of the family agency, such as relief, housekeeping service, help with problems in family relationships and so on, it is another matter to attempt to describe a specific focus for the family agency as a whole. In other social work functions the specific focus centers upon a single service, clearly defined, which the agency is established to offer. The child placement function is an example. This function, it is true, is a complicated one, and the beginning placement worker has much to learn about work with the foster child, the foster parents, the child's own parents, and so on. Each of these aspects of the placement job represents unique problems. However, all are integrated into a meaningful pattern when each of these problems is related to the central specific purpose of the agency, placement of the child. This makes it possible for the worker to integrate his experience and to develop the specific skills essential to the child-placement process. WHILE

Although any client of any social agency is usually a member of a family, and the family as a whole is ordinarily affected in some measure by the client's problem, the more specific aspects of the problem, e. g. illness, or behavior problem of a child, will usually determine which agency is best able to be of help to the family or individual. While the understanding of human behavior and of the case-work process is generic and basic to working with clients under any circumstances, there is a special body of knowledge and skill essential to dealing with problems in each of the functional areas that extends beyond the generic foundations. This special knowledge has to do with the distinguishing characteristics of the problem, the distinguishing characteristics of the service, and their impact on each other. For example, the feeling and attitude of the parent who is trying to solve a personal or family problem through 111

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the placement of a child is obviously quite different from the feeling and problem of a patient in a hospital who is trying to decide whether or not to undergo a major operation. Each requires the differentiated knowledge and skill that comes from identification with the paticular services and from experience with its meaning for clients. A worker in any functional field soon learns that every client is different from the next one. He gets to learn the different meanings that the service of his agency has to different clients, the different uses that they attempt to make of the service. One of the essential factors that helps a worker to develop skill and sensitivity, that enables him to be of help to so many different personalities presenting so many different problems, is the common denominator of the service, the specific purpose of his agency. As the worker really learns to understand that service, as he identifies with it flexibly and dynamically, he can lend himself most fully to understanding the client. He can then best be free to understand what the client is striving for, and he can relate the service of the agency to the client's problem creatively whenever the service seems to offer some possibility for solution of that problem. The family agency, however, has not one particular service, but many and varied services. In any one day the family case worker may be called upon to represent and administer several different services, such, for instance, as financial help to a man for purposes of job training, housekeeping service to care for the children of a mother suddenly taken ill, case-work interviewing, as such, to a woman coming about a marital problem and considering separation. This means that beyond the generic background common to any case-work service, the family case worker must develop different specific skills necessary to the administration of different kinds of service. Family case work has found it difficult to establish, as have other fields of practice, a clear, integrating, and specific focus that helps to unite the various services into a common purpose. There is no question but that the family agency does have one broad general aim, in its concern for family welfare. However, the lack of a specific focus that unites the many services, that can be concretely visualized and utilized in any family agency case, may result in a looseness of organization that ultimately requires that each worker represent several functions at the same time. It is

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questionable whether, without the common denominator of a specific function, the family case worker can lend himself, evenly and consistently, to the changing identifications required by his varied case load. It is no wonder that this creates a difficult problem in learning, teaching, and administering the services of a family agency. This situation, it seems to me, faces those of us in the family field with two challenging problems. First, it is necessary for us to establish some criteria for determining which services rightfully belong within the province of a family agency. I do not for a moment imply that the services which the family agency now offers are not necessary to the community. I do, however, question seriously whether all such services can be successfully embodied and helpfully administered within the framework of one agency and within the case load of one worker. Too often, when a need arises in a community that requires some new service, the family agency, because it is less clearly defined than other agencies, serves as a catch-all and adopts the new service automatically. I have expressed my conviction that this places an almost impossible professional task upon the worker, and inevitably, I believe, reduces the effectiveness of the agency as a whole. Some family agencies, recognizing that certain problems and the services necessary for them are so distinct as to comprise complete jobs in themselves, have set up separate departments, with a worker or workers assigned to each specific department. For example, one agency may have a department to deal with problems of "unattached" men or "unattached" women. Another has a department for services to discharged convicts, and so on. Whether this represents the ultimate solution of the problem, I do not know, but it is certainly something to which we must give consideration. The family agency will perhaps always be different from other social work functions in that it will offer more than one service, but that should not prevent us from facing the second crucial problem, of how the essential function of the family agency may be defined so that all services will naturally derive from that specific function. Is it possible to find a focus, to define a general differentiating principle, through which all the specific services of the family agency are united? I believe that a determinative focus for family case work does

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exist in the seemingly obvious but overlooked fact that a family agency, as differentiated from any other, is intended to deal with the problems which primarily concern the family as a whole. It is accepted generally that the essential purpose of the family agency is to help preserve and enhance family life and coherence, wherever this represents a solution for the family and is within the facilities of the agency. It follows, then, that in carrying out the agency's purpose, the worker's perspective must necessarily embrace the relation of the client's application to the family as a whole, and the effect that the agency's service may have on it. True, the client must be individualized, but certainly he need not be isolated from his rôle as family member. The fact that the agency has a responsibility to the whole family would make itself felt for every worker in such questions as these : Is the request which the client is making related to a problem which normally falls within his rôle in the family? If not, does the member of the family who normally deals with this problem know about the request and desire the service? If he or she doesn't know that the request is being made, can the agency assume the responsibility of working with the client who makes the application, without the participation and consent of the affected member of the family? Let us consider three specific illustrations: If a woman applies for financial assistance because her husband is unemployed, or his earnings are inadequate, does the worker have the right to complete the application and offer service without the participation, one way or another, of the husband? Earning the living and maintaining the family is ordinarily his responsibility. It is because he is not meeting this responsibility adequately that the woman comes for help. Yet any real change in their circumstances is dependent on the man. Whatever the motive may be, protective or punitive, that brings her instead of him, if she gets the assistance without his participation—in effect, if she finds a means to supplement or usurp his rôle in the family—she may meet an immediate need on one hand, but the man's feelings of inadequacy and failure may only be accentuated. The agency, if it identifies with her, instead of holding to the premise of equal responsibility to the whole family, may not only confirm the man's doubts about himself, but may obviate any real possibility of helping him, and hence the family as a whole, to meet this problem. If in the particular family it is

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the man who is the provider, I believe that his participation in the application for assistance is essential. What this participation may be will vary according to the situation. In one instance the man mav just confirm that he is aware of the request and desires the service; in another instance the man may become the continuing client. In no case does his participation have to represent the rejection of the woman. This is illustrated in the Green case, which is presented in detail later. 1 Here is another illustration of what we mean by gearing agency service to our responsibility to the whole family: A man applies to the family agency asking that the agency provide a housekeeper to look after the home and children, because his wife must remain in bed for two months due to her illness. Sometimes the situation is acute and it may be essential to place a housekeeper in the home before we can see the mother, sometimes it is not. In any instance I believe that the application should not be considered finished until she is seen, if it is at all possible. There is no question that the service is physically necessary, and within the province of the family agency. However, we do not know what the illness means to this woman. Up until now, caring for her home and her children has been the essence of her role in the family. What will it mean to her to have another woman enter the home and perform that job, when she has had no direct part in arranging for that service? As she participates with the agency, deciding whether or not she wants help, planning the kind of work the housekeeper is to do, the hours she is to come, the probable length of time she will be needed, the woman may indirectly hold on to her feeling of usefulness and to her place in the family. On the other hand, if the agency works out plans without the woman's participation, if it feels no direct responsibility to her, may it not heighten the normal anxieties that come with illness? May it not threaten her security in her role in the family, when she sees how quickly "her job is filled"? The third illustration has to do with the agency's responsibility to the children. A young couple apply to the agency for assistance, part of which has to do with helping them to maintain themselves and their two children, four and seven, all in one furnished room. Although the assistance the family asks is available through the i Page 118.

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agency, the agency cannot consider helping if the family insists on living in this one room, which is obviously unhealthy for the children. While it is the family's right to decide how and where they will live, it is the agency's right and duty not to offer support to a plan which it feels is destructive. The agency, of course, will help if the family desires to make a change to quarters which, though they may have to be limited because of circumstances, nevertheless provide minimum standards to safeguard the health of the children. The worker throughout must consider the meaning of the help requested to the whole family, as well as to the individual who requests it. He must, therefore, have an understanding not only of individual growth and change as it is related to case-work practice, but an understanding of family organization, growth, and change, and how it may be affected by case work. The strength in family organization, it seems to me, grows out of the fact that it emphasizes and preserves the natural difference between man and woman in their respective rôles of husband and wife, mother and father. At the same time that the individual feels a unity with the family as a whole, through that very experience his individuality is reinforced in his awareness of the uniqueness of his own contribution to the family life. In no other experience in life does a man live and achieve the rounded, satisfying masculine rôle, as he does in the normally functioning family. William Saroyan, in his The Human Comedy, catches the spirit of this truth. The elder son, speaking of his father, who was a simple workman, the symbol of the "average individual," refers to him as a "truly great man"—not great in achievement for the outside world, but in meaning to the family. Similarly for woman and child, the framework of the family offers a background for a deeper, richer feeling of themselves, their uniqueness and value, than does any other life experience. The particular combination of personalities, opportunities, abilities, will define for each family its unique destiny and pattern of life. But the success or failure of the family in fulfilling its function will in good measure depend on whether different rôles are productively and satisfyingly maintained through the various stages of maturation and change in the family life and experience.

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Dr. Frederick H. Allen, 2 discussing the function of the family in the child's growth, writes: The family can function only through the individual differences of its members, determined and experienced in the three basically related roles of father, mother and child. When these differences are denied or obliterated, even by one member of the group, the configuration essential for normal living changes, and confusion and chaos result. This happens when individuals fail to find value and satisfaction in being what they are, and attempt to deny their own difference by assuming the role of another. The most apparent expression of these essential but complementary differences lies in the typical division of responsibilities within the family, the woman as homemaker, wife, and mother, the man as provider, husband, and father. Each family works out its own differentiation of responsibilities. The specific overt expression of this pattern is not the essential factor so long as the individual differences in the respective roles are preserved and respected and are satisfying to the individual members of the family. The question of the basis of family unity or family coherence is certainly not an abstract one for the family case worker. The majority of families that apply for assistance to the family agency are striving in their own way to achieve, to preserve, or to regain satisfying family life. Some families are well integrated and are able, with a minimal assistance from the agency, to resume and maintain a life satisfactory to them. Others have been thrown off balance by difficulties which have broken up their pattern of unity, and in the subsequent struggle to find a way of life the individual differences have been denied and overrun, with various members of the family assuming in a disorganized and desperate manner, either too much or too little of their normal function within the family. It is the responsibility of the family case worker, then, to determine whether the client's request for assistance represents an effort to maintain an existing family unity, or whether it is symptomatic of a deteriorating family situation. The worker must be concerned as to whether meeting a particular request in the way 2 Frederick H. Allen, Psychotherapy with Children, W. W. Norton & Co., 1942, p. 35.

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it is presented, while serving a specific physical need of the family, may, on the other hand, only widen the breach in family unity. Neither the worker nor the agency can decide for the client what he is ready or willing or able to do in meeting his individual family problem. But the agency does have a responsibility for the role it assumes in the client's life in offering or withholding service. It has a responsibility for the way in which it offers service and the conditions under which it offers them. These conditions and procedures, which must be established by the agency itself, would necessarily derive from, and be consonant with, its basic focus of "responsibility to the family as a whole." This provides a framework for the contribution of the individual case worker. The case of Mr. and Mrs. Green demonstrates clearly, I believe, first, how an experience with a family agency can help a family to achieve a more normal balance, so that the several individuals within the family may regain the feeling of value and integrity in their individual roles; and second, how the family agency's responsibility to keep the whole family in central focus, while working with the individual, helps the worker to contribute to this achievement. The Green family, which consists of Mr. Green, aged forty-two, Mrs. Green, thirty-five, Helen, thirteen, Joan, eleven, Ann, seven, and Ralph, five, was known to my agency 3 through several previous applications. Mr. and Mrs. Green have been married almost seventeen years. Mr. Green came of a relatively well-to-do middle class family. He went through college and completed one year at medical school. At that point his family suffered financial reverses and he had to give up the study of medicine. He has had various positions, all connected with radio work, since he had had training and skill in that field. He is a small, stocky man, who speaks well but glibly, apparently anxious to convince one that he is a "nice fellow." His only apparent assertiveness is limited to this earnest effort to get himself liked. He married Mrs. Green at the time when he had to leave medical school. She, unlike her husband, is always described in the records as attractive, impulsive, and spontaneous. She has had very little education but apparently always makes friends easily and is well liked. She describes how awed she was by her husband's education, by the possibility of marrying someone 3

Jewish Family Welfare Society of Brooklyn.

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who was "almost a doctor." His education, his fluency, his ability to "talk about anything intelligently" attracted her and led her to believe that anyone "so smart" would earn a substantial livelihood. They were able to manage adequately for the first few years of their married life, but at the time of the birth of her first child the depression set in and Mr. Green lost his position. From that point on their economic position was precarious, Mr. Green going from one job to another, his income always marginal. In 1936 the family had to apply for public assistance, and from then on they managed either on WPA or Home Relief. Mrs. Green has made four applications to the family agency in the past three or four years. Each time the problem arose from the inadequacy of their income to meet the needs of a family of six. The requests were always made by Mrs. Green. They were usually specific, i. e., clothing for the children, help to meet a pressing rent arrearage, and so on. Mr. Green never participated in the family's application for assistance, nor could Mrs. Green think of any way of using the agency to modify their difficulty, except for filling the specific needs as they arose. Mrs. Green was the member of the family who was known to the public agency, as well as the private agency. She was extremely aggressive and demanding in dealing with the agencies. She was deeply attached to her children, "never wanted anything for herself" and alwavs felt that she was entitled to assistance because of her trying circumstances. She was very bitter against her husband. She resented his failure to fulfill her own original expectations of him and seemed to reject him completely. She grudgingly admitted that he was fond of the children, and in a negative way she still spoke of how "smart and educated" he was. She apparently shared little with him, controlled all the income in the family, and whenever any additional needs arose, applied either to the public agency or to the private family agency without consulting him. In each of her contacts with the family agency, and throughout her experience with the public agency, she had threatened to separate from him and break up the home. This was generally offered impulsively and in anger, never as a solution thoughtfully considered. At the time of the present application, when my experience with the family began, Mr. Green had a job in private industry, earning twentyfive dollars a week as a radio technician.

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Receptionist's Report, 9-14-42 Mrs. Green in office, pressed for an appointment today. She did not know she had to renew her application for surplus food stamps, and thus lost out on several weeks' allowance. In addition, the children all needed clothing in order to go to school, and she was "in a fix." An appointment was arranged for the earliest time available. First Interview, 9-18—42 Mrs. Green is obviously tense at having to return to the agency for help. Ignoring my introduction of myself as a new worker, with a rush of words she reviews all of her past and present circumstances. There is a quality of both frustration and belligerence in her tone. She indicates that it is impossible to continue living this marginal existence, and yet she sees no way of changing their situation. She insists that she has to have some help, and belligerently adds that for her children she'll go to any extreme to get it, and that's why she returns to the agency. After about fifteen minutes, when she has partly "talked herself out," I say that she has mentioned so many of her problems that I am not sure I have grasped everything, but one thing is very clear, she feels that she has more than one person can handle, and having to return to the agency is upsetting in itself. I say I do not know whether I can make that any easier for her, except to affirm her right to reapply, although I have some question as to how helpful we have been to her in the past, or whether we can be of help now. Although in one sense this helps her to "be here," it creates a problem too, since she has to prove that we are helpful. When I point out her very half-hearted demeanor in affirming this, it precipitates a sharp reaction in which she literally screams at me, "Well, what do you want me to do, leave? Do you want me to break up my family?" I say I am sorry if I have upset her—yet this interview is concerned not with what I want of her, but with what she thinks the agency can do to help her. Although she described a different problem in reception, I can see that the thought of separation from her husband as a solution to her problem is not new to her, and if she wants to talk with me about it, we can both try to find out if that is something with which our agency can help. This precipitates another vilification of her husband, her disappointment in him, and the consequent struggle that life has been. At the same time she describes, with mixed feeling, his intelligence, his education, and what life "might have been" if he had really made use of these talents. However, she decides that at this point she would prefer to continue with her original request. In a quieter way, she repeats the information she gave the receptionist, and her request is limited to help with the deficit created by her problem with food stamps, and clothing for the children. In contrast

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to the explosive feeling and frank admission of problem inherent in all of her discussion about her husband, the request for material aid is made almost fearfully. I comment on this great difference in what she described as her fundamental problem, and the nature of her immediate request. I can see her getting ready to start a strenuous struggle about these requests she is making. So I break in to say lightly that I can see she is getting set to make a fight of it with me, almost as though she is sure I am going to refuse her. She pauses for a moment, and then says hesitantly, "Well, I've been here a few times before and I guess that it's always the same old story, I need a lot more money to run a family of six." I acknowledge that what she says is so, and say that from her previous contacts she is probably expecting me to tell her that hers is a chronic circumstance and that we don't meet chronic needs in this agency. Then her job will be to fight with me to see whether she can't get it from me anyhow. She smiles in guilty recognition and there is a moment of silence. I say I almost feel a little sorry for not letting things go as she expected they would, since, from everything she had told me, so much has gone against her life that maybe it is a disappointment that even this little thing she had planned here couldn't be quite as she wanted it. Mrs. Green replies that the thing she is most concerned with is being helped: "The kids can't go to school without clothes, and I can't pay bills without money." I say that I know that with a family of six living on $25 a week, the slightest disturbance can throw them off budget and create a deficit. Thus while I can understand her recurrent needs, and am ready to see how we can be helpful, I am skeptical as to what value meeting these needs will have in the long run. Unsurely, she says that she thinks her husband is expecting an increase in three months, and then they might manage. However, she isn't at all sure of when this might be, or how much it will be, since they haven't discussed it. She presses again the urgency of her needs, and I agree that they seem urgent and necessary and that under certain conditions we can meet such a request. This brings us to a consideration of requirements. I say that since the financial difficulties in the family are due to her husband's lack of earnings, and since any potential change in the situation is dependent upon her husband, it will be necessary to speak with him about this request for financial assistance. Her response is literally a temper tantrum. She berates her husband and will not hear of his coming in. She is hostile to me, the agency, and her husband. Then she becomes very protective of him—he won't come in, he can't demean himself, he's not a person to ask for help. Again she threatens separation. I say that again I seem to be making things quite unbearable for her, and I regret it. I guess that rather than meet the conditions of the

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agency, she might decide to do without our help. Yet the request really is for supplementation of her husband's earnings, and it will be necessary to see him. At this point her attitude changes considerably, and in a tired, almost wistful manner, she says, "I'm still young and I have a right to some happiness in life. Will it always be such a struggle?" I say that with so many things not working out for her, she probably feels that unless she has her hand in whatever happens to her family things can only get worse instead of better. As she continues to sense my desire to help her, the readiness of the agency to do so, she is able to yield a little and to speak of the possibility of her husband's coming in. I agree that I will be ready to see him, but I wonder whether she doesn't want to give it some thought, since she has so much feeling against it. With some measure of relief, she finally decides that she wants him to come in, and we agree that he will call me. She wonders if we have any time left, and I say we have about ten minutes. In a frightened though less emotional manner, she asks specifically what I meant about the agency's help toward separation. Briefly I tell her of the services we have: 1) relationship to the Family Court; 2) our ability under certain conditions to help financially if this is the only problem in the way of separation; 3) interviews with a social worker to help a person clarify her own feeling about separation. Mrs. Green doesn't react to this directly, but says if only Mr. Green were more aggressive, with his skill and education he should get a good job easily these days. In the same breath she begins defending his not leaving this job. I say in a way she blames him for not going out and doing something different, and yet she too may be afraid of his trying something else. She nods, and I comment that coming to the agency would be "something else" for him, too, and perhaps she still would want to think about it. She affirms her readiness for him to come in, but says that she would want to come back and talk further with me. I agree to see her after seeing Mr. Green. From our previous agency experience with Mrs. Green, and from the experience in this interview, w e can see the degree to which she has literally obliterated her husband's role in t h e family. Her conscious and expressed motive is to keep her family together and provided for under adverse circumstances. The impulse to preserve her family, which impelled Mrs. Green to move beyond the role she h a d originally conceived for herself in family life, brought her into conflict with Mr. Green, since it was his apparent

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inadequacy that created the problem initially. Thus, on the one hand, there is a strong desire to preserve family unity, and yet her very efforts to achieve this create and sharpen the break between herself and her husband. Strong and aggressive, she succeeds in denying him any effective, satisfving function within the family. In our subsequent contact with Mr. Green, it became apparent that he will accept any rôle within the family, no matter how obscure, in order to continue as part of the family, which holds a great deal of meaning for him. Mrs. Green, on the other hand, finds little of a satisfving nature in her extended and controlling rôle in the family. Nevertheless, in coming to the agency she insists on having it accept her estimate of the inevitability of the family situation, her husband's inadequacy, the necessity for her and the family to continue to function precisely as they are. The contradiction between her desire for one kind of life for the family, and the difficult contrary situation which she helps to create, is apparent. The agency requires that Mr. Green participate in the application for the financial assistance which Mrs. Green requested. The reasons for this derive from our premise that the family agency has responsibility to the whole family and must respect the different rôles of each of its members. However inadequate Mr. Green may actually be, he is the essential provider of the family, and a social agency has no right to ignore him in plans concerning his family. Again, the specific help requested can be given only if there seems some reasonable possibility that it is not part of an indefinite supplementary need, since the agency does not have the funds to offer such general supplementation to the community at large, and it is essential to learn from Mr. Green what his possibilities and plans are, and thus to determine whether the service can be rendered. Finally, experience with families beset by some internal or external problem, struggling to adjust and find a pattern for unity, reveals that at times, in spite of mutually positive motives for the family, in the course of the confusion, pain, and unhappiness of day-to-day living, the common purpose becomes obscured and gives way to bitterness and struggle between the members of the family. It is important, then, not to permit the agency to become drawn into an identification with one member of the family as against another. In this case it is important to see Mr. Green, to learn what his feeling is about the family, to learn his feeling

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about using or not using the agency, to let him participate in an experience which is predicated on acceptance of the importance of his rôle in the family. Mrs. Green reacts strongly against this requirement since in effect it challenges her control over the family. She reacts against worker and agency much as she probably does against her husband, that is, with aggression, hostility, and threats of breaking up her family. However, when the agency holds to its way of giving service, Mrs. Green is apparently able, at least for the moment, to forego some of her excessive domination of the family. Whether this yielding on her part will begin to help her to give greater freedom to Mr. Green to assume more of a normal rôle within the family, and whether he can with help actually assume that rôle, cannot be known at this point. What is clear is that the request as she makes it does not seem to offer any solution to the family's problem, and the agency cannot meet it on her terms. Yet the agency can offer the service under certain conditions which, it has learned through long experience with family problems, are more likely to further the welfare of the family. As Mrs. Green shows at least a limited readiness to accept this, plans are made for continued service. I saw Mr. and Mrs. Green separately, each for fifteen interviews, over a five-month period. I believe that when both husband and wife are to be seen, a great deal of consideration must be given to the problem of how they will be seen. Should they be interviewed together, or separately? Should the same worker see both clients, or should the case be divided, each client to be seen by a separate worker? I have found in my own experience that when a man and woman are having a marital problem and each is experiencing some impulse to separate but cannot act—either to separate or to adjust the problem between them—it is sometimes helpful to divide the case and have each client seen by a different worker. In a limited and unthreatening way this gives them some experience with separation. If this structure is used dynamically it helps the client to face and test this feeling ( impulse to separate ) which he may have been denying, and to move beyond the stalemate in the relationship to something more acceptable to both. I did not feel that Mr. and Mrs. Green were primarily concerned with the problem of separation. I felt, after my interview with Mrs.

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Green and then with Mr. Green, that neither at the time was considering separation seriously. Both were obviously unhappy because of the negative relationship that existed between them, yet each continued the pattern of behavior that made for such a relationship. I felt that if each became related to me as the representative of the agencv from which both wanted help, it might represent a new element in their relationship, a common bond, even though a bond brought about bv the weakness in their family situation. If this different experience could break into the rigid pattern of their relationship, then it might be possible that the agency connection could serve as a fulcrum in their new efforts to find a more balanced relationship. For purposes of clarity and continuity in this paper, I will present detailed interviews only from the experience with Mrs. Green, interpolating pertinent information from the contacts with Mr. Green. Thus, before the second interview with Mrs. Green, Mr. Green had been seen twice. In these interviews Mr. Green was able to clarify his eligibility for the specific services the family needed; also, and more important, he became engaged in a plan to use the agencv's assistance, through which there seemed a real possibility that he might get additional work on his own that would substantially increase his income. He needed help in purchasing equipment, and he needed to obtain consent from the organization which employed him, since the work must be done in their plant. It is interesting to note that at first his attitude was that of an acquiescent emissary of his wife. In a detached, friendly way, he would mechanically "do his part." When this was not sufficient to meet our conditions, and more of himself was drawn into the experience, one sensed what at first seemed like an immobilizing fear of doing anvthing lest he jeopardize in some way the slim thread of relationship that he feels holds his family together. This is equally true of his job. He is obviously dissatisfied with his role, both in his family and in his job, but rather than do anything that "might stir up trouble" in either relationship he would maintain the status quo. Nevertheless, he moves by the end of the second interview to some consideration of the new plan by which he may increase his income. Although this appeals to him, the idea of discussing it with his employer is a great obstacle and he admits his fear. Then, too, he expresses some concern about his wife's con-

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tinuing to see me. He hopes I won't "misunderstand some of the things she says" about him. This is part of his concern that I may identify with her rejection of him, but also he is fearful of her seeing a male worker, one with some authority and in a position to give money to make up for Mr. Green's own inadequacy. It is necessary to deal with this additional problem that I create for him, and, technically, its meaning is something to watch for throughout the experience with Mr. Green. Second Interview, 10-1-42 Mrs. Green came in for her appointment. The general tenor of the interview was quieter as compared to last week. At first I felt the sense of strain with me, and she was partly able to acknowledge some resentment that her husband was able to accomplish something here that she had not accomplished. Superficially she articulates very glibly the reason for his getting the money and her understanding of it; nevertheless it did seem to unsettle her somewhat. Thus I focused our interview today on the question of where she was left in relation to plans with the agency. As the interview progressed, she felt my acceptance of her and as she became easier in feeling, she spoke of our last interview. With considerable guilt she apologetically said, "I'm sorry if I was a nuisance last week. When I get excited my feelings run away with my tongue and I act hysterical." I recognized with her that she was wont to let her feelings go easily, but I commented that I knew it didn't make it any easier for her after it was all over. At first there was a rambling, disjointed quality about the interview, as though, with the crisis over, it was hard to think coherently about her problem. She rested momentarily on several aspects of her situation, came to the problem of separation, and discussed this pretty intently for a while. With a little help from me, she was able to articulate her feelings. In one sense it wasn't so much a question of the "right thing to do" that was keeping her from action, there was the feeling of just being mired, not being able to do anything. On the other hand, the more she spoke about this, the more she evidenced a pull away from the idea of separation, not necessarily out of her lethargy but rather with some positive feeling for whatever there was in family life. At this point she put it all onto the children. The only acceptance she could express for her husband was in terms of respect for his intelligence. The more she dressed up how learned he was, the more I sensed that it was a real problem for her that she felt so different, and in effect so inferior in her difference. I referred to this rather simply, commenting that on the one hand she was telling me with real feeling and real respect about

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his superiority, and yet I just couldn't help but feel that it had created a problem for her, too, over these seventeen years. This brought into the interview a new and more dynamic focus. She said that there were so many times she would just love to talk to him, but frankly she didn't know how: "I feel as though there is a wall between us, and I feel my ignorance doesn't let me tear it down. What I say to him sounds so silly, even to me, that I stop the conversation myself." I said I knew what a problem that could be and I could sense from what she was telling me that she felt almost ashamed in talking with him "of her ignorance" (since she had described herself thus). She nodded feelingly, expressed a certain amount of confused undifferentiated anger, both at herself and at him for this breach between them, and seemed again puzzled as to whether it was possible for her to talk to an educated person. Rather lightly I said that we had talked together for a couple of hours now, and I was educated, too, and yet apparently she didn't have too much trouble talking with me. She stopped, seemed puzzled, guessed that maybe it wasn't just being able to talk, but then this was too much for her and she went on. In reviewing her present circumstances, with the food deficit made up, she stressed the need for clothing for the children and for a few household items. We both recognized that on his income, plus the food stamps, they couldn't very well allow for these needs, and yet since there was some prospect of an increase at the end of three months, we did plan to meet some of those needs. Today we would consider the essential clothing needs. Although agency assistance was predicated on the possibility of a change in their circumstances (increased income), we had both had enough experience to know that actually it might not work out that way. We spent a good part of the hour going over the clothing budget for the children. Very timidly she wondered whether she might ask for something for herself—she wanted me to decide. I said I saw that this was quite a problem for her—was she worth anything as an individual, or was it only in her role as mother that she had a right to make requests? I said that I just couldn't help her with it; I was ready to discuss her requests with her, but not to make them for her. Still fearfully, she made a request for a pair of stockings and a pair of shoes for herself. It was obvious that asking for herself provoked more feeling than all the rest of the material help the agency is giving. I commented that it was interesting that the help we were giving today worked out to about what her husband had gotten. I think this had a good deal of meaning for her, but we did not discuss it further. We planned on regular weekly appointments at least through the period that the agency would be assisting financially.

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In this interview we begin to see some of the initial results of her impact with the agency. Even in this limited way, by assenting to her husband's coming in, she begins to yield some of her double role in the family to her husband, and one can sense her concern about what will happen to her as a result. Instead of the total rejection of her husband expressed previously, she evidences a wish that there could be some more satisfying relationship between them, as, "many times she would love to talk to him." It is a feeling which she has denied for many years that begins to emerge. The question as to whether she has any right to ask for assistance for her personal needs seems again to be part of her concern as to who she will be if she does give over all control of the family. In the eyes of the worker, and the agency, is she a person, does she have rights as a separate individual apart from the role she has carried these many years? The worker uses the service and himself to help her experience an acceptance of herself in this new capacity, if she will permit it. However, realizing how tentative and still ambivalent her feelings are at this stage in the process, he makes no effort to press her decision, but gives her an opportunity to work on it at her own pace, for example, letting her decide whether she wants to make any request for herself, apart from the family as a whole. In his next (third) interview, Mr. Green brings in written confirmation from his employer, stating that Mr. Green's plan is acceptable to the firm and that they will help him in any way they can. He is very pleased at this success, although it is apparent that he is quite fearful as to where all this new activity will lead him. It has broken u p the mechanical routine of his existence, and although it holds good prospects he is fearful lest it lead to disappointment. Nevertheless "he wants very much to continue. He has told his wife what is happening." This represents the first direct sharing of a hope between them in years. Third Interview, 10-8-42 The general tenor of this interview is quieter than last week's. Mrs. Green seems easier and more comfortable. In describing her situation I get the sense that she begins to share a little bit more of her husband's conviction that something will come both of his job and of his beginning efforts at earning other monies with the help of this agency. Her attitude toward him still is ambivalent. She indicates her respect for his intelligence and capacity and a resentment for all she's been through and for the little she's gotten from mar-

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ried life. It is interesting that in this interview, where there seems to be a greater acceptance of him, she at the same time condemns him not only for what he has failed to accomplish materially for the family, but with some determination says she thinks he is "stupid"—yes, a man must be stupid in spite of all his brains and book learning if he hasn't been able to do more than her husband has. Up until now the breach between them had been based on her identification of herself as the stupid one and her husband as the bright one. It is perhaps in this very condemnation of him that she brings him closer to herself, beginning to bridge the gap between them. I comment on her generally calmer attitude today, yet say that I sense an uneasiness that seems to be related primarily to me and even to coming here. This precipitates again a kind of general complaining, but it lacks conviction and feeling and I point it out. I comment that I have the feeling that she is almost afraid that she has no right to tell me that things are all right at home, that somehow coming here stands for criticizing and complaining about the family. With this she relaxes a little and attempts to break the quality of "all right" down to her own realistic level, and I feel this is done with considerable reality in feeling. She explains—yes, things are much better than she thought, as a matter of fact the past few weeks have been different from any she has known over a great many years; it isn't that it "suddenly has blossomed into a love life" between herself and her husband, but rather those things in family life that are important to her—namely, her children, her home, and a certain peace of mind—have become clearer and more outstanding and even more desirable. She knows that in the many years of married life many women "wear out" their first relationships to their husbands and have to find new ones; she doesn't know if shell ever find a fully satisfying one with him again; all she can say is she can live with him now and still get more satisfaction out of family life than she could in facing the possibility of breaking it up. In the course of this discussion she tells me how at certain points she has threatened and deprived him, that she has learned how to do this pretty well. I make some comment about the fact that sometimes in a difficult life filled with bitterness it is easier to find a way to hurt another person than to work things out so that one can derive more pleasure for oneself. She acknowledges that it is true that they were awfully good at hurting each other, but it has been a little different over these few weeks, and as she says, she's pretty clear in her own thinking that her wanting to stay on in family life is not just inability to get out of a rut that she's created for many years, but really comes out of her own desires. "My seventeen years of married life are not just a bad habit that I can't break, they have their

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daydreams and hopes in them, too." There is something deeply simple and sincere in this, and I acknowledge with her that it might well be that a person has to take less out of family life than he would have wanted, and yet might find it more than what he might get otherwise. With this she is again able to acknowledge a little more of her positive feeling, not only for her family but for her husband. She discusses specifically the additional needs which they have, but we agree that it won't be possible for us to meet them at this particular time, till we know better what the result of Mr. Green's new venture will be. We will know then whether she is asking for help because he has no earnings, or asking for some help, so that with his additional earnings they can start in with a clean slate "by utilizing some help from us." She is quite accepting of this and we confirm the time of our next appointment after my meeting with Mr. Green. In this interview there is a developing acceptance of her changing rôle within the family. She is beginning to limit that rôle more to her relationship with the children and her responsibility in the home, and she is articulate as to her greater happiness and peace of mind. It is interesting to note that as she works on defining a more satisfying rôle for herself, although she speaks of this in positive terms, any acceptance of her husband is slower, more cautious, and questioning. Yet the meaning and value of "family," as something of value beyond any one relationship within it, begins to emerge, and the worker helps her to hold on to this feeling. Even at this early point in the case, one notes changes in the feeling and behavior of both Mr. and Mrs. Green. This grows out of the immediate experience, I believe, in which each is related to the agency in an effort to achieve something that alone, between themselves, they were not able to achieve. The agency is the common bond, holding their mutually positive purpose, which their problems prevented them from realizing by themselves. The change in each of them is too new, too tentative, for their own relationship to sustain them through the next period of uncertainty. The agency is actually holding the balance between them as each fumbles toward a rôle that eventually will permit them to maintain their own balance. This illustrates the technical problem in working with both man and woman at the same time. The experience with one client must never become isolated from the experience with the other, else the common goal may be jeopardized.

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Mr. Green, in his fourth interview enthusiastically tells me that he has already begun to earn some money from his new project. Although he did not earn very much this first week, he is now really convinced that he will be able to count on a "sizeable, steadv supplement" to his regular wages. He seems more sure of himself today and much less fearful than before about the future. Fourth Interview, 10-22^42 Mrs. Green is a few minutes early for her appointment and I am able to see her when she comes. She greets me in a very friendly fashion and wonders whether today is really the day of the appointment. Rather lightly I say that maybe it isn't quite so important for her to come, and so she isn't too sure about the time of the appointment. She laughs and then for the first time in my contact with her, begins speaking about her husband positively. She is obviously quite pleased with his efforts to supplement his income and quite satisfied with the beginning results of his additional earnings. As she discusses this in detail, the general feeling behind it is a satisfaction in the development, a little fear about saying too much about it, lest she be too optimistic. She discusses her husband's appointments here and her awareness of the fact that he and I are considering personal needs as well as family plans. In general, behind what she is saying, there is apparently more sharing in their relationship and I believe that it is with real satisfaction that she lets me know all the things he has told her, both about his job and the changes there, his new efforts, and even about his contact here. When we come to talk about the specific things which the family needs, she mentions linoleum, a dresser, and a mattress. We have some serious discussion as to whether she ought to be the one to carry this request through with me, or whether to leave it with her husband. Instead of the hysterical anxiety and fight which resulted from our earlier considerations of who should carry responsibility, there is a deep thoughtfulness behind her consideration today. She tends to divide their responsibilities more effectively now—his as provider, and hers as homemaker. She says, "I'm the shopping expert in the family. He's working so hard now to earn more that he comes home dog-tired every day. I don't think he can do as well as I on quality and prices." If it is necessary she is willing for her husband to get the money, but she will do the shopping. I accept her differentiation of her responsibility as valid at this point, since there seems to be a cooperative balance in what she is implying, and I agree that she and I can work out this part of the family needs, recognizing that the larger responsibilities for earning and providing are her husband's, and that help in general, for the family, from the agency revolves about develop-

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ments within his situation. Since it is part of agency requirement that Mrs. Green explore prices for the articles she requests, I cannot grant the funds today. She asks whether she can come in tomorrow afternoon, after she has had a chance to get estimates on the various items, and I arrange a four o'clock appointment. There are many new components in today's interview that are indicative of a greater unity within the family. She goes back to last week's discussion about her relationship to the family, and particularly with Mr. Green. She talked about her own greater satisfaction, yet with a little reservation about her "deepest inner self," which obviously isn't fully satisfied in their present relationship. For the first time, however, in all of this kind of discussion she is less arbitrary and final about the impossibility of change. She says that money, particularly a lack of money, in a family can do terrible things and tear people apart, creating differences that otherwise might not have occurred. She says philosophically and with some feeling, "Who knows—when Mr. Green's raise comes through, with these additional few dollars—maybe we will get together again like other people. After all, what people married for so many years need between them is understanding." I comment on her general feeling today of being somewhat more accepting of Mr. Green, of his efforts and even of their relationship. I agree that we can't know what will happen next, and for my part what she said last week was quite valid, that many families change in their relationships to each other, yet find enough in life together to keep going; maybe that's all there will be, or perhaps there will be something more. Right now I know, and she knows, that she certainly has not reached the kind of relationship with her husband that she would want ideally, perhaps we don't even have to pretend that that will happen. She acknowledges this, but affirms her feeling that it is more possible than she had considered earlier. She tells more of her experiences with her children, and her plan to make her son independent, and her hopes that he may become a physician as his father had originally planned. Again she talks of little things that with just a minimal increase in their income she can begin to do; she and her daughter could go skating in the park—things like that require outfits that are cheap and yet for which she never had money before. In general, the things she envisions now seem to fit more nearly within what she really feels she has a right to expect within her own family. It is hardly necessary for me to hold her to a reality to keep her from jumping from one extreme to another, because it is apparent that she is not doing that. Toward the end of the interview I comment that among other things, today we have been planning for the last specific help that Mrs. Green

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is requesting of the agency. Since this will take but a few weeks at most to complete, I wonder whether we might not consider how much longer Mrs. Green will be continuing to come here. Mrs. Green nods vaguely, but from the expression on her face it is apparent that she has given no conscious thought to ending. She says, "Let's see how things are next week." Fifth Interview, 10-23—42 In feeling and attitude today, Mrs. Green is pretty much at the same level as she has been for the past time or two. She enters into a very detailed discussion of her shopping efforts, and except in the case of the chest of drawers she has been able to get furniture within our budgetary limits. She hopes she will find something during the week. In reaction to my observation, she agrees readily that our allowance is small, and with prices "sky high today," it is hard to find furniture that "will stand up" at that price. Nevertheless, she does not express any resentment, but since the general flow of her feelings seem to be on such a positive level, for a little while she has to justify for the agency why money is so limited. I laugh and say she is feeling good today, and so friendly to me and the agency that nothing we do can possibly be difficult for her. For my part, I doubt it, because I know it is a headache to run around and try to get something for so marginal an amount, but if it has to be easy for her, well, it was okay with me. She laughs and admits the difficulty, but holds pretty firmly to the fact that she's "not sore" at us. We did not use the full hour today, and she comments on it herself. She is a little embarrassed at leaving before the time. I say it is our second appointment in two days, and I guess it is quite natural that we may need less time. I tie this to the question we raised at the latter part of our last interview, namely, the whole business of how much longer we would be going on. We agree then that in our appointment next week, we will continue our discussion of help for furnishings, and then think more fully about our continuing plan. In these two interviews (fourth and fifth), Mrs. Green's fuller acceptance of her husband, her satisfaction with her changing role in the familv and her differentiation of it from Mr. Green's, is readily apparent. At this point in the process (the end of the fifth interview), the worker, relating both to the agency's ability to continue to meet specific needs and to Mrs. Green's changing use of herself, her attitude toward her husband and her greater optimism and security in her hopes for the family, introduces as something for them to consider in the next interviews the matter of how long

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it will be necessary for Mrs. Green to continue to come to the agency. This introduction of the question of time is not based on a conviction that the case is at an end, and that Mrs. Green is now ready to go on without help. The agency represents the means and experience through which Mrs. Green (and Mr. Green) is effecting a reorganization of her relationships and role within the family, so that it may be more satisfying to her individually and more constructive for the family as a whole. For years she has struggled in her own way to achiev e this goal, and yet until now, without the help of the agency, the struggle resolved itself into an inter-personal destructive one. Now, however, Mrs. Green in her all-positive mood, with apparently much more satisfaction in family life and with greater acceptance of her husband, seems to express little conscious need for going on. The introduction of the discussion of termination provides the new problem. As she works on that it will help her to a better understanding of how ready she is to go on. It will help her to differentiate the security she feels about the changes in her family situation while the agency is a continuing factor in her life, as against going on independent of worker and agency. In the process of reorganization, of change, through which she is living, in her desire to safeguard these changes that already mean much to them, it is possible she may exert her strength to hold on to the worker and agency, not accepting them as an outside source of assistance, but unconsciously including worker and agency as an essential part of the changing configuration of the family upon which the new family unity will be dependent. The normal family usually has a number of outside "permanent anchors" as a kind of insurance for its stability. Thus the "family" doctor or the "family" dentist are factors outside the family relationships which are reassuring in their permanence. This is normal and sound, since such factors represent contributions to the family welfare which the family cannot, and is not expected to, produce within itself. By the same token, the case worker and agency should not represent such permanent "anchors," since their contribution to the family welfare is one which the family does ordinarily expect to produce and maintain within itself. Whether the agency helps with a financial problem, or with some aspect of family relation-

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ship, it must b e recognized that these are problems which families usually contain and resolve within themselves, and their sense of strength and unity is in some measure dependent on being able to do so. Help should be offered so as to meet the client's current need for dependency without losing sight of or threatening his co-existent strivings for independence and internal stability within his family. T h e worker, in discussing with Mrs. Green the length of time she will need to continue, demonstrates the agency's readiness to let her depend upon it for a time, and yet points toward an end of that dependency as well. At this point in the case a discussion of ending ma)' cause Mrs. G r e e n some anxietv, since her newfound satisfaction is so closelv tied with agencv. However, in the continuing process, it will help her to experience and evaluate more realistically the changes within the family and the degree to which such changes are rooted in herself and her husband rather than dependent on anv outside factor for continuance. It is obvious from these interviews and the next ones that the consideration of this question of time is not arbitrarily controlled b y the worker. It is a fnutual problem in which both client and worker participate. Sixth Interview, 10-29-42 Today's interview is particularly interesting because of a shift in the dominant feeling tone. The even calm, the progressive hope, that have been apparent in the past few weeks, although still inherent in Mrs. Green's attitude, have given way to a feeling of tension, and I sense some anxiety. All the facts within the situation remain the same. Mr. Green's job goes on; his supplementation through the help that we have given him seems to be picking up; she describes the relationship as better; certain specific items of help that we had planned for today we are ready to meet, and yet there is this apparent tenseness. I comment on this difference in her attitude which I feel today, and at first her impulse is to deny it and prove that everything is all right. Though I acknowledge that in a sense, from the facts that she describes to me, it would seem so, I know that it isn't, so as far as her feelings are concerned. I say I have a hunch that it is not unrelated to my having spoken last week about the possibility of our coming to an end of help here. She relaxes at this point and expresses some of her insecurity about the changes that have occurred and her fears lest they won't endure. I say that in a way I almost feel as if I am more responsible for her concern right this minute than is her actual home situation. She smiles nervously and says she knows that she cannot go

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on depending on us, that actually inside her own self she wants more than anything to "shake free" of us, to be able to live like other "normal families." For a few minutes we consider how much hardship she has been through in her life and how natural it is to distrust changes that have come within a relatively short period of time. She admits how important coming here has been. She reviews their specific needs which we were able to help with, and also feelingly emphasizes her relationship to me as a factor that has helped her to get more happiness out of her life— "for one thing, talking to you I learned I could talk to an educated person, and so I've had less trouble talking with Mr. Green." During the course of the interview I sense a degree of relaxation and an easing of the tension, and I comment that she is beginning to feel easier, yet"in a way the facts continue to be the same and I would not be surprised if for a while she would be having, from time to time, real upsurges of discomfort and worry as to how things would work out. She doesn't react to this except to acknowledge that she has some awareness that she has been trying to "pretend that all the bad was gone and everything now in my life will somehow turn good" and she knows that it cannot be this way. As we talk more specifically about how much further she and I will be going on, we consider the several specific needs that are still left, the last with which the agency will help. We agree that we have no way of knowing whether actually at that point we will be altogether through with her contact here, or if we might not consider going on for a time to see how they manage on their own. What is clear is that we are certainly coming to an end of a part of the help, and perhaps even approaching a point where she will want to try going on entirely by herself. In the seventh, eighth, and ninth interviews (not presented here in process), one could see opposing tendencies operating within Mrs. Green. On the one hand there is the fear that the constructive developments within her family life will not be sustained through her husband and herself alone. Since the agency and worker have in several respects, for example, through financial assistance and through relationship with worker, represented the means through which change was made possible, she is afraid lest upon their withdrawal everything will revert to the untenable life she had previously been living. This fear was clearly apparent when an interview had to be delayed a few days because the worker was out ill. Mrs. Green was obviously upset at not being able to see the worker,

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and although she knew why he had been out she was anxious as a result of this very limited experience of having to do without the worker and agency. She was reassured when she realized that no pressure was being brought on her to set any immediate time for terminating the experience. Actually the pressure was more her own, related in part to what I referred to above as the "opposing tendency." This is an emerging and strengthening desire to feel that she and her husband will manage, without the agency, to be self-sufficient and to function like other "normal families," as she describes them. This development within herself is interestingly expressed when she tells the worker of a neighbor who is having a serious family problem. There is both a marital problem and a financial one. Mrs. Green tells the worker that she advised the woman to come down and discuss her problem with him at the agency. However, she also describes at great length and with conviction the advice she offered the woman on her own. She responds positively and without fear to the worker's interpretation of the story in relation to her own situation, wherein she got a good deal of help from the agency, and yet she was discovering that she had a great deal to do with the change in her situation apart from the agency. During the four weeks covered by these three interviews, Mr. Green was taken ill with a bronchial infection and was confined to bed. One of the children caught cold, as did Mrs. Green. She was exhausted because of the additional burdens, but it is interesting that she took the situation with a minimum of upset. She did not express any hostility toward her husband, and she seemed impressed by the fact that the institution for which he worked gave him full compensation during this sick leave, comparing it with jobs that paid more but offered a worker no such protection. They were faced with a financial problem since Mr. Green's supplementary earnings, which now averaged about ten dollars a week, were suspended. With the increase in the cost of living, these ten dollars had been readily absorbed into the weekly budget. In seven weeks Mr. Green will have completed a year's work and would be entitled to an increase, they believed, of ten dollars a week. Mrs. Green asked whether the agency could supplement the income until that time. The worker agreed that it would be possible if Mr. Creen could get some verification of the increase from his place of em-

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ployment. In discussion with Mrs. Green it was agreed that it would be best for Mr. Green to discuss this with the worker when he would see him the following week, since because of the nature of the company for which Mr. Green worked, there might be some difficulty in getting the information. Tenth Interview, 12-7-42 Mrs. Green and I had arranged this appointment by phone during the week. I had as yet not seen Mr. Green since he was still rather weak and was not working full time. Our plan was that I would be seeing him next week. However, today Mrs. Green informs me that Mr. Green tried to get the necessary information to become eligible for our supplementation until his increase of salary, since, as we said last time, it would be necessary for us to know that this increase was confirmed by the company. However, when Mrs. Green and I had discussed it last time, I pointed out that she and I could not really know just how Mr. Green could best clarify that for us, and that it would be best if he and I should discuss it. Apparently, however, he had gone ahead, after speaking with her, to talk with somebody at his office, and it seemed he was not able to get a written statement to the effect that there would be such an increase. He was disturbed about this, both because of his experience there and because he was concerned as to what that would mean so far as continued help here was concerned. The thing I was most interested in was that Mrs. Green was able to discuss this with me evenly, with a general feeling of security and lack of emotionalism, when actually I knew how much the supplementation meant to them. I commented on this. She smiled and said she was aware herself that somehow or other she didn't feel "bowled over" by what had happened, that when she and her husband had discussed it they really were able to talk about it. Some months ago, she said, it would have led to a tremendous scene and quarrel. With a certain amount of coyness, and yet at the same time with a good touch of reality, she said this time instead of getting mad at each other, they were a little mad at me for asking for this clarification about the job. It was interesting that in the next part of our discussion we somehow got to considering the fact that this difficulty had arisen at a point where Mrs. Green had in effect tried to be a "middle-man" between Mr. Green and myself, and somehow it hadn't worked. With a certain amount of conviction, and I felt a general sense of ease, she said, "I guess he will just have to handle his own business; maybe it wouldn't have been such a problem if we had waited until he came to talk with you." I said that although it sounded quite logical I thought she wasn't quite ready

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yet for him "to handle his own business." Maybe from time to time she would have the feeling that she ought to step in. Her impulse at first is to deny this—she looks at me, laughs, catches herself in the middle of a phrase and simply says, "Who can tell, I hope not." Mrs. Green hopes that when I see Mr. Green this coming week, it may still be possible for him to succeed in becoming eligible for the supplementation from the agency. They need this badly until he is well enough to carry both jobs, or until his increase arrives. I confirm the agency's readiness to assist to the maximum of our budget if Mr. Green is able to find some way of clarifying his income. She laughs and says, "Well, this time I'll let the two men handle it. I'll stay in the kitchen." Then quite easily, but thoughtfully, she adds, "You know when his raise comes round in a few weeks we won't be needing any more help and I hope we'll manage our own headaches. Although I won't be getting any more money from you, I'd like to keep coming in until then." I said that I thought she was getting prepared to say good-bye. The last time we had talked about ending here she'd gotten pretty upset. She doesn't discuss this very much but comments in her typical, sincere manner, "I think it's different now. Then you spoke about it, now it's me." I believe this interv iew affords us an interesting opportunity to observe the direction in which Mrs. Green is moving, as well as the change that already has taken place in relation to two principal inter-related problems—first, her relationship to her husband, and second, her relationship to worker and agency. In the early part of the case we noted Mrs. Green's almost total rejection of Mr. Green. In this interview we see that she still has some impulse to take over some of his responsibility. However, we note, too, how aware she is that this is not helpful, that it is a problem within her, rather than something she must do for the benefit of the family. One senses, too, that in her own way she is trying to curb this tendency, and that as continued experience confirms Mr. Green's ability to carry his role within the family, she may overcome this residual pattern. Again, in the beginning of this case, when the agency introduced a requirement that meant her husband's participation, she responded with hostility both to agency and her husband. It seemed at the moment to sharpen and extend the conflict between them. At this point, when a similar requirement is introduced, which implies some difficulty for them, instead of reviving this reaction, she tells the worker that she and her husband were "a little mad at the agency." This shift in response, to a

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unity in the reaction of both Mr. and Mrs. Green, I believe is descriptive of the development in their relationship. This "united front" against the agency, offered lightly and with warmth seems, nevertheless, Mrs. Green's way of saying that though the agency is a help to them, it is a problem as well, and in her greater security within her family I believe she is readier to think about doing without it. This is borne out in the natural way she plans in this interview for the termination of her relationship with worker and agency. Whereas, in the early and developing parts of the case, discussion of the length of time she would be continuing, of the temporary nature of the agency's service, created a great deal of anxiety and fear, at this point, in the light of her changing circumstances and her growing readiness in feeling to accept and trust these changes, she is able to plan both for the additional help needed and for the termination of help as well. When she can do it herself, she is no longer so fearful of leaving. The combination of these factors indicates an important turning point in the case. I believe that Mrs. Green has resolved in good part the conflict of "opposing tendencies" which we described earlier, and is now definitely moving toward ending her relationship with worker and agency. She will need help in carrying this impulse through constructively. It is not a precipitous termination of her experience, and the worker in subsequent interviews continues to meet the conflict she may have in carrying this decision through, and helps her with it. It is as important to help a client live through a constructive ending of a helping relationship as it is to help him undertake and make constructive use of help in the early and developing part of a case. On resuming contact with the worker, after his illness, Mr. Green was able to get satisfactory corroboration of his anticipated salary increase, and the agency offered budgetary supplementation until the increase would begin. I think it is interesting to note something about his attitude on returning, after having missed three appointments. I felt there was no question but that he meant it when he said, "I missed my visits and was very grateful for the note you sent me." He spoke of his illness, his satisfaction at being paid during it. He is convinced that he will "pick up where I left off" with his private work. With all of this warmth and congeniality, I note, however, that there is an undercurrent of edginess and an-

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ger. When I comment on it, he admits it freely. He projects it all onto the unpleasantness of his experience in trying to get a written statement promising him a raise. He expresses anger at his wife (something he'd never been able to do before) for making him feel that this was required. When she came home after her last appointment she told him that she was sorry that she "messed things u p " for him, that although the agency had to know certain things, I had never said that it had to be that particular letter. When I acknowledge his right to be annoyed and say I don't see how he could help but be angry with me too, he makes no effort to deny it. However, he says that "women just have no head for business." I say that he might feel annoyed that I saw his wife three times while I wasn't able to see him. If I hadn't seen her he might have been spared this uncomfortable situation. He grins, puts it on envying her because she was able to come in, and then adds that now that he's well he hopes that in a few weeks, by February at the latest, he'll "take full charge" of the family. Mr. Green was able within a few weeks to resume his additional private work, and actually continued to increase these earnings, so that apart from his weekly salary he earned about ten dollars a week. I have not attempted any description of the process with Mr. Green in this paper. However, it is important to note several changes that have occurred. Mr. Green has grown much more confident of his capacity to provide for his family. He has become more certain of himself as a person, and with this development he is able to express and assert himself more fully. The first evidences of this were limited to his relationship with the worker and agency. Then with his growing security, he began to assume a fuller, more satisfying role within the family, and the interviews began to reflect his satisfaction in the role of father and husband, as well as provider. This difference in himself he was finally able to express outside the confined relationship with agency and family, when he went to his employer and expressed dissatisfaction with his job, asking either for greater remuneration or a change of jobs, threatening to leave unless he got what he wanted. This much assertion on the part of one who had never dared say anything that would incur the slightest displeasure from another, was a satisfying though frightening step forward for him. This experience resulted in his transfer to a more technical part of the institution that ulti-

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mately resulted, together with his outside earnings, in doubling the salary he earned on first coining to the agency. Over this same period (interviews eleven through fourteen) Mrs. Green expresses the acceptance of the change in her husband indirectly through giving up discussion of problems in management, fears about her husband's inability to provide, problems in their relationship, as well as making no further requests for financial assistance. Her emphasis in the interviews tends to shift more to discussion of her children. She expresses concern as to whether they are getting an adequate background so that they will have the proper "start in life." She intersperses descriptions of her own inadequate childhood. She wonders whether Helen should take a commercial or general course and is worried as to how to make the right decision. She is troubled by the frequency of Ralph's colds, the need to keep him out of school, and her inability to find out why he is so susceptible. Joan's teeth are bad, she worries whether she can meet the cost of dental care, whether less expensive care will be as good, or will the child suffer in the long run. She discusses these problems with the worker and seems eager for "advice" about them. He helps her by letting her know how to use the school more effectively for educational guidance for Helen, by referring her to a dentist which the agency uses, for Joan, etc. However, he recognizes that these problems (coming at this point in the case), do not represent "new" problems or unresolved problems for which Mrs. Green seeks continuing assistance from the agency. Actually, with this shift in content, Mrs. Green is already moving past the helping experience, in effect leaving it behind her. These problems which she describes represent the continuing everyday problems of family life. They symbolize the typical maternal concerns. Her emphasis on these, her yielding of other aspects of family problems to her husband, is in effect her living more clearly her natural role within the family, with its satisfactions and anxieties. The worker does not minimize these problems by any means, recognizing full well how serious they are, yet he does help Mrs. Green to see that the very fact of this change in the focus of her problem indicates that she is approaching the end of her agency experience. She is very aware that such problems as these will continue indefinitely. Although she protests that the worker is very helpful to her, she acknowledges that she and her

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husband talk these problems over and frequently "decide the same things" as she and the worker do. This is further evidence that she is freeing herself of her dependency on the worker and agency, accepting the family's ability to make important decisions and handle problems within its own capacities. The worker is aware of some guilt on her part for her feeling that she is increasingly able to do without him. Although she does express some concern about what the future holds for them, it is clear that she is ready to continue without help. In the fourteenth interview she repeats a request which her husband made in his corresponding interview. She asks that for the last interview the worker make a home visit. She is very anxious for this, as was Mr. Green, and the worker arranges an evening visit, so that he can see both Mr. and Mrs. Green at home. It may be questioned whether it was technically sound to arrange for the terminating interview to be held in the clients' home rather than in the agency office, where the whole experience has taken place. I feel it was valid for several reasons. Mr. and Mrs. Green, I believe, used the case-work experience well and accomplished a great deal. Earlier I pointed out, it was the agency that was the sustaining force for them while they were struggling to find if it was possible to change their way of life and to find the different roles that such a change would necessitate. At this point I believe their mutual request that I visit, that I see their home, implies that the home is now the symbol for them of the unity which they have achieved. I had a part in helping them realize this goal, and to have me see them together in the setting of the home is a way of sharing something that it is difficult for them to describe. It also gives them the opportunity of seeing that no matter how dependent they may have been upon me and upon the agency, at this time that home is quite complete without the agency as an essential factor, that they really have no need to hold on to the agency. Fifteenth Interview, 2-2-43 Mr. and Mrs. Green are obviously waiting for me when I arrive. There is an undercurrent of excitement that runs through their greeting. I find that in spite of the inexpensive surroundings and furnishings, the home is scrupulously clean and tidily arranged. Mrs. Green is obviously extremely pleased with my comments to this effect, and Mr. Green, in an almost patronizing "man-of-thefamilv" way, says that his little woman is about the best manager there is.

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All of the children are at home, and Mrs. Green introduces me to them. The children are very spontaneous, much at ease, and apparently quite attached to both their mother and father. However, it was interesting to note that the difference in the relationship of the children to each of the parents represented much of the difference in personality between Mr. and Mrs. Green. With the mother there is an easy camaraderie and friendliness; with the father, although there is an evident display of affection, nevertheless there is a politeness and reserve. When all of the introductions are over and I have really seen their home, and commented several times on how attractive Mrs. Green had made it, we settle down to talk in the "livingroom." At this point, there is quite a lag in our conversation, in spite of several efforts on Mr. Green's part to initiate some discussion about world events, etc. I comment lightly on the fact that although all of us are quite pleased at being able to get together, it is a new experience for us in many ways—first, my visiting here, instead of their coming to the office, secondly, the three of us talking together rather than just two of us at a time. Mrs. G. laughs and says that besides, up until now, they had been coming about different problems and asking for my help, but really they wanted to feel that this time I am visiting them as a friend, which is so different. I acknowledge that it is very different, saying that in a sense I guess we were all aware this time they are no longer in need of any help from the agency, and I certainly am impressed, in coming into their home, to see how well they are managing things. Mr. Green, in almost a blustery way, launches into some important "man-to-man talk" about developments on his job. Mrs. Green listens without comment. Everything he is telling me indicates how clearly he is able to manage things by himself, and his own hope that this "was just the beginning"; he was making a place for himself at the firm and he expects to do much better in time. I comment lightly that it seems once he started he just wanted to keep on going, and I didn't blame him. However, I didn't know how things would work out, but conditions did seem quite different now from what they had been. I would certainly be glad to know some time later on, how things are going with him. Mrs. Green grasps at this, saying that they will want to write to me after a few months, or even maybe just stop in to say hello. It is apparent that this somehow makes terminating the contact a little easier. In a rather embarrassed way she speaks, too, about the fact that she has tried on her daughter's skates and "fell all over myself," but the children are very excited and they all want to go skating together. Throughout, everything they say emphasizes how much better things are for them now, how each is enjoying more of family life in his own

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way, and also they introduce plans for the future which obviously in no way included me or the agency. Throughout the interview, too, I felt an ease in the relationship between Mr. and Mrs. Green, some readiness on her part to let him carry the bulk of discussion, but at the same time being very much there herself. At the end of an hour, I laughed and said although this last interview of ours had been very different from all the others in every way, one thing in a sense was the same: I still did work for the agency and still have an hour's time for our visit together. I think this was helpful to them, because it was a natural and acceptable way for bringing my visit to an end, and it had been increasingly apparent that in spite of their warm friendliness and feeling of gratitude toward me and the agency, there was at this time little left for us to talk about. On leaving, they thank me again, repeating with much sincerity their feeling that the agency has helped them in ways that "you can never know," and that they will want to keep in touch with me and let me know what happens. The focus throughout this entire experience has been on Mrs. Green's relationship to the family as a whole. Her many and varied feelings, the many material needs, have all been related to their influence on her as an individual and as a family member, as well as their influence on the other members of her familv. While individualizing her problem, the process never lost sight of her as part of the total family configuration, trying to find a more effective role within the family, or perhaps determining that she could not continue as part of it. The family is not just a background for understanding Mrs. Green (or any client). The distinguishing aspect of family case work is its responsibility to the whole family; it cannot exclusively focus on one member without responsibility for its effect on others. The combination of a real interest in her, and yet an equal responsibility to the rest of her family, on the part of the agency, presented a problem for Mrs. Green. Although she responded to the worker's interest and willingness to help her, she inevitably tried to establish as basis for that help, the rejection of her husband which dominated her attitude and role in her family. The worker and agency did not require of her a change in attitude in order to get the help she requested, nor did they deny that her attitude might be justified. However, they could not adopt the attitude as their own and follow in the pattern of rejecting Mr. Green by ignor-

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ing his part in the help that was requested, since this would help neither Mrs. Green nor the family. The rôle which the agency assumed in Mrs. Green's life at the very outset through its policy structure, which required that Mr. Green be seen, achieved several related ends. I should like to repeat here that this requirement grew out of a long experience in working with families, out of an understanding of the positive values in normal family organization (elaborated earlier) which were absent in this family. Mrs. Green's long standing pattern of rejecting Mr. Green, with its inevitable obliteration of his rôle within the family (and diffusion of hers as well ), came into conflict with the agency's policy. Her attitude or pattern projected all responsibility for the family dilemma on to Mr. Green, carrying no awareness or responsibility for any part she played in the problem. Agency requirement that Mr. Green be included broke into the unconscious operation of the pattern by testing its motive. Is she, for the benefit of the family as a whole, ready to let Mr. Green participate in the application so that they can get the necessary help? Or will she have to sustain the old pattern rigidly at any cost? This experience is painful for her, flooding her with the confused feeling inherent in the contradiction between what she has always felt was her desire "to do everything for her family," and her sudden awareness of the irrational impulse not to let Mr. Green into the picture even at the cost of deprivation to her family. Her decision to yield to the requirement of the agency is in reality the initial step in the breaking up of her destructive pattern and in movement toward a more constructive rôle in the family. Secondly, it brings Mr. and Mrs. Green into a living experience of sharing a common family problem, through the agency. For them this is an awkward, stumbling experience, since for many years they have operated either against each other or unknown to each other. Finally, this has resulted for the first time in years in bringing Mr. Green into a situation wherein he is accepted as an important, responsible individual within the family. This acceptance from the agency is transitional to an acceptance that he ultimately gains from his wife and family. Throughout the case it will be noticed that the services of the agency are continuously related to furthering the working out by

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each of the clients of his own unique role within the family, and its difference from the other's. I believe that when family case work accepts as its focus a responsibility to the whole family, it defines a useful uniformity of purpose, structure, and method, in spite of the large variety of problems and services with which it deals. This responsibility includes an understanding of family organization and the different roles normally assumed by the several members of a family. It involves an ability to relate a particular request for service to such an understanding, and to help the family to clarify which member should be the rightful client (or that both should play some part) under the circumstances. It means being able to utilize the policies and services of the agency in such a way as to help the client or clients to reestablish or preserve their different roles within the family when the existing problem can be met within the sphere of the family agency service and family case-work skill.

THE RELATION OF CASE-WORK HELP TO PERSONALITY CHANGE Grace Marcus IN THE last twenty-five years social case work has devoted its major energies to the task of understanding the psychological element in the case-work job and evolving a method that would be psychologically sound. Its literature reflects the changing concern of case work with the personality of the client, the changing psychological and social ends to which the concern has been directed, and the changing means used to achieve the ends. The literature also reveals the disorderly character of the evolution. Case workers took it for granted that their practice embodied a method, but it had no method in any real sense of the word. There were concepts, valuable in their essence but vague and ill-defined: they harbored unanalyzed contradictions and were mutually inconsistent, and they had a very uncertain relation to practice. Case work had humanitarian purposes but they were not developed into an operating power; they had not come to terms with actual conflicts between the divided will of the individual and the confused will of the social group, and so they were liable to unintentioned and undetected compromise. Case work was possessed of technical devices or "techniques" of sundry sorts, but they were not definitely harnessed to a practical purpose on the one hand, nor to a practical necessity arising out of the client's problem on the other. The specific professional task of the case worker was variable in its nature, and the determination of its elements was subject to shifting influences in the single case, in the individual worker, in the particular agency, and in the specialized field of case work. Case work was an exciting but uncontrolled flux. It lacked the basis for a method—a defined problem—and it lacked the direction for a method—an explicit, single-minded purpose. The distinctive compelling interest in all the ferment of case work was the interest in the individual and the firm conviction 148

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that what he is, how he feels, and what he wants cannot sensibly be ignored in efforts to help him. It was appropriate that this same interest and conviction should finally create a case-work method, the first self-sufficient, indigenous method in social work. Because it is a genuine method—defined, integrated, and ordered—and therefore different in kind from the loose collection of ideas and devices that otherwise compose the equipment for practice, effort of another quality than that to which case workers have been used, a methodical effort, is required either to explain or to understand it, or to put it to the severe test by which a method must be judged. If it is anything, a method is a whole and not merely an aggregation of pieces to be examined and appraised in their singularity. It must have a definite and unifying purpose, internalized and controlling. Its means should be means directly leading to the accomplishment of that chosen purpose and to no other, however inviting or beneficial another purpose might seem. But more than this is required of a method if its validity is to be trusted. Its choice of means must be dictated by knowledge of the problem and of what produces change in the problem for better or worse. An initial difficulty in taking hold of the case-work method, digging out its meanings, and challenging its implications, has come from the fact that no professional method is born fully formed. The ramifications of a method are not immediately and automatically visible even to its authors, and like every other growth it has to develop in practice to be realized in its rounded entirety. In ten years enough growth has occurred in the use of the case-work method for the interconnections between purpose, problem, and means to become manifest. In attempting to discuss the relation of case-work help to personality change, I shall try to show the interrelation of purpose, problem, and means, and how they are rooted in the psychology of the individual and his situation of needing and asking a service from the case-work agency. Out of a long process of experimentation in practice, came the discovery that furnished the ground work needed to support a case-work method. This discovery was that case work, in dealing with the client, is dealing with the higher psychological development in him that is technically known as the conscious ego, or self. The conscious ego, or self, is the organization of his mental forces and capacities which we recognize in some aspects as his char-

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acter, in others as his intelligence, in others as his personality: for the individual this development comprises his individuality, his special identity—it is he. With it and through it he has awareness of himself and his own separate existence; he has consciousness of what goes on inside and outside; he feels, thinks, wishes, decides, and acts. All the developments that take place from earliest infancy —of habit, coordination, sensation, behavior, conscience, capacity for personal relationships, learning, feeling, special skills and individual abilities—become organized within this ego or self. Not only the forces of physical growth in the individual induce the development but a necessity in human animals, that is essentially social, to escape from a dangerous helplessness and a precarious dependence on others through increasing self-reliance and selfdirection. It is through the self or conscious ego progressively developed by the individual that he secures his place in society; and it is through this mental organization that he carries on his social responsibilities, engages in social relationships, and steers his life course. It constitutes the continuity that takes him through external and internal change. Because the conscious ego has such crucial personal and social values for the individual, his besetting difficulty through life is to maintain a sense of its wholeness or integrity against inner conflict and division, and against external injury and disruption; and since conflict from within and without are inevitable in experience, the basic problem for each and every person is to learn how to live through conflict without damage to psychological organization. It is of primary importance to emphasize that the conscious ego is an organization of the individual's developed capacities to register, sort out, and meet his own needs, personal and social. This emphasis is important because the focus of the case-work method on this organization marks the chief and apparently most puzzling difference between the psychology of the case-work method and the preceding psychology, with its emphasis on the irrational, unintegrated, and uncontrolled elements in the psyche, from which the self originally develops and from which it must continue to derive its sustaining and creative energies. When case work identified the conscious ego as the psychological entity with which it is confronted in the relationship to the client, it acquired a stable basis for a method. The method recognizes

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that when the individual cannot supply his essential needs or conduct his personal affairs through the usual resources of self, he stands in real danger of no longer being able to maintain his psychological organization intact. Throughout its history the problem which case-work practice has tried to solve is this of helping the individual to maintain the psychological as well as physical self in the act and process of taking case-work help^Nojriore is required than a superficial survey of the paternalistic tendencies that in one form or another have dominated the various stages of case work, to conclude that their chief error has lain in the interfering attempt of the worker to take over the ego's functions, virtually to become a substitute for that ego. The case-work method has realized this error: the case worker's role in relation to the client is not that of substitute for his ego, but that of its assistant in its individual struggle with the social need which the case-work agency is designed to supply. The psychological recognition of the fundamental need of the individual to maintain an organized, integrated self, defines for case-work method an essential purpose in the individual with which it can ally itself. The identification of the case-work method with this stake of the individual frees it from conflict in its inner direction. If the basic interest of the individual is to defend the personal development that enables him to operate as an autonomous social being, the basic interest of the group depends no less on the growth of this conscious ego in all of its members and on protecting it from avoidable disablement or disintegration. The case-work method can, therefore, embrace an undivided, underlying purpose, equally valid socially and psychologically: the professional purpose of helping the conscious ego or self of the client to preserve its place and its function in the social scheme from the hazards associated with a need beyond the individual's own capacity to meet. The necessity for an informing, orienting purpose in case work is recognized in the_grinciple of agency^function. The usefulness of a professional purpose lies in the guidance it gives in the complicated and confused situations of practice, where the case worker is confronted with manifold conflicts within the individual, within society, and within the relationship between the two. To be of any practical value, the general professional purpose must be formu-

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lated in terms of the special objectives to which the particular agency believes its specific resources and services should be directed. This definition of the agency's purpose is not for the case worker alone, but for the information and guidance of clients and general public. The definition is a recognition of the interest of the public in knowing what the agency offers, and it assumes an accountability in the agency for fulfilling the purpose it avows. If the professional purpose defined in the agency's statement of its specific function is to be properly incorporated and motivating in its case-work operations, policies must be framed to keep purpose clear and self-consistent and from being led astray at points where professional experience has indicated that it is both difficult and important for direction to be sustained. There would be no justification for this emphasis on purpose unless there is a direct relation between the objectives animating the agency's functioning and the psychological necessity of the client in a situation of need that he cannot meet without organized help. What is this psychological necessity and is it sufficiently typical of clients in general for the agency's whole scheme of operation to be geared to it? One of the important functions of the active conscious ego is to master the immediate unknown in living, to take possession of the assets it contains and erect safeguards against its liabilities. The resistance to change is counterbalanced in most human beings by a psychological need of change, which once embraced requires that the individual muster all his resources to make change turn out favorably for him. When, however, change comes unsought and is precipitated by some failure in the supports of ordinary living, or by an exhaustion of the individual's tolerance of a mounting difficulty, or by a problem that is unfamiliar and complex, the ego is exposed to a disorganization at the very moment when it should be mobilized for action. It must contend with the pain in the loss or the conflict that occasions the need, and with the loss or lack itself that is undermining the basis for living. There is the self-preserving impulse to hang on desperately to what is left of the old state of affairs and pattern of operation, in conflict with the plain necessity to find relief from an untenable present. A great deal has been written on this subject that requires no repetition here: the problem I want to stress is the peculiar disability under which the ego labors in making a change that is, or

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seems to be, forced from without and that has produced results beyond the ego's means to manage. The difficulty in the individual's ego is reflected in such feelings as that of not knowing where to start; of not being able to get his head above water; of not knowing what can or should be done; of not being able to measure the requirements or the consequences of possible alternative courses; of not knowing where he'll come out if he tries this or if he risks that; in short, of being disabled in the normal functioning of the self. This condition arouses a deeper fear, of further loss of selfdirection if the wrong step is taken, a fear not only of this loss of self-control, but of falling under controls that are alien to every established way of feeling, thinking, and acting. The ego feels that the bottom has fallen out or that everything is going to pieces. Whatever the individual's ordinary resistance to change, the problem now is more than that: it is the problem of coping with change under handicaps and without preparation in experience, resources, and knowledge, therefore without the opportunity to gauge probable consequences. When the compelling force is the need of relief from the unmanageable or intolerable, what the individual wants or would choose is obscured through his being in a situation not of his own choosing, in which perhaps the positive purposes that have previously motivated him no longer seem to have any place. This picture is generalized and in a sense it is exaggerated, for some individuals fight anxiety by immediate planning and action, but even in these individuals the dangers to the ego are felt under cover and the planning and the action are often warped by the insistent underlying fear, and by the difficulty of mastering the unknowns that have broken the pattern of living. The problem in which the client is caught is the problem of change, not only change in his outer circumstances, but in his selforganization. There is an inner struggle to be endured and worked through by the client. This struggle is not created by the case worker, nor is it dictated by some well-meant but intrusive concern for the development of the client's personality; it is inherent in the using of case-work help for ends that will be constructive for the basic welfare of the individual client and of the social group. The struggle is the client's struggle for, and with, a purpose of his own. The struggle is waged against the conflicting feelings that beset him in finding and pursuing his purpose with the case

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worker—feelings that may exist in him, in his personal relationships, and in his relationship with the worker as the representative of the agency. Case work has had ample experience of the diversions, defeats, and reversals of the helping purpose by conflicts that operate unperceived, that entrap case worker and client in open or insidious oppositions, or that suddenly wreck an apparent progress, proving it illusory. The case-work method offers means to be used in assisting the ego of the client in the struggle to reorganize himself and his situation. The means are the agency's purpose or function, policy and procedure, and also the skill of the case worker in helping the client to work his way through the entanglements of conflict, forging out of it, step by step, resolutions that are his own. We have noted that an unmet and essential need and the problem producing it, throw the operating self of the client into a more or less disorganized state. The seeking of help from an agency is a decisive move on the part of the client to recover or preserve himself by modifying his environment, modifying himself, or both. From the start the case worker uses agency function, agency policy, and agency procedure to inject reality, pertinent and homely, at spots where the client's own discussion of his difficulty shows that he is befogged or is hampered by ignorance and apprehension. The immediate impact of this activity of the case worker's on the client may be reassuring in some respects and painful in others. Help from this agency may be available but not for the exact purposes or on the exact terms that the client's request suggests. The revealed conditions or procedures may be less difficult in certain ways, more difficult in others, than he expected, and they may or may not seem to him to be necessary or effective ways of getting hold of his problem. For the moment we shall not concern ourselves with the mixed reactions the client is experiencing, but rather with the more general meaning that the contributions made by the case worker to the defining of his problem have for him. He is being given an opportunity to objectify the problem, to bring it into real focus, to extricate it in its actuality from his own fear and confusion about it, to see more clearly what he has to contend with, and to discover whether this is the place at which he wants to begin, and whether this is the track he wants to take. What the agency is there for is a use that may appear only partly to fit his entirely individual needs and desires; he may realize, as concrete

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possibilities shape up, that another course of action is preferable for him. What is happening in him is a movement toward recapture of those powers of the ego that were thrown into disorder or were helpless in a vacuum. Since the problem situation is painful and the way out of it is inevitably painful, this experience that the client has in having both the problem and the way out externalized and made real will also be painful, yet for an ego disabled by fear of concealed pitfalls and hidden consequences, the precipitation of the reality in the confusing problem of need serves the positive purpose of uncovering-what is genuinely good or bad in his situation, and, from his point of view, in his relationship to this agency. The agency's particular usefulness, its definition of what can or cannot be done, its way of working with him, involve restrictions, some of them unavoidable under its own circumstances, but most of them arising from the agency's analyzed experience with all the kinds and varieties of the specific need it supplies, and with what is involved in the need and in meeting it realistically and constructively. it is at these points where the worker brings agency function, agency policy, and agency procedure into active play, that the worker is placing at the client's disposal more than her own individual knowledge and skill and is offering him the appropriate essence of the understanding accumulated by the agency for working effectively on his problem. It is through the purpose of the agency as it is carried out in its function, through the policies that elaborate and define it, through the procedures that are set up to facilitate pursuit of it, that the client has a chance to find for himself, as he works with the case worker, what he wants to do, how much effort he is willing to put forth to do it, and how far he wants to go with it with the case worker. It is a very different matter from toeing the agency line and acting in an obedient acquiescence or in intuitive anticipation of what will please the worker. It is a struggle to find himself in his purpose and in the tortuous ramifications of purpose that may take now a positive and now a negative turn, or be bewilderingly ambivalent. It should be emphasized that what the agency requires for a working partnership is minimal, the barest essentials for proceeding on a realistic basis in a realistic way. If the client takes the agency's help, what is further demanded of him personally in the

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using of it and what he makes of its use depends on what he is, what he wants to do, how much he and his situation can take of change, and it depends also on the development within the agency and on the skill of the case worker. One client uses financial assistance to mobilize himself out of the disintegration of long unemployment. Another client uses it to wring out of his initial resistance to the unskilled, ill-paid jobs for which he is equipped, a compensating determination to develop the potential skill he has lacked the confidence and the persistence to master. One mother uses the placement service of the agency to discover for the first time what a responsible relationship to her baby really involves. Another mother tries to escape through placement of one child a direct encounter with her inability to care for a husband in the advanced stages of an incurable, chronic disease; as she confronts the emotional cost of placement to that child, to herself and to her other children, she discovers that her reason for placement is not good enough to sustain her in her plan and that she is sacrificing not only this child but the other two, in her retreat from the fact that she cannot give her husband adequate care at home. For one young woman, pursuit of vocational training is a test of her capacity to face her own fear that neither her abilities nor her opportunities justify the ambitions she has been nursing. For another woman of thirty-one, choice of a vocational plan precipitates elements of conflict with her father and plunges her into a struggle against her own need of his complete sympathy, against her tendency to doubt that she has any capacities that he doesn't recognize, and against her fear that she will be punished for any independent initiative by failing in it. The relation of case-work help to personality change is indirect, for the decision to effect change within the client is not the worker's prerogative. What necessity there is for change is dictated by other and innate factors in the client and his situation—the conflict the client experiences as he becomes engaged in using help and finding his own purpose; the kind and degree of conflict that interferes with his pursuing his chosen course; the amount of change his living situation requires and permits; the nature of his own aims and his present capacity to make headway toward their accomplishment; the realized or latent strength he can command for assertion of himself. But if the worker does not determine the necessity for change, the client's chance to meet his own particular

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need of change depends, in large measure, on the help she is able to give him in the process of interaction between them. The direction of the process is broadly set by agency function, but in its development the individual skill and judgment of the case worker play a potent role. The elements of conflict in the client that properly concern the case worker are those that interfere with his use of the agency's help for his own constructive purposes and, therefore, with the agency's aim in serving him. It is no business of social case work to stop to investigate and treat the various conflicts that may exist in him. It is, however, the case worker's responsibility to help him to make decisions and moves that are effective and real for him and that are not merely his half-hearted concessions to a necessity that can easily seem to be a necessity imposed by her. Psychological experience tells us that the conscious ego strives persistently for a sense of unity and self-consistency because this is necessary to the confidence and strength demanded in action, and that a failure or lack in the ego's resources for meeting an essential need exposes it to intensified conflict at a time when action is imperative. Not only the immediate reorganization of the ego but its fate may be determined by the way in which the individual manages this struggle. He may cut off part of himself by closing from consciousness or denying value to feelings, interests, and capacities that he does not know how to deal with unaided. In order to relieve the tension of conflict and avoid being lost in its confusions, he may shut out the doubts, desires, and possibilities that throw into question the only course he imagines is open to him. Skill in the case-work process requires that the case worker help the client to avoid this loss of self, to conduct this struggle toward wholeness and action without the suppressions of contrary feeling that would leave him burdened with inner fears and conflicts and with the necessity of holding these at bay. The cost of open struggle for the client is the immediate pain of experiencing more of the conflict involved in his problem than he would consciously experience without help in sustaining it; the gains are the survival of more of himself, choices that are better grounded in his real feeling, and a release of the vital energies that would be spent in fighting divisions within himself. The case worker's responsibility requires that she ally herself

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with the capacities in the client's ego that can arm him against neurotic solutions of conflict, against surrender of valuable parts of the self and surrender of valuable parts of reality. The ego that matures in strength during its life course must develop the capacity to withstand its own fear of looking at the world within and facing the world without, for this is the fear that may impel it into headlong conclusions, unstable compromises, forfeiture of its own integrity and sacrifice of the opportunities of experience. Case work has for some years recognized not only the value but the necessity of self-determination for the client. The task that has confronted case work in helping the client to maintain and improve his capacity for self-determination is, however, infinitely complicated by the fact that so often the very problem that has overtaken him plunges him into conflict and divides his self among opposing tendencies. This is why the job of the case worker is twofold: to help the client really to preserve himself against damage to his ego economy on the one hand, and against submergence by an unmet essential need on the other. The case worker's obligation demands that she not collaborate with the tendency of the ego in trouble to solve conflict by suppression and denial of its own unruly feelings. The case worker's capacity to identify the client's lurking uncertainty, antagonism, desire or resistance, and her open recognition of their possible bearing on his problem of decision, have the effect of embracing, in a sensitive and respectful understanding, the emotional realities he might be driven to ignore from fear of himself, his situation, or her. Supported by comprehension, from her, that is at once noncritical and unflinching, the client has a chance to admit his feelings to himself, to take them seriously as his feelings, and to find out how much they count as factors that might set him on one or another course. The worker's use of the agency's definitions of what can or cannot be given and of the terms on which available help may be secured plays an indispensable part in this process: policy and procedure keep the practical problem on which she and the client are working focussed for both and clarify that other realitv of means and consequences against which the ego must weigh its emotional alternatives. It is through the worker's fidelity to the

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agency's purposes and to the agency's experience of sound ways to proceed, that the client in the throes of uncertainty is enabled to keep hold of his own impulse to achieve mastery of himself and of his situation: without a steady orientation to the present possibilities of concrete action, he might again be lost in a confusion of feeling, helpless to distinguish the problem of circumstance from the problem in himself, and so be no better off than if he had been left to his own unaided devices. The worker's unfolding definition of the help that may be used and the conditions under which it is obtainable assists the client in crystallizing positive purposes out of the negation of the old and offers him practical means for action out of the resourcelessness in which he has been bound. In so far as he has clung desperately to fragments of the past to stage off utter disintegration of his old framework of living, the worker's patient identification of the help the agency can offer and of the uses to which it can be put reduces his necessity to clutch at remnants of a security he must leave behind if he is to find a new foothold. With skillful help, each move that the client makes is a move toward inner reorganization, and each resolution of purpose is a discovery of an integrated capacity in himself to deal with some immediate part or phase of his difficulty. There can be no doubt that the way traveled by client and case worker is the hard way, through the midst of the pain and struggle which the human ego so frequently tries to escape, in the false and neurotic solution of self-compromise. The ego naturally shrinks from the difficult choice, and many of the choices open to clients are between one harsh external compulsion and another. To meet these compulsions may exact of the client changes that penetrate deeply into his habits of feeling and acting, or that call for assertions of himself that he has previously dodged, or that demand that he measure some new independence against the effort that he himself must make to gain it. In this process the case-work method offers him two complementary kinds of leverage: the material help that he may use to work his way out of his intolerable practical situation, and the discovery by him of purposes more truly his own, more representative of his real self and therefore worth more of a struggle than he would otherwise have made. It is this advance toward self-realization that rewards the client for having grappled

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with whatever problem stood in the way of his determining his own course. Self-determination is such a neat, attractive phrase that it is easy for case workers to assume that it proceeds automatically, whereas, even within the restrictions of the case-work process and the bounds of the agency's function, self-determination involves some finding of the person by himself, some decisions as to which of contradictory impulses and desires are most essential to that self, and a steadfast effort to effectuate in living the purposes that he identifies as his own. The use that some clients make of case-work help is minimal: they find in it assistance needed to reorganize their management of an external situation, and experience no need and no desire for more than that. Others in varying degrees gain strength against some of the fears that have hitherto hampered them in taking cognizance of their own feelings, in giving value to their peculiar needs and interests, in freeing themselves from impediments in their relationships or manner of living. To the extent that they acquire ability to tolerate more knowledge of themselves and of their external situation, there is a development in their ego capacity for decisions that are realistic emotionally and practically, for decisions that they can acknowledge as of their own making, for choices that diminish the role of external compulsion in their lives and give them an experience of the freedom that comes to any individual from accepting both the inner and the outer necessities as his own. The case worker does not take responsibility for effecting personality change, in the sense that she does not determine for the client that certain changes are desirable and necessary, that they shall come about in a prescribed way, and that they shall have some preconceived result. On the other hand, the case-work method places on the agency and on the worker a precise and exacting obligation for seeing that the influence that is wielded by the giver in relationship to the receiver is exercised in such ways as will not infringe on the individual's control and direction of himself. The purpose of the case worker is to assist that self to recover and strengthen its organized powers through the maximum use of them in the case-work relationship. The case worker cannot be responsible for the total result since she is not omnipotent. She; can be responsible for what she does that affects the result, that is,

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for the method and process she employs and, therefore, for the degree to which she helps or hinders the client in gaining command of the ego that makes him a person to himself and an asset to society.

A DISCUSSION OF TWO CASE RECORDS ILLUSTRATING PERSONALITY CHANGE Virginia P.

Robinson

THE two records I propose to discuss and compare came into the possession of the Pennsylvania School of Social Work, in answer to a request to some of its field work agencies for case material which might be useful for teaching. One, the case of Joseph Marks, has been thoroughly used in classes in this School and on the West Coast; the other, more recently acquired, was used for the first time in our summer school of 1943. I myself have taught only the Marks case, and that briefly, once at Pennsylvania and once at the University of Southern California, so that I approach these records, here, not with a sense of familiarity with their teaching points, but rather with a sense of discovery of something new in case-work process. These cases came into my hands this summer shortly after I had read Grace Marcus' article on "The Relation of Case-Work Help to Personality Change" 1 and it is because of the striking illustration they afford of that problem that a discussion of them seems a logical sequence to her paper. I face a difficult technical problem in deciding how to set up two case records of some ten pages each with discussion by a third person. There are three possibilities: I have rejected the possibility of placing my own discussion first and the two records following, preferring to give the reader the chance to explore the meaning of the records for himself. I find also that to break the records up with annotations of my own would seem an intrusion into the process as described by the case worker. It seems essential to me to present these records intact with only so much of introduction as will serve to engage the reader in a search for the common case-work method they illustrate and with a few questions which may point up more sharplv the difference between this method and 1

See p. 148.

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others. The records will follow this introduction and in a concluding discussion I will present my own thinking about the method and process here illustrated and the nature of the personality change effected as I understand it. In introducing the case workers it is important to note that both are trained case workers with many years of experience in the field of family case work. Both are competent experienced supervisors, at home with agency function. They carry function surelv and responsibly, so naturally that it never appears as a problem. In the Marks' case perhaps the most important factor in treatment is the worker's ability to identify herself with the whole agency and to carry responsibility for the man's past experience there, when he failed to get help, as well as for the present experience. In both cases, the worker's capacity to say, "We do have a service for this if you wish to use it," rests upon mature experience. In addition, I should like to recognize that both workers have a common understanding of what case-work help means and a real skill in offering it. There is marked and interesting distinction in each worker's individual way of giving help, as there would be in "style" between two pieces of creative work by different individuals in any field. But the striking difference between these two pieces of case work is introduced by the two clients and it is this difference which I shall later want to examine. In one respect they present to a case worker a common problem: Joseph Marks, an attractive-looking young man far along in his twenties, who has never found a "permanent" job in his life, who has constantly depended on the support of his family and has distorted agency service to his need; Carolyn Lee, a drunkard, down-and-out, of whom the best that can be said by the family friend who introduces her is that she has seen better days. Each faces the worker with an apparently hopeless problem; the one involved in some miscarriage of psychological development, the other in actual offense against social and moral law. A young worker might delight at this chance to try her power against such odds, but the greater the experience of the worker the more soberly she will approach patterns apparently so deeply rooted, so firmly fixed. There is indication that the workers in these two cases approached their clients with this soberness, with much reservation as to their desire to be different and their capacity to change.

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At the same time, both workers gave every chance to their clients to demonstrate their willingness to change if it were there. In spite of this likeness in degree and depth of problem, these two pieces of case work are differentiated strikingly by what these two clients inject, once they begin to be active in a case-work process. This difference could not be predicted by any worker, no matter what her experience or skill, but can only be responded to and dealt with as it develops. If this can be followed through in these records, the reader will have in his possession the basis for an understanding of a process of personality change and the way case work can make its help effective in that change. By "followed through" I mean not in one but in several readings. For myself I have found it necessary to read these records many times before I could abstract the process of change so easy to recognize as a fact in a first reading. The teacher, the practicing case worker, even the student of case work, has an obligation to understand to the best of his capacity and the limits of his professional experience, the process of change in any piece of case work. It does not answer the question to rely, as the beginner must, on agency function as the necessary and inevitable precipitant of change. Granted the firm, sure use of agency function which we feel in these two pieces of work, we must know what other forces give direction and form to the movement in these two individuals. If these two records are valid accounts of processes of case-work change we must be able to find in them answers to a number of questions: What is the source of the dynamic in these two cases? Miss Lee is described as desperate and reiterates that she wants to do something different but asks, how can she when she has neither money nor a job? She does not even get herself to the agency office alone. Mr. Marks has a history, in the agency's own experience with him, of dependence on family and agency in intervals between episodic employment. His first appearance in the current record with the new worker savors of the old use. What does each worker inject into these fixed patterns, and where is there evidence of something different in the client's response, the beginning of a process of change? If evidence of such a process is apparent, what carries it further? To what extent is the process projected, or put out onto the worker (and her agency), by each client and carried then between

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client and worker? What use is made of outside resources by each client in addition to his use of the agency? Does this projection 2 have an inevitable form and course determined by the individual client? To what extent does agency structure or limits or the worker's difference modify the course of the client's movement? An answer to this last question should illuminate one of the most baffling problems of case work, the problem of ending and its control. T h e records follow; first, Carolyn Lee, and second, Joseph Marks. CAROLYN LEE

11-28-40 An appointment had been made by Mrs. S. from WPA for Miss Lee to be seen in application. She did not keep this appointment. 11-29-40 Mr. M. of the Social Security Board telephoned. He wanted to talk about Miss Lee to see if we could help her in any way. It was his understanding that Mrs. S. had called us about her. I said that was so and that Miss Lee was given an appointment for yesterday but she had not come in. He said that he was very much disappointed to hear that, because indeed she needed something and he did not know what to do with her at all. He had known Miss Lee all his life because one of her brothers was a good friend of his. She comes from a very nice respectable family and has no business behaving the way she does. She knows what's right. For the last four years, however, she has let herself go completely. She drinks to excess and has really been a street walker. Mr. M. went down to see her today to give her something to eat, because as far as he knows she doesn't have any money at all. She is living with a man who was employed until recently but is not working now. He found her in a very wretched condition and in a desperate state of mind. She says that she wants to do something different, but how can she when she doesn't have either money or a job? Mr. M. seemed to feel that the girl ought to be given a chance. Her brother, his friend, is a very fine man and holds a responsible position. Another brother, who is here in W. is not much good, drinks heavily, but is kindhearted and is able to struggle along. There is an 85-year-old father who is still working and is heartbroken over his daughter. The mother has been dead for several years. Miss Lee is a typist and at one time must 2

1 am using projection here not in the usual psychiatric sense of the word, but in. the literal meaning of putting out some activity from the self upon the object. Ira this sense projection is the most common expression of living and the basis of all relationship.

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have been pretty good. Mr. M. did not think that she was in any condition to work right now, but he has talked with Mrs. S. and thinks that they will keep her in mind for a job some time. I said that we would be interested in seeing Miss Lee although I did not know of course what we would be able to do. I pointed out that this would depend entirely on Miss Lee, whether she was sincere in saying that she wanted to live differently from now on, but that we would be interested to see if we could help her. Mr. M. wanted to know if it would be possible for someone to go down with him to see her. I said that we did not do that, that people came here for application. However, I would be willing to write to Miss Lee. While Mr. M. accepted this procedure, he had the feeling that if she were seen she would be more likely to come. He said again that he was disappointed that she had not come in last Thursday. I said that I thought I could understand that, that she was probably frightened and she did not know us and that if he felt he could tell her something more about us perhaps she would have more confidence in coming. He decided that he would do this and asked me when I could see her. An appointment was made for the next morning at 9 o'clock. Before hanging up he asked me if I would call him after I had seen her. 11-30-40 Miss Lee at the office. She is of average size and seems older than her 35 years, with wavy black hair and dark hazel eyes which look into the world in a melancholy way. Her face was lined and bruised, adorned with conspicuous make-up. She was dressed in an old leopard fur coat, a red woolen sweater and a dirty black skirt, with an old brown hat pulled down over her face. Sitting in the waiting room she seemed extremely nervous, fidgeting and biting her fingernails. When I addressed her and asked her to follow me she gave me a frightened look and followed me into my office timidly and in silence. After I had offered her a chair, which she took with hesitation, I had an opportunity to look at her a little more closely and I noticed that she had bitten her nails so badly that all her fingertips were bloody. She looked at me so anxiously that I found it necessary to open the interview by asking her what had brought her to us. In a very subdued, fearful, and anxious way she was able to stammer out that Mr. M. had suggested her coming here to talk about job possibilities. Did we— we probably didn't—have any jobs that we could refer her to? I asked about her being out of work and about the kind of job she had been thinking of. Instead of answering she broke down very suddenly to say that she might as well be frank with me. She hasn't been leading the kind of life that one should, she has been drinking to excess, and all sorts of dishonorable people took advantage of that so that now she is

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a complete wreck. She has to do something different she knows, and she wants to, but much as she wants to, she doesn't know how she can possibly get out of this because without a job she won't have any money, and without money one cannot live. Often before she has wanted to do differently, but in the end there was nothing else for her to do but to go back to her old ways because she needed to live. I said that I knew that it was necessary for all of us to have money to live and I was interested in her wanting to get a job. Could she tell me something of her work experience, for even though we did not have any jobs to give out it would help me to understand better in what way I could help her if I knew something about her job problems. She said that she was a typist, had gone to Business College and had had some jobs in the past. The only thing she doesn't have is shorthand, which is definitely a handicap, but she is a very speedy typist when she is in shape and until two years ago she had jobs most of the time. Since 1938 she has had nothing and her jobs were not very regular before that because of her drinking. In answer to my question about the drinking she told me that it was about seven years since her mother died and their home was broken up. Somehow she got into bad company then and has not been able to get out of it. I said that she sounded as if she did not like her company. Were there other people whom she would rather be with? Indeed, she certainly doesn't like her company, but she doesn't know how to get out from under them. She knows nobody who is different from them just now. The people she had known in the past, friends of the family and church members, will have nothing to do with her. They all know how she has been behaving and so they don't know her any more. I asked about family and she told me about her father who sees her very infrequently because he is so unhappy about her. One brother who is doing well is not in town, and another one here in town is not much better than she is. He is good enough though when he does have the money and sees her. He buys her a meal occasionally. She feels, though, that she cannot live with his family either because it would not do any good. I asked if she could tell me something of how she was living at the present time. With much disgust she spoke of the place where she was staying and said that this was a terrible neighborhood and all the people around there were not much good. She was known there and people expected the worst of her. She simply had to get away. I asked her if she was living alone there and she said that she was not, that there was a man who had been with her for the past two years. I said that I didn't understand quite well, had she thought of moving away

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herself, or of their moving together some other place? She replied that she wanted to move alone, away from him too. I wondered what he was going to do. She didn't care too much, she replied, after all he could work, a man can take care of himself better than a woman, and she didn't see why she should keep him all the time. He has treated her awful at times, sent her out on the street, kicked her and beaten her. While she said all of this as if she didn't care about him at all I had the feeling that she had turned over in her mind nevertheless some concern she had for him, which led me to say that I wondered why they had never considered marrying when she had lived with him for two years. It is difficult to describe her reaction to this question. She was silent for a little while, while I was trying to straighten out what her thought might be. It was obvious that marriage had never occurred to them, that this question coming from me, who seemed to belong to a very different kind of world, which at one time she had known, had a startling effect on her. I felt that she was struggling with a reply in my language that I would understand. Finally she said very slowly that it was true she liked him—in a way. But she did not love him. There didn't seem to be any other people about whom she would care at all when she was leaving this particular neighborhood. I asked her how she had thought to go about building up this new life, and, if she had no friends other than those people she didn't want to associate with any more, wouldn't she be quite alone? We explored together the possibilities for meeting other people and it looked as if there were very few. She assured me that this did not matter, that all she wanted was a job and to get away from this group. Perhaps it was not too late. I said that I thought it was not too late if she really wanted to do that, but I wanted to tell her that I thought it would be very hard. All of us needed to have company, needed to be with other people at times, and she had been used to being with people, even though she didn't think they were the right kind of people. Nevertheless she would miss the company. This discussion was evidently a very strange experience for her, and I gathered from her reactions that she wondered why I thought that she had any right to express any needs at all. She finally said something about this and told me very directly that I was very kind to her. I tried to make clear to her that I was seeing her in order that we could figure out together whether this agency could help her in any way to carry out the things that she wanted to do, and therefore, it was necessary for me to understand what it was she needed and wanted first of all. She indicated that nobody had cared about that for so long; she had been sent around, pushed around, and kicked around so that she had quite

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forgotten that there would be people any different from the ones she had known. I said that if she wanted to use the help that this agency could give her she would have to try to take from me that the majority of people did not want to kick other people around and that perhaps that was one reason why it was so important that she find some new people who were going to be different. She didn't know whether anybody would want her, but she seemed to be willing to try anything. I said that as long as she was willing to try we could help her in making possible some of the things that might not be possible all alone. As we organized ourselves around what needed to be done I said that I could offer her some money to find herself a different place if she wanted to move. We could discuss together afterward more definitely how some of these things might be worked out. She said that she thought that this would be very kind and a great help. When I proceeded to work with figures, she had a very difficult time to make any definite statement about her needs, so I said perhaps until she had done more thinking about it I would give her something that she might make a start with. Then I could see her again soon, and from then on we could have more regular appointments. This seemed very satisfactory to her, so I gave her $3.00 for food, $3.50 for rent, and 50? for moving, a total of $7.00. An appointment was made for Tuesday at 1:30. She got up to leave as if it were very difficult for her to tear herself away, and I tried to give her some encouragement by speaking briefly of what a job it was to look for a decent place to live these days. When she finally left she thanked me again and made sure of the appointment for Tuesday. Telephoned Mr. Nl. He said that he had brought her in in the morning to make sure that she was going to come this time. He was most anxious to hear what had happened and when I reported to him he sounded very pleased. He said that he had never heard of the F.S. before, and it was exactly what Miss Lee needed. He wants to let the brother know about her, but he felt he did not want to let him know until she had gotten on her way and had improved a little. I agreed with him that this might be very much more satisfactory, and the brother might be much more willing to help if he saw that she had already gotten started and was really going to be able to carry through what she said she wanted to do. We agreed to keep in touch with each other occasionally. 12-3-40 Miss Lee at the office promptly for her appointment. She was dressed as before in her rather dilapidated leopard coat, but looked cleaner and a little better put together. Under the make-up, one could see that her skin was clean. I also noticed that she evidently had had

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some sleep and food and, recently, at any rate, had not been under the influence of liquor. She greeted me with obvious pleasure and followed me into my office very much in the manner of a faithful dog. She sat down to wait for me and I asked her briefly how she was feeling. She said immediately that she felt ever so much better, that she had had some rest and a bath and felt like a different person. She started out Saturday afternoon and found a room but she herself felt it was entirely too expensive and she was sure that I wouldn't think that she could keep this up. I asked how much the room was, and she said it was $5.00. She was sure that was entirely too much. I inquired about the room, how she liked it, what conveniences it had, and she described it as a very nice room, heated, with running water and a stove to cook on. I said that while I agreed that $5.00 was quite a bit of money for one room, if she had a stove she could save on meals a lot, which might make up for the difference. She said that it was nice and very comfortable and convenient, that she could be herself and alone and nobody in the house seemed to bother her. I said that I could appreciate her wanting to look for something cheaper, and of course it was up to her if she really felt she wanted to do that, but that as far as this agency was concerned it would be possible for us to allow her that much for rent, for the time being at least, until she felt a little bit more settled and could look more carefully for other quarters. With a sigh of relief she said that she would be awfully glad if it could be arranged that she stay there. She did object, however, that anybody should charge as much as $5.00 for one room, but she had to admit that the room was nice. I then asked her what she had been doing with herself since I had seen her on Saturday, and she told me with a great deal of pride that she had not been drinking at all and had not missed it. She had not seen any of the people that were around where she lived before and she did not care at all about seeing any of them. She went to see her father last night and he was very glad to hear that she had made this contact and had told her that now was her chance to do something different. She looked at me as if she wanted to find out if I agreed with her father. I simply .said that I was glad she had been to see her father and that he seemed to be interested in what she was doing. She then talked a great deal about her father. He is 85 years old and still working. It is a shame that he should be working at this age. In some way it is her fault. He is a machinist, has never been idle and has always lived a straight life. She thinks it is awful that she has done the things she has done to disgrace him. What she wants is a job. If only she could find something right away

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she would like to have it because she wants to make good. I said that I could understand that and I thought, too, a job would help her a great deal. Perhaps it might be a good idea, though, for her to get started first on getting herself more straightened out. I had noticed she was quite nervous and in order to get a job today and hold it, one had to be in good health. She realized that. She wanted to do everything she could to get herself in shape as quickly as possible. I noticed that while her fingernails were still bitten down to the quick, at least they were not bleeding today and she did not have her fingers in her mouth quite as much. However, her hands were trembling very greatly, especially when we began to talk about her health. She seemed to be under tremendous tension. She began again to talk about the fact that she had not been drinking, and I said that I thought it was very nice that she could do that and wondered how she had been able to do it. She said she didn't know, she really didn't like "the stuff' at all. It was just that she drank it before when all this gang was around and everybody drank. Drink seems always available. I said perhaps she could tell me, because I had never been able to find out, how people who had so little money found it possible to get a drink. She replied with a smile that people seemed always willing to buy you a drink. There have been times when she had met people and they would suggest her having a drink with them. When she would ask them if they wouldn't rather buy her a sandwich, as she was hungry, they would never buy her a sandwich but they would always be willing to buy her a drink. She isn't going to touch that stuff any more. I said that she didn't know and I didn't know whether this would be entirely possible and that I would expect that there might be times when she could not hold to this, but that this did not mean that this agency would lose interest in her. W e would understand that she might have to fall many times before she would be able to stay up. She didn't respond immediately except by a reaction in facial expression and gesture which seemed to indicate gratitude on the one hand and some uncertainty and fear on the other. W e talked about the possibility of her finding something to occupy her so that she wouldn't have to think about herself all the time. She is very lonely and there is little that she can do. The only thing she can really do is typing and for that of course one needs a job. I asked her about sewing and reading and other such activities. She thought that she might read although she didn't know just yet whether she was able to concentrate. Sewing was out, since she simply couldn't do it. She said this with a humorous smile. I then wondered whether she thought we could sit down today and

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figure out a temporary arrangement about the financial assistance we were to give. Again she was embarrassed but succeeded in blurting out a request of some sort by saying that if we could help her financially she would be most grateful. We struggled over the budget for some time and finally worked out the following figures: rent $5.00, food $3.00, clothing $1.00, carfare $1.00; total $10.00. Since she had had to stock up with food supplies and since her rent was higher than we had estimated when she had been in on Saturday I gave her the food allowance for the week and an appointment was made for the following Tuesday. While Miss Lee was in the office Mrs. S., WPA, called and wanted to know whether Miss Lee had come in to see me. I told her that she was in the office just now and Mrs. S. said that I could call her later. Later Telephoned Mrs. S. and gave her a brief report of our contact. She told me that as soon as Miss Lee was in a little better shape she could probably place her as a typist. Mrs. S. did think, however, that it would be necessary for her to have a medical examination because she had been running around so much. She indicated that Miss Lee was fearful of being infected with venereal disease and it might be a relief to her to have an examination. I told her that Miss Lee had been thinking about seeing her and Mrs. S. said she could talk with her when she came. Just as soon as I thought she was in shape to work Mrs. S. would be very glad to recommend her. 12-10-^0 Miss Lee at the office promptly for her appoinment. While she was still wearing the same clothes, I thought that she looked better and had actually some natural color in her cheeks. She greeted me rather brightly as if she had been looking forward to this interview. She told me immediately that she was feeling much better and that she was most anxious for a job. She had gone to see Mrs. S. and Mrs. S. had told her that she might be able to place her soon, but had suggested that she get some blood tests, so Miss Lee went to the hospital on Friday and she will get the results this coming Friday. I asked her if she was worried about results and she said that she really wasn't, but she did think it was better to make sure. In a rather low voice she added "because I have been running around so much." She was evidently under very strong pressure for work and was thinking of all sorts of things that she could do to earn a living. She felt that if she had a job she not only could provide for herself, but it would keep her busy. This led us into a discussion of how she was spending her days. She said that she had been spending most every night at her father's and that he had said if she was really going to make good and get a job he would see what he could do about their living together after the holidays. This

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seemed to please her very much. Again she told me how old her father was and that it wasn't right he had to board some place when she was perfectly able to make a home for him. Then she spoke with pride of the fact that she had not been drinking at all since she had come in here for the first time. I asked her what she was substituting for the liquor and she said that whenever she felt like having a different taste she went for some ice cream. She really liked it better than liquor. I said I thought this was very interesting. Perhaps that was a very good way to substitute. Then she came back to talking about her father and said, "He doesn't believe, either, that I will stick to this now." I said that I wondered what she meant by the word "either." Who else did she think might not believe she could do it? She smiled as if she was embarrassed to answer this question and then said very timidly, "You, perhaps." I wondered what made her say that. She replied that once I had said that, because I wanted her to feel that even if this happened I would be still interested and try to help her up again. She seemed to plead with me for more reassurance that she could do it, and I said that I really thought that if she was sincere and wanted to lead a different life there was nothing that could stop her and that I believed that she could do it. She said as earnestly as she could that she really wanted to; she couldn't tell me what it has meant to her, what I have done for her. I said I was glad that she felt it was helping her to come here, that this agency was interested in helping people work out difficult things, and that if she thought I was helping her to do that, I was very glad. I then proceeded to fill out the receipt and when I came back with the money she said again that she couldn't tell me how much all of this helped and the money, too. Then she got up to leave and as she went to the door she said that she was sure that I didn't need to be sorry for having done this for her, that she was not going to fall. J2-J7—40 to 1-14-41 Miss Lee came to the office regularly each week throughout this period which means five interviews. There was a great deal of development on her part and increasing strength could be clearly observed. In the interview on 12-17-40 she was upset when she came in, and told me immediately that her father was ill so that she was called upon to make some plans for him. I could not help but observe that this particular event, hard though it was, did mean a challenge to her in that it represented to her something that she alone could do. As she began to talk about it and gradually outlined some of the things it would be necessary for her to do I could see a growing satisfaction in her. Her father was threatened with pneumonia and the landlady was quite unable to take care of him. He was confined strictly in

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bed and needed to be waited on not only with food but in the care of his bodily functions. While she felt that she was very willing to do this she realized her inadequacies and decided that the best thing to do would probably be to consult the doctor. I gave her some information regarding the Visiting Nurse and the WPA Household Aid Service and she decided that should she feel, after consulting the doctor, that some of these services were necessary she would call me about them. There was a new note of independence in all of this. In that same interview she reported that she had received the results of the blood tests last Friday and that she was quite all right. With a great deal of feeling she said that she ought to consider herself pretty lucky, what with all the running around that she had done. In coming back to the discussion about the father she regretted so much that she didn't have a job and couldn't establish a place for him just now when he needed it. If she only had come here a little sooner she would probably be on her feet enough now to take him with her. I encouraged her in thinking about the things that she still could do for her father and as she left after the allowance was given, she looked as if she were going to be very busy and were glad for it. In the interview on 12-24-40 she told me that her brother in New York had come and had gotten her father, saying that since he did have a well established home it would probably be better for the time being if the father went up there. Her father really didn't want to go. He cannot think of not working. However, her brother didn't listen to this and insisted that he go. Mr. Lee will stay up there now until he is quite well, and by that time she hopes to have him come back and join her. She appeared to be a little defeated about this, and I attempted to bring out her feeling around it as much as possible. She did say that she had had an earnest and careful discussion with her brother, and I wondered if this did not mean that even though she herself could not provide for the father now, she, too, had participated in the plans for him. She recognized this, but could not rid herself of the feeling of guilt about having neglected her father so long. He ought not to be working. She should be the one to provide for him. He is not eligible for any pension because he was older than 65 when the Social Security Law went into effect. All of this bothered her and somehow she seemed to feel that she had quite a bit of responsibility in this. I thought it would probably help her to talk about this freely and did nothing for a while to lead the discussion into other channels. Finally she seemed to have exhausted the subject and returned to the question of a job again, wondering how soon she was going to get something now. I said that I thought she was probably good and ready

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in her own feeling and that she looked to me as if she were a great deal more ready than she had been a few weeks ago. However, it seemed to me that she might want to think about a few more things to get herself in shape before actually applying for work. She wondered what I meant and I told her that I wanted to be quite frank in discussing this with her. There was this item of clothes. While she and I both realized that clothes did not make us good workers they did help in getting us a job and they also were important in making us feel better about ourselves. She said that she realized that and that she had been trying to get those things with her clothing allowance from this agency. I said I was glad to hear that but that there were probably a few things that were big items that she couldn't get with this allowance. Had she thought what she might do about this? She talked about her coat which was in pretty bad repair, and I said that we did receive special gifts around Christmas and if she wanted me to I could give her $10.00 that she could use for a coat. This seemed to give her tremendous encouragement. I was able to find a very nice knitted suit which had just been cleaned and asked her if she wanted this as a change from working clothes. She said that if I could give it to her she would appreciate it very much. This led quite naturally into a discussion of Christmas and she expressed again a feeling of great loneliness. There is nobody she can really go around with during the holidays. Her friends of the old days do not want to have anything to do with her and the ones that she had known during the last few years she doesn't care to associate with. She does have an invitation for Christmas dinner. As she mentionel this it sounded almost like a question directed at me, asking whether she ought to accept it. I said that I thought that sounded very nice, that holidays were far more pleasant if we could share them with someone else and that I hoped she would have a good time. On 12-31^i0 Miss Lee came in with a black eye. There were several other bruises on her face and I was concerned as to what might have happened. In walking down the hall together to my office I asked her how she was and very timidly she said that she was all right now, putting the emphasis on "now." As soon as she was seated she pointed to her eye and wondered what I thought of it. I asked her what had happened. She then told me that the friends who had invited her to dinner Christmas had invited her back on Friday to take a ride with them to Philadelphia where her friend was going to visit a sister. At the corner of R and S streets they ran into another car. At first I was not quite sure whether there was actually an automobile accident or whether perhaps she had been in a brawl, because she acted so guilty

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about it. I thought that in order to clear the air it might be helpful if I questioned her about the accident quite closely, to give her an opportunity either to prove to me that her sore eye was due to the accident, or, in the event that there was something else the matter to admit it to me frankly. As it developed she could be quite specific as to how the accident occurred. Her friend was driving and she was in the front seat. The woman's husband and little boy were in the back seat. Miss Lee's face struck the mirror when the car suddenly stopped. They were taken to the hospital, where Miss Lee received some dispensary treatments and was discharged, and where the friend had to remain until Monday because they were not sure whether or not she had had a concussion. Miss Lee hadn't taken any money with her and had no way of getting back to W. She had to stay with her friend's sister until the car was repaired and the family returned on Monday. She was pretty much upset about this because she was to see someone at WPA about a job on Saturday and of course lost this opportunity. She called Mr. C. about it this morning and he told her that he was sorry to hear that she had had an accident and made an appointment for her to come to see him on Thursday. I felt that even though she had been able to give me this very adequate explanation, she was uneasy and guilty about something. When I was getting up to get the allowance she became quite restless in her chair and I made some remark about this being New Year's Eve and wondering what she was going to do. She said that she might go to the movies alone. She didn't feel that she wanted to go to the home of these friends again. They had invited her but she doesn't want to go. I wondered why. She then said that they drink too much and that if it weren't for that perhaps they wouldn't have gotten into this difficulty. She is tired of that and doesn't want to have any more trouble of this sort. When I said that perhaps they had been drinking before the accident occurred last week she admitted that they had been having a few highballs and that was probably why her friend lost control of the car. She is going to stay away from them. They are very nice people, but she is not the kind of person who can stop at one drink and she knows it isn't good for her. I said that I hoped the time would come when she could accept a drink that was offered her and could let it go at that, but that perhaps her decision was very wise at the present time. She seemed very much relieved after this discussion and soon after the allowance was given, she left. 1-7-41 Miss Lee was in very much better shape again although she was quite upset that she still didn't have a job. She said that she had hoped by this week she could tell me that she was employed. She won-

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dered whether she would ever get a job. Did I think that her past was just too difficult; did I think she ought to go to another city to try to find work? I said that of course this is up to her, but that probably her opportunities for getting work here, especially on WPA, would be very much better and that it seemed to me that she could fight it out here and didn't need to go away. She said again how much she appreciated my consideration in what this agency had been doing for her. She doesn't know what she would have done without it. I said I was sure she would have done something, but that perhaps we had been able to help her to do the things she wanted to do more quickly than she would have been able to do alone. Her father will be coming back soon and he insists that he will go back to work. She is troubled about this because he ought not to, but then she thinks he has worked so long that if you deprived him of that he would probably die. She was very proud to show me her coat which she had bought with the money I had given her for Christmas. It was a second-hand coat purchased from a friend, but very much better than a new coat for that price. She asked me to examine the material and got up to have me look at the way it was cut and how the seams were finished. She really looked quite nice today. Her make-up was more moderate and her face more rested and quite pretty. Her fingernails were in very improved condition. I have brought up the subject of fingernails at one point or another in almost every interview, and in this interview I noticed that she had polish on and that beyond the tip of her finger there was still some nail showing. When I remarked about this she displayed quite a bit of pride and said that she was sure it was just nervousness that made her do this biting and picking all the time. I said that I noticed that she was not nearly as nervous as she had been and that I thought she was quite ready for a job. At her request I called WPA while she was in the office and Mrs. S. said that they were trying to place her just as soon as they could. She suggested that Miss Lee come to the WPA office frequently and also visit the State Employment Office once a week. We discussed a little the fact that even when she does get her assignment she might not receive pay for two or three weeks and I told her that we could continue with our allowance until she received her first full pay. 1-14-41 Miss Lee came in beaming to say that she had an appointment with Mr. C. and she hoped that this time it really meant a job. She reviewed again what this contact had meant to her and what a different person she really was. For the first time she let me know she had an old dog of whom she was very fond. She is very fearful that he

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might die soon as he is 14 years old. We decided that since we were not quite sure whether or not she would be working next week that she could call me and let me know and we could arrange about the allowance in some other way. 1-20-41 I received a telephone message that Miss Lee was working and had been asking if she could see me the latter part of the afternoon. Since I expected to be in a meeting I left a message for her that the allowance could be given through the operator and that I would contact her about an appointment later on. 1-21-41 Letter to Miss Lee: "I was so glad to hear yesterday that you finally got the job and would be most anxious to hear from you more of the details. I am not quite sure when it would be convenient for us to get together and wonder if you would like to call me up and tell me what times you might have available. As far as the allowance is concerned, we can do the same thing next week as we did this week and if it is possible for you to come in the following Saturday we might arrange that day for an appointment. "Best wishes for your continued success with the job." 2-11—41 Miss Lee and her father at the office. They were both dressed in their very best clothes and looked as if they were making a very formal visit. Mr. Lee is an old, rather dignified gentleman. He shook hands with me when they entered my office and said with a great deal of warmth and feeling that he was so glad to meet me, that he could not rest until he had met the person who had given his daughter back to him and had helped her to be again the kind of girl she used to be. I told him that I was very glad to meet him too, that Miss Lee had told me a great deal about him and about her plans of having a home with him. Mr. Lee made an effort to tell me in as many words as he could think of and in as many different ways, how much he appreciated what I had done. I told him that it was not I who had done this but Miss Lee, who after all had found her way to us and had been able to make use of the kind of thing this agency had to offer her through me. I told him that I did not know, when Miss Lee and I started out together, whether she would be able to do as much and do it as quickly as shfe had, but that I believed and hoped that she would. I also told him that I thought he had done a lot, too, when he was able to forget the past and was willing to consider making a home with his daughter. He said that he was an old man and he was so happy to have her back again. He did not feel, however, that he wanted to depend on her and he is thinking very seriously of going back to his job.

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Miss Lee said very little. She sat in her chair with a happy smile on her face, looking back and forth from her father and then to me and back again to her father. I noticed that there was a candy package in Valentine wrappings between them on the desk. When they finally got ready to go Miss Lee said very timidly that her father had wanted to bring this to me as a token of their gratefulness. I asked if she felt that the service the agency had rendered to her was done now. She thought very definitely that that was so. I said that under those circumstances I would be very glad to accept their gift. After a few more words of appreciation they left. July, 1943 [follow-up note]: Nothing was heard of Miss Lee until October 1942, when she phoned for an appointment. Seen in interview she is described as follows: She was well dressed, attired entirely in black. The dress was simple, with a single gold ornament and the hat was quite becoming. She wore a slight amount of make-up which was attractively applied. Miss Lee accompanied me to my office and seated herself with a great deal of poise. She spoke in a quiet, unembarrassed way and while I felt it was difficult for her to come, there was real dignity in the way she presented her problem. She was living with her father in a three-room apartment in a fair section of the city. She was still employed on the same WPA project she had been working on at the end of the previous contact and was earning $17.20 a week. Her father had just had two serious operations and her earnings were not adequate to meet the hospital expense. She asked for some help with this expense and was able to take it in a realistic fashion. At this time the inadequacy of her earnings to her needs became apparent to her and she began to work toward finding herself a new job in her own line—typing—with some real use of agency help in this. Throughout this contact she presented herself with new strength and assertion of self, as a person in her own right, with confidence in her difference and in her ability. « e a s e JOSEPH MARKS

Summary of old contact 1937-1941: The Marks family first applied to the agency in November 1937. They had at one time been very comfortable financially, owned property, and had had sufficient money to lend it out at interest. Mr. Marks had had a good busi-

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ness, and the two sons had earned good salaries, the older one, Abe, as a musician with a well-known symphony orchestra, the younger, Joseph, as an actor and, at times, as a musician. At the time they first applied Mr. Marks was dead, and his business had gone out of existence. Abe and Joseph were both unemployed. The family had exhausted all available resources, and though there were still some people who owed them money, this could not be collected since the people involved were unable to pay back their debts. We assisted the family with full relief while they were trying to establish their eligibility for public assistance. This took four months, primarily because of Abe's unwillingness to meet the requirements of the public agency. The worker from this agency was caught by the family's real difficulty in adjusting to a lowered standard of living and often interceded on their behalf to bring pressure upon the public agency to help and to understand the family's psychological problem in establishing their right to relief. After the public agency began assistance we supplemented their income for two months with the intention of helping them accept their need to live on a relief standard. About two months after our help was discontinued the family reapplied. Joseph had been given a WPA job but was removed when the project was reorganized. We again helped them until they could get reinstated on relief. Once more they did not cooperate well with the public agency. The investigation began to be so drawn out that we set an arbitrary time limit. They finally got public assistance in January 1939, two weeks after our assistance terminated. Nine months later (October 1939) they reapplied. They had been off relief for a while because Mrs. Marks had secured money through renting some of her rooms temporarily. Now they were again without resources. Mrs. Marks asked if we could not assist with fare to a nearby city where a relative, who owed her money, lived. Perhaps she could avoid returning to the public agency by collecting something on this debt. The worker had question about this but did help. Mrs. Marks and her daughter then left the city, as domestics to a family going south for the winter. Their move left Joseph without any resource or place to live. (Abe had been married in the interim.) We then assisted Joseph

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for several months while he tried to establish his eligibility for public assistance. Our help was arbitrarily ended when the family got relief in January 1940. During this contact we began to help Joseph with carfare to look for work. This assistance was terminated in January 1940, but began again in January 1941, when Mrs. Marks applied again for help in securing employment for her children, and for relief until public assistance was reinstated. This had been discontinued because of the daughter Marion's employment. Though the worker had some question about how Joseph was using this help, there was apparently sufficient desire on his part to do something to make it difficult for the worker to refuse to go on with him. Yet she could not trust him fully. Toward the end of Joseph's contact with J.L. (the last worker) they had begun to discuss vocational re-training since he was giving up the idea of being a musician. He had applied to one school and had been refused because of a congenital heart condition. Joseph (born 1908) is a well-built, rather attractive young man. One worker described him as a "sheik." His relationship to his family is interesting. Throughout the record there are frequent comments that the family feel the need to protect him. The older brother always got him jobs or provided him with money in their better times. The mother never really depended upon him but rather took care of him. Yet that the feeling for him was not too deep was witnessed by her ability to desert him and by his brother's complete indifference to his need at that time. Joseph himself has never expressed any desire to provide for the mother or sister but felt rather that he was entitled to their help. He is not demanding of them, however, and expects only food and shelter. There is a child-like quality about his attitudes toward his family. Each summer Joseph has been able to get a job in some small resort as a musician. He is able to earn enough to clothe himself and to have a little money left over. After this runs short he invariably pawns his musical instruments and lives on that money for a while. Since 1940 he has used the agency as a resource for obtaining carfare to seek employment. He has not had other than summer employment since the WPA job. At the time of his last contact with the worker, J.L., he had indicated a desire to go on with someone else in the agency. He

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was still interested in vocational re-training. He seemed quite regretful about her leaving for he was attracted to her as a person and felt her interest in him. She told him I would be interested in going on with him, and would send him an appointment.

Present contact with Joseph: 7-1-41 Letter to Joseph Marks, giving appointment for 7 - 3 at 2 p. M. 7—3—41 Joseph Marks came in more than an hour early for his appointment and asked whether he could not be seen immediately. He could not wait for his appointment because he had a job and had to leave this afternoon. I saw him for just a few minutes in the reception room and explained to him that since I had another appointment at this time, I was not able to see him. He showed me a written contract and said that he had to leave this afternoon; he did not know if he would be able to keep his appointment here. He made some mention of the fact that it was too bad J.L. had left at this point, because with her he could have settled things very quickly. I told him that I would be glad to see him at our appointment time but I could not do so now. I went on, however, to comment on the possibility of his having some question as to why he had to see me at all when he had a job. He said that he did need to speak to me because he had to have money to get to his job. It was just that he did not know whether he would have enough time to speak with me and to get to the place where he had to be by four o'clock. I offered him the possibility of waiting. If I got through earlier with the person I was seeing, then I could see him a little sooner. He accepted waiting. I was able to see him about fifteen minutes before the appointment time. He was somewhat apologetic for having been so insistent about seeing me. He commented on the irony of the situation, when he had worked with J.L. so long in trying to find a job, now that he was finally accomplishing something, she was not here. I related this to the question this could create as to whether he really did want to begin with somebody else at this point. He denied this, saying that this job was not a final solution to his problem and that he would need to have further help. He went on then to tell me about his contract and allow me to read it. He apparently had contracted to act as a director of recreation for a small hotel in the country at a salary of $35 a week, minus a ten per cent deduction to his agent. Following this he again spoke of his disappointment at not having J.L. there to share in this experience of finally getting a job. I said that perhaps, now that she was not here, he might even have some question about whether he wanted to take this job. With an awkward laugh he said quickly that he did but he was not

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sure whether he could hold it. He went on, then, to tell me about his physical condition and showed me a card from a school physician saying that he was suffering from a rheumatic heart. The school had thought he always would have difficulty in getting a job because his heart condition would be held against him. He has often had pain in the region of his heart and it was for this reason that he has had to give up the show business. He did not know whether being director of recreation would be something that he could carry through physically. I again tied this to the fact that this was something perhaps that he had wanted to achieve, to be able to show J.L.; that now, however, that she was not here he was left, in a sense, holding the bag with a job and no one to show it to. I could see where perhaps he would have had the same question about his physical ability long before he ever took this kind of job. He admitted to a good deal of question about this and also to a feeling of having wanted to show her, but at the same time said that he did want the job for itself. He felt that it would give him sufficient money so that in the fall he could return here and continue to get our assistance toward seeing what kind of permanent employment he could work out for himself. At this point I asked him how long it has been since he has been coming here with this kind of problem. He hesitated for a moment; then said he thought it was about two and a half years. I told him that, as he knew, we would not refuse him the opportunity of returning here and that I certainly would be glad to work with him. However, it seemed to me that it might be something he himself might question. I thought that if, after two and a half years, he was in the same spot that he had been in the beginning, he would have reason to question whether this was the right agency for him to be coming to, or whether we really know how to be helpful to him. He seemed quite surprised at this and immediately began to prove to me that we had been helpful. I said that I did not mean to say that we had not been helpful at all. I knew, too, that he had had a certain amount of satisfaction from some of his contact here. Yet, in the last analysis, he was not much further ahead, and therefore I would question whether this was the right place for him. Since he seemed to take out of this the fact that perhaps I would be refusing him an opportunity to return, I said I was not doing this, but I felt that this might be a question that we might well want to consider, he beforehand, and I at the time he returned. He seemed to want to settle it now, but I said that I did not feel that we could decide this so quickly. We then turned to a consideration of whether I could help him with his fare to his job and a few dollars to tide him over the first week of

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his employment. I told him that I had considerable question about doing that, since I was uncertain that he would be able to hold the job. However, I did not want to stand in the way of his going. Mr. Marks was very frank to say that he did not know whether he could hold the job, putting the whole problem on a physical basis. I agreed that the physical would play a very large part, but I added that it seemed to me that once he got there, he might find that he was not quite so interested in showing himself or J.L. or anyone else that he could hold a job. This led him into saying that he needed to have this job, that it would give him the money that he needed for all kinds of things that he had been unable to get for himself during the year. It would also give him some cash with which he could begin to look for employment again in the fall. I told him that I would let him have this money since there was no real basis on which we could settle the matter one way rather than another. However, I wanted him to know that I had a good deal of question about doing this, because it seemed to me that I might be catching him in a situation that he would like very much to be free of. He denied this and insisted that he would like to have the opportunity for himself. He thought that it would help him settle too, whether he really could do this work or not. We finally agreed that I would let him have $10.00 to cover fare and a few incidental expenses related to his going to this job. When I was giving him the check, Mr. Marks had to let me know again how good an actor he had been and the fact that he had been quite successful previously. I said that I thought he might well find himself pretty frightened with so much responsibility once he did begin this job. It was hard to go back to work when one had been away from it for some time. He seemed appreciative of this understanding and admitted a good deal of fear on his part. In leaving, he told me that he had appreciated meeting me and felt that he would be interested in continuing to work with me. When he was at the door, he stopped, turned around, and said in a very puzzled way that some of the things I had said really had him worried. Was it possible that he might never be able to get out of this hole? I said that I did not know how to answer that. However, I did know that sometimes coming to an agency might be just as much of a rut as anything else. I terminated the interview by wishing him success and apologizing for not being able to talk with him any further. During the interview Mr. Marks asked me for J.L.'s address. I told him that I could forward any letter to her, but I was unable to give out personal addresses since this was contrary to agency regulations. Mrs. Marks came in a week later asking for help while she was get-

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ting back on relief. When I clarified the role of this agency in relation to the public agency she stopped pressing for emergency assistance and seemed to be really questioning her right to be here. 7-22-41 Letter received from Joseph Marks telling me that he had given up the job because it had been too hard. Last week he went to another resort with a friend of his as co-director of social activities. He was finding this rather arduous, too, and might be home the following week. He added as a postscript that he would telephone me when he got to New York. 7-30-41 Sent letter to Mr. Marks saying that since I had not heard further from him I was assuming he had been able to hold the job. I told him I was leaving on vacation and would be back on 9-9^11. 9-11—41 Mr. Marks telephoned to ask for an appointment. He said he was interested in considering a continuation of our help. We arranged an appointment for 9-16. 9-16-41 Although Mr. Marks was obviously dressed up for the interview today, he seemed to be quite depressed and troubled. We exchanged some comment in regard to the summer and he told me what had happened to him since we had last seen each other. He had been unable to keep the first job because he found it too strenuous physically. He was then able to get a job as an assistant director in another hotel and, although he at first had doubted whether he could keep it, he was able to. This had been a very difficult job for him, too, and served only to convince him even more how important it was for him to find an occupation that he could hold steadily. At this point he did not need to have money but was coming to us for assistance in planning for his future. Perhaps he might need to have some money at a later date, but this was not the primary reason for his return. Before I could respond, he went on to say that he had been thinking about our last interview a good deal and my questioning whether he was in the right agency since we apparently had not been very helpful to him in the past. He seemed to need to convince me that this was the right place. I dealt with this in relation to his being afraid that I would cut him off without much regard as to how he felt about our service. I took the fact that he had returned as an indication that he still did feel there was something here for him, and said that my question now was only about what it was that we had to offer him. I indicated that I was really asking him to help me understand how our service was of any value to him. He had a good deal of difficulty in answering this but it made him thoughtful about why he felt we could be helpful. At first he was quick to say that it was not the money. I recognized that the helpfulness of money could be very limited and indicated that

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this was not the basis upon which we would decide to stop our helping him, that is, if he did need money. He then reviewed our connection with Federation Employment Service and his feeling that he did need to have their assistance in vocational guidance. He could not get into their special service department without our interest. I agreed that this was unfortunately so and that for this reason I would be willing to go along with him until he could get vocational tests and counseling. I wondered then whether it wasn't really Federation Employment Service that he thought could be helpful to him, rather than this agency. He thought he really needed to have both agencies and for a time there was a good deal of confused discussion on his part. It seemed to me, however, that not only was he trying to see for himself what he wanted from us, based on some real conviction on his part that we could be helpful, but was also wondering about beginning a relationship with us again. I commented on this and at first he denied that he was at all fearful of beginning with us. However, with some indication on my part that this was only natural, he was able to express some question of what really would be different this time in his experience with us; he went on then in a rather confused way to say something about his not being certain just what he could do, it has been so long since he had worked. I picked this up to say that I felt that this in itself might create quite an obstacle for him. I related it a little to a feeling that everyone had after being unemployed for some time. It was almost as though one really questioned if one had the ability to do any kind of work at all. I added that my realization of this was very fresh now, for on returning after a five weeks' vacation, I, too, had wondered if I could do my job any more. He found this amusing and apparently quite relieving. He spoke at some length about his fears but ended up by saying that he really did want to try to see what there could be for him. I said then that perhaps what he really wanted was to be sure that he could have us go along with him in this experience, at least until he were sure he could go on by himself. He agreed that this was so and I told him that we did have this kind of service to give but again raised my question as to whether he really was at this point so ready to try. When he insisted that he was, I said I did not feel that I could refuse to accept his saying so. This led us into a discussion as to further contacts and appointments. He had a good deal of difficulty in arranging a next appointment with me. At first it was because he was not certain just when the vocational test would be given him and later it was for a variety of rather flimsy reasons. I said that it seemed to me that perhaps he did want to think this over a little further. Perhaps he wanted to have the tests at Federa-

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tion Employment Service and then see whether there was any reason whv he should return here. He felt that this was not an open question and we finally arranged an appointment for 9-30-41, by which time he expected to have his tests completed. 9-30-41 Mr. Marks called to say he would be unable to keep his appointment today because he had been referred for a job and had to go down to speak to the prospective employer. When we had some difficulty in arranging for another appointment, I again said that perhaps he really would like to see how he could manage without our help; for mv part that was perfectly satisfactory and that I wanted him to know that if later he did need to have our help he could return at any time. However, he insisted upon a definite appointment being set, so that finally one was made for 10-7-41. 10-7—41 Mr. Marks failed to keep his appointment and sent me a card explaining that he had been called out on a job but would call me later in the week. 10-20-41 Since I had not heard from Mr. Marks I wrote him a letter and asked him to come in on 10-22 at 4 o'clock. I indicated that this would be helpful to me in planning my work since his not coming in created certain problems for me. 10-21-41 Notice from Federation Employment Service that Mr. Marks had been placed as a factory worker. His salary would be on a piece-work basis. 10-22-41 Mr. Marks was somewhat disheveled in his appearance. Although he was also depressed, this seemed to be different than the last time I had seen him. I had the definite impression throughout the interview that he had reached some initial decision for himself, that if he were ever to come out of his difficulties it would be through his own efforts. He had apparently been able to take the necessary steps toward this since he had taken a job in a factory as an unskilled laborer. The work was of a very difficult nature, physically quite dirty, and certainly different from anything he had ever done to date. In the way in which he spoke of this job, I felt his determination to struggle with himself against all that was pulling against what he was doing at this point. His conflict came out around the request he had to make of the agency. He explained that he was working on a piece-work basis and definitely was making progress. He thought at some point he ought to be able to earn as much as anyone else in the shop, which was as high as $35 a week. However, at present he was earning only a very small sum of money, but this had increased from $4 the first week to $9 this week. He asked that we supplement his income until he was earning

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enough to take care of himself more adequately. He also asked that I help him get his overcoat out of the pawn shop, as well as a watch. He was able to accept quite readily my inability to supplement his income, on the basis that $9 would be our budget for a single person, and more than we allowed a person living at home. I told him that I would be able to help him with the overcoat, since this did relate to his ability to keep the job, but that I would not be able to help him get his watch out of pawn. It was around this that he mobilized all of his fight, insisting that I help him. Throughout all of this he wove in a good deal of his feeling about the difficulty he had in doing the work, how different it was from anything he had ever expected of himself, and yet he was doing it. I expressed my understanding of what he was really asking for. I said that it seemed to me he was struggling with himself to keep going on this job, and that in a way he was saying to me it was hard to keep up this struggle if he could not have anything more out of it than he had had to date, namely room and board. I felt that he was really, in a way, asking me to help him keep his job. Tears came to his eyes at this but he struggled against them. At first he insisted that the watch was necessary for him to go on working; he had to know what time it was, otherwise he would be late in getting to work. However, he was gradually able to acknowledge that he needed to have some encouragement to go on. I told him that I, too, felt his need for this, and his right to ask for it, yet I could not encourage him in ways in which the agency did not help. I was concerned, too, with whether I had the right to encourage him in going on with a job that I questioned I could hold myself. I said that I frankly did not know how he could have the strength to do what he was doing. His reply was that he had come to the realization that if he wanted to get help out of his problem it was up to himself. I said that perhaps I was going to say something that he would resent, but that in a way I was going along with him in what he had just said. I did not feel that I had the right to do anything that might take away from his own right to choose the degree to which he was willing to cope with his problem. Actually, at some point he would have to face what it meant to work and live within whatever one did earn. I did not know whether that kind of living would be worth the effort it cost him. He did not ask me for help any further with this, but then indicated the problem that had been created for him by his necessity to keep his appointment here today. He had actually lost out on a half-day's work, which would mean that he would make a dollar less this week. I told him him that since I had not offered him the opportunity of an

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evening appointment, I would want to share this responsibility with him, and could therefore offer him for this week the dollar he had lost but that subsequently I would have to make evening appointments with him. This led us into some consideration as to whether he wanted to go on with the agency. He said that there was something definitely helpful to him in having these appointments. He needed to have someone understand what he was going through, and to share this experience with him almost as though this would help him hold on to himself and to the working out of his problem. I told him that if he wished to make this kind of use of us it was a rightful use of our service. I said that I did not know how much longer he would need to have interviews of this kind but for the length of time that he felt the need of them, they were available. Relief, $7; $6 for overcoat; $1 for budgetary relief. 11-5-41 Post card received from Mr. Joseph Marks verifying his appointment with me for the following evening. 11-6—41 I was impressed with the degree of change in Mr. Marks today. There was still some lingering feeling of depression about him, but he seemed stronger and surer of his own strength. I expressed my appreciation of his writing to verify our appointment. I indicated that we had made it at the last minute of our last contact, so that I was not quite sure whether he would be coming in. I said I hoped he would, because I was interested in knowing how things were with him. He showed me his pay envelope indicating that he was now earning $14 a week. I commented on the difference between this and his last check, and this brought him into an evaluation of his present status in his work and some description of the place itself. I felt, as he talked, that he was not so concerned with his own ability to improve his skill, nor to retain the job. This was in spite of the fact that he built up a picture of the difficulty one had in working in that place. In some ways it was nothing more than a sweatshop. There was a difference, too, in the way he described the difficulties under which he worked. It was not as a preamble to a request for himself, or even as a request for understanding of what he had to put up with, but seemed rather to be a way of telling me that he had mastered something and that he had faith in himself. I commented on my feeling of some difference in him today. I said that while he was still telling me he had a terrible job and that there was a lot for him to put up with, there was something different in him. He laughed and said I was right. A good deal had happened to him since he had seen me last. He guesses that what has really happened

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is that he has learned a lot. In essence, he seemed to be telling me that he had grown up. He has learned what it means to be a worker. He has learned the meaning of a dollar. He found that this made a tremendous difference in him to leam to evaluate what it means to him whenever he has to spend money. He went on to say that he had learned something more, though—that no matter how hard he had things at this point, it was still better than what he had before. He wants to be independent. He knows that this job is only a beginning; it is not something he will stay with. Yet he knows, too, that if he has any choice he will not give it up until he has a better job. He expressed some anger that at his age he should just be beginning in the business world; he should never have been so long out of work. He switched abruptly then to a request, asking me whether I could give him enough money to buy some shirts and a hat. He said very frankly that he needed these things but he just could not see himself taking the money out of what he earned for this purpose. He would prefer to have it from us. However, he knows that this might not be something I could give him; he just wanted me to say whether I could, because he certainly could use it. I told him that this was not possible, but I made the mistake of adding that I did not think he would like it even if I could give it to him. This threw him into a need to convince me that he would not mind having this help. I finally was able to convey to him that this was not the basis for my refusal, that I would not have the right to refuse him on such a basis but only on the basis that $14 a week, according to our budget, should include money for replacement in buying new clothing. He was then able to say quite matter-of-factly that this was all right with him; he had thought he would ask me, but if I could not do it because the agency did not allow for it, it was all right. There was something in his tone which prompted me to say that I thought in a way he was glad to have this opportunity to tell us we did not count for so much. He laughed uproariously at this and said that maybe he had really wanted this opportunity. Again he spoke of his anger that he should be at the bottom of the ladder at his time of life. In response to my saying that perhaps he felt we were somewhat responsible, he did agree, and then went on to review his experience with the agency. He expressed a good deal of resentment for the way in which he had been treated, and although he did not say so in so many words, I had a feeling that he did not think he had ever been treated as an adult. He seemed also to question how much we had trusted him. He went on to say that one of the things he had liked about me was the direct way in which I spoke with him; I let him know what I think, and I let him know whether or not I could do a thing. He did not think

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this had been true of his experience by and large previously. I commented then that if this had really been his experience with the agency, I was glad that he had this opportunity of letting us know he could do without us. He laughed then and said that he did not want to leave me with this kind of feeling; he did think that we had been helpful to him, too. The actual money we had given had been a help to him, and he needed us to go along with him for quite a while. He ended by saying that he thought we could have pushed him more. I accepted some partial responsibility here, but said that from my experience with people, I knew that pushing was not always conducive to a person's accepting the need for something different. I related this to his own statement that he had come to the conclusion that if a person wants to do something he has to help himself. I added that I would only like to say that perhaps he could have used a little help. He agreed with me; then said that he did know what had been wrong with him, that he had allowed himself to be treated in this way and to go along for so long without protest. I questioned at this point where the agency now stood in relation to his plans. I said that it seemed to me, while he had many problems which were not solved, and while things were not quite perfect for him, I had a feeling that he would want to be finished with us. He said that he did; yet he does not know whether he can really say so. He is concerned about his future; he cannot stay on this job forever, because it is really not one for him. What if in the future he should decide that he needed vocational re-training for something. He did not think that he would be able to afford tuition and he would like to know that this was something he could get help from us for. I said that this would be something we could consider with him. He wondered what I meant by this and I indicated here the problem that I would have in guaranteeing him anything at this point, since the agency, too, might find itself in a different situation. However, all things remaining the same, we might be able to help, and I would like him to know that we certainly would be interested in seeing if we could. He thought then that there was no need for continuing contact with us at this point. I offered him the possibility of considering this before coming to a final ending and said that maybe in a week or two he might not feel quite so sure that he would want to terminate his contact with us now. He, however, felt certain that he was ready, especially since he knew he could return whenever it would be necessary. At this, he rose to leave and offered to shake hands with me. W e did so, and he expressed the hope that I understood how much he had

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appreciated the help and interest I had given. He made some mention of J.L., the former worker, which then prompted me to ask him whether he would like her to know that he was working. He laughed and said that it was a funny thing, but somehow it did not seem to matter so much now. At one time he would have given anything that she should know. He seemed somewhat puzzled by this, but added that if I thought she would be interested, it was all right with him, I could tell her. As he was leaving he said that maybe he would send me a Christmas card. I told him that I would be interested in hearing from him and perhaps in a month or so if he had the time he might let me know how things were with him. However, if I did not hear from him I would feel that things were going along as well as could be expected. We finished on my saying that I thought things might happen which might make it necessary for him to come back, and if this were so, I wanted him to know we would always be interested in seeing him. He thanked me warmly. July, 1943 [Follow-up note]: Exactly a month after the last interview Mr. Marks came asking for some really necessary assistance in taking a new job that he already had. The early part of this interview was chiefly concerned with his insistence that he had been fired from the other job. It seemed so important to him to have it that way, that I suspected he had brought that firing about. I didn't make any issue over this, but some awareness of my reaction must have gotten across to him, for at one point in the interview he looked up and catching something in the expression on my face burst into laughter and I joined him. After that he spoke quite easily about the way he had irritated his foreman to the point where the man had to fire him. He saw clearly that the job was not one for him, but it had served its purpose; to use his own words, "it proved to me that I could work and hold a job if I wanted to." The rest of the interview was concerned with the necessary relief. He had gotten a job as a salesman and really needed a few items of clothing to make him more presentable. He did not see any need for going on after that. He did say that he would get in touch with me sometime in January to let me know how things were. Towards the end of January, Federation Employment Service notified me that his temporary salesman's job had ended, but he had been replaced as a cashier in another firm. This was a full-time, permanent job. I tried to contact Mr. Marks when I did not hear from him. He did not call me on the day that I asked him to, but called the following day at lunch time, and left a message that he was still working and that everything was all right. I feel sure that it was not an acci-

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dent that he called at lunch time, since he well knew that this would be a time when I was likely not to be in. It is a year and a half now, and he has not been back to the agency at all.

DISCUSSION

Case work has three choices in undertaking to help people effect some change in themselves or their circumstances. The first choice goes in the direction of trying to understand all that would be involved for the client in that change, by study and diagnosis of his past experiences. Much effort has been expended in such study and perhaps through it much has been learned about human experience, if not about the dynamics of personality change. A second choice, in great favor in some places today, goes in the opposite direction of setting up services of a tangible nature with such clarity that in the mere use of them the client will achieve the change he seeks. There is much to be said for this method, and astonishing changes have been accomplished through the use of a tangible service given with a clear and sincere relation to eligibility factors. It provides an external focus essential for the rearrangement of a man's circumstances; it necessitates the reorganization of his attitudes in relation to this focus. It guarantees limits within which he must move, beyond which he cannot go. Out of this may result what change is within a man to make. The change which is illustrated in the two records quoted above obviously has no connection with the first school of case work. There is a conspicuous absence of history and diagnostic "study." Obviously, too, the method here cannot be identified with a dominant interest in the tangible service and eligibility factors. True, eligibility for help is demonstrated in the course of the use of it, but this could not have been established by either client in advance. Miss Lee is in obvious need and is not asked to bring corroborative evidence of any sort. She is offered money to move almost immediatelv to implement her rejection of her way of living and her desire to change it. Mr. Marks, on the other hand, is met with question and doubt from the beginning: "Do you really want to begin with someone else at this point?"; and later, "I thought he would have reason to question whether this was the right agency for him to be coming to, or whether we really know

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how to be helpful to him"; and even in a later interview, "I was really asking him to help me understand how our service was of any value to him." He is quick to say it is not a matter of money. The worker finally states the service he seems to be asking for as "having us to go along with him in this experience" (of trying to see if he could find permanent employment) "until he was sure he could go on by himself." Actually these words "to go along with the client in an experience change" best describe the nature of the service not only in the Marks case, where material relief of any land is so obviously secondary, but in the Lee case as well, where relief was necessary. It seems to me we are forced to the conclusion that the workers in these two cases are operating neither with the protection of a diagnosis and prognosis of personality patterns, nor solely on the safe firm ground of tangible service and established eligibility, but on some immediate direct response to what the client presents. This response is wholly different in the two cases, not so much because the workers are different, but because the clients differ in the nature of their projections and their ways of using the worker. Carolyn Lee comes to the agency just as she is, down-and-out, battered and bruised in body, weary and exhausted in spirit. She is literally brought to the agency's doors by a friend and sits in the waiting room biting her nails nervously. She can only look at the worker in anxious silence until questioned: what has brought her here? In response there is a feeble flicker of effort to meet this agency with an appearance of respectability and independence as she stammers out: "Did we—we probably didn't—have any jobs that we could refer her to?" But she cannot sustain even this and breaks down into a confession of her bad life, wasted in drinking with bad companions. She is a complete wreck, she says. She has to do something different and she wants to, but she has reached this stage before of wanting to do things differently and in the end there was nothing to do but go back to her old ways. Without a job she can't get money and without money she cannot live. In this admission one feels a thorough-going rejection of the self as it is, with all its associations. All her energy seems used up in this rejection, leaving nothing to use in a new effort. She knows that new life can only come for her from some outside source; she

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puts it in the simple, practical, tangible terms of money and job. But she refutes the agency's capacity to help with job before the worker can do so, with her honest realization of her own inadequacy. There is no illusion left in her and no strength to project her need on agency or worker, no belief in their capacity to help in her extremity. Rarely does a case worker have to face so bald a revelation, so desolate an admission, of human failure. There is great temptation to brush it aside in shame and embarrassment, or to deny it in pity, or to put one's own life and strength to its service at once. This worker, on the contrary, meets it directly and simply with a recognition of the validity of her client's reasoning; money is necessary and a job is the way to get it. We all have to have it, the worker adds, including herself in this human necessity. Then she adds that, while it is true the agency does not have jobs to offer, she would be interested in knowing something of Miss Lee's work experience that she might better understand how to help her. What Miss Lee gives in response is factual information about her training and her jobs as typist, but it serves the purpose of bringing to consciousness a former, respectable, independent self. Some further information as to her drinking habits and her family connections follows, which, in the hands of a worker interested primarily either in causes or resources, might have been expanded indefinitely. This worker chooses rather to use what the client has gathered together to present as the basis for the self she wishes to restore. She makes only one telling remark: "She sounded as if she did not like her company." To this Miss Lee responds with greater strength and energy than she has shown before with a move to separate herself from her associations—the place she is living in is so terrible, the people are no good, they expect the worst of her. She simply had to get away from there. She mentions a man she has been living with for two years. She wants to get away from him, too. There is force and direction in this expression. Some part of this person, apparently so purposeless and lifeless, has been galvanized to action. We see it actually moving away from the dead, disgraceful self and its involvements. The worker will not accept so complete a separation as wholly real and questions what will become of the man. Is she so free to leave him behind? Why, if

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she had lived with him two years, did they never consider marriage? This question startles her. There is silence between them, the worker striving to understand the meaning of this question to this woman, keenly aware of the sharp sense of difference it precipitated. She records her feeling of the separation effected, in these words: "It was obvious that marriage had never occurred to them and that this question coming from me, who seemed to belong to a very different kind of world which at one time she had known, had a startling effect on her. I felt that she was struggling with a reply in my language that I would understand. Finally she said very slowly that it was true she liked him—in a way. But she did not love him." Again, we feel new strength and assertion as a reaction to this facing of a difference from the worker. She wants to get away, to get a job, perhaps it is not too late. The worker supports this strength and purpose but adds, "But it will be hard." She will be lonely. Again Miss Lee is arrested by the worker's attitude. This time she feels it including her in its understanding and consideration. "Kindness" she calls it. And that anybody should care how she feels, want to know what she needs, is amazing. For so long, she has known no one who cared, only people who wanted "to kick her around." The worker takes hold of her hesitation here with great firmness, telling her she will have to take it from the worker that there are people in the world who do not want to kick others around. It is faith that goes beyond her client's experience for which the worker is asking here, and it is forthcoming, tentatively and timidly, but sincerely. With this measure of trust between them, a new and sounder basis is laid down in the relationship. On this basis the worker offers concrete help, money to use in moving. She tries to initiate a discussion of her client's needs in concrete terms, but when Miss Lee cannot articulate these specifically as yet, the worker wisely decides on a sum to start with and suggests another appointment after she has had time to think her needs over. The next appointment was set for three days later. Miss Lee came in promptly. She had found a room which she timidly confessed she liked, but surely the worker would think it was "more than she could keep up." In approving the choice and agreeing that the agency can afford to pay this much for a time, until Miss

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Lee could see what she wanted to do, the worker sustains the new self which has dared to move forward into a new choice. It is a good choice; whether she can keep it up is for her to determine. In this interview she refers to her father, whom she had visited. At eighty-five, he is still working. She is full of guilt for her inability to take care of him now, impatient to get a job to support him and to occupy herself. This turn to the father, to want to do for him, would seem in direct reaction to having herself taken help from the worker. When her father later let her know that he would be glad to live with her, she used this happily to plan a future of caring for him. The pressure to get to work, which she felt increasingly from this point on, seems to grow out of this goal she had set for herself. At no time does the worker introduce goal, time limit, or pressure. Since this is carried so completely by the client, the worker attempts to slow up this speed by the reminder of reality factors; she must get in better shape physically, for instance; her appearance, her clothes, require attention. There must be in the worker's mind some question about the hold which liquor might have on a client who has been drinking so habitually. But from the first this constitutes no problem to Miss Lee. She assures the worker that liquor has no hold on her. When the worker injects her doubt that any change is so easy—"We would understand that she might have to fall many times before she could stand up"—she is met by this client's characteristic response, which takes in the doubt and question. There is gratitude for an understanding beyond anything she has known. Also, it permits her to face the denied fear and uncertainty in herself as to whether she can control her behavior. In the third interview, just ten days after her first contact, the worker is struck by the improvement in her looks, and Miss Lee herself is delighted that she feels better, proved by the fact that she has not been drinking and has not wanted it. Another evidence of her increasing strength is seen in her ability to come back to the worker's doubt and test herself against it. Her father, she begins, doesn't believe "either" that she will stick to this now. When the worker picks up the word "either" and inquires into its reference, she can admit timidly "you, perhaps." With this help she can go on to recall what the worker had said. She seems to be pleading for more reassurance and the worker

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gives her her own conviction in these words: "If she really wanted to lead a different life I believed she could do it." Her answer, "She couldn't tell me what it has meant to her, what I had done for her," is convincing proof of the depth of her own purpose, realized as her own with the release of feeling and appreciation for the other's help which spontaneously follows. As she leaves she thanks the worker again and expresses her conviction that she is not going to fall. That her conviction grows out of an essential soundness at the core of herself, rather than from anv mere willed determination to be different, is attested by the absence of fear in facing the test for venereal disease required by the employment agency. She thought it better to make sure because she had been running around so much. That her real self had been infected did not occur to her; the tests bore out her confidence. The month that followed before she found a job was a difficult period. Her father had pneumonia and she had to bear the guilt for her own unreadiness to offer him a home. At Christmas she got involved with old companions, a drinking party, resulting in an automobile accident. She had to face the worker with a black eye, the obvious sign of her "downfall." Perhaps it was necessary for her to test out in this way her adjustment and the worker's capacity to bear with her. She finds the worker equal to the test. Much constructive activity related to her appearance and her clothes is undertaken and serves to mark the time as getting ready for job, rather than merely waiting for it. From the moment of her affirmation of a will-to-change in the first contact, one can feel its drive forward to reach a point of stabilization where it can come to rest in a new environment. Its projection on her father as an object for whom she can care and provide, serves the purpose of an anchor in reality. She uses his illness and his insistence on working as pressure to drive her to a job. So the actual finding of the job becomes a natural and inevitable point of ending with the agency. There is no indication at any point that the agency has exerted pressure or set a time limit. On January 14, just six weeks after her first interview, she announces that she believes she has a job. This realization of ending brings out from her an evaluation of the meaning of the agency's service to her. For the first time, strangely enough, since she has so often

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spoken of her loneliness, she mentions her dog, the only living creature which belongs to her, and admits her fear of losing him since he is fourteen years old. It is as if, at this point of leaving the worker and feeling the strength of her new self, she can for the first time face separation from a creature who must carry peculiar meaning for her. Perhaps he has carried some sense of continuity for her through this period in which all other associations have been changed. The record ends with one more contact, when Miss Lee brings her father into the office to express his gratitude to the worker. Their happiness is obvious, their gratitude deeply felt and sincerely expressed. The follow-up note bears witness to the stability of this adjustment. The case-work problem in the Marks case is differentiated technically from the Lee case at the very beginning by the fact that the family has been known to the agency for two and a half years. Joseph Marks emerges from the record of the family's use of the agency, as an attractive young man with a child-like dependence on his family and a habit of turning to the agency for carfare in job hunting or money to live on between a job and a relief check. He had begun a discussion of vocational re-training with his case worker, referred to as J.L. in the record, when she left the agency. He expressed a desire to go on with someone else, and at this point the new supervisor of the district took over the case and sent him an appointment. He arrived an hour early, full of haste and pressure. The worker was busy but saw him briefly in the reception room to learn that he had a contract for a job; he was afraid he would miss out on it if he waited for the appointment time; he has to have money to get to the job. In contrast to his flurry and pressure, one feels the quiet firmness of the worker, who cannot throw other clients aside for him but who will at the same time make every effort to see him earlier. When she offers him a chance to wait and he accepts it, a first step has been taken in a difficult task of redefining the relationship with this client. The worker moves into this case with a definite purpose in mind which determines her function in the first contact, the purpose of

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clarifying the agency's role and disentangling its service from the use he has made of it in the past. The fact of a change of workers offers the first basis on which to tackle this differentiation. Beyond this there is no intention to change him, indeed no pressure to have him use the service at all. In this first interview one sees her clarity in defining this, at the same time her sensitivity to his confusion and ambivalence. His reference to the former worker (who, he obviously feels, would not have kept him waiting) brings out from the worker an expression of genuine doubt as to whether he really wants to begin again with someone else. When this doubt, which was so surely his own, is expressed thus openly, he can assert that the job he is on his way to accept is not really the solution of his problem. He admits his fear that he may not be able to hold this job (referring to his rheumatic heart). When the worker goes along with his doubt, his energy is immediately mobilized against it, to assert that he really does want this job and wants, too, to return to the agency in the fall, to see what kind of permanent employment he can work out. With this evidence of movement, of some new sense of direction in him, it would have been easy for the worker to accept this statement of problem and seeming request for help as evidence of a new basis of relationship with the agency, but she is not willing to run the risk of letting the relationship slide into the old pattern. Against his easy assumption that they would go on together in the fall she set the question: How long has he been coming here? One feels the force of this question and the depth of responsibility for agency and for what agency has meant to him, that she takes on herself in asking it. When he recalls that it has been two and a half years, her answer cuts him off from that past with agency and forces him into the position of having to make a new choice if he wants to come again. In her statement of this, every word is important: "While, as he knew, we would not refuse him the opportunity of coming here and I would be glad to work with him, however, it seemed to me that it might be something he himself would want to question. I thought that after two and a half years, if he was in the same spot that he had been in in the beginning, he would have reason to question whether this was the right agency for him to be

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coming to or whether we really knew how to be helpful to him." His surprise indicated that these words had had an effect. He attempted to reassure her but she repeated her point. When he wanted to decide at once, she told him it could not be done so quickly. It was a question he would want to consider before he came back; she, at the time he returned. The rest of this interview is occupied with his effort to get her to pay his fare to the job. She would not be maneuvered into supporting his doubtful will to take the job and shows him with complete honesty that to do so would be involving herself in supporting what she has no conviction he wants to do. She might be "catching him" in something from which he wanted to be free. He struggles against her doubt with more assertion of his desire for the job until she finally agrees to give him $10 because, as she tells him, she can find no way to settle the matter one way or another. Her genuine recognition of his fear of work leaves him with a feeling of being truly understood and free to return even if he fails on the job. Had the worker injected into her gift of the ten dollars one iota of her own will to have him take and keep the job he would have had her help on which to blame his failure. It is clear that he leaves this interview free of any will of the worker's. The two sides of his conflict have been thrown back into himself, and the conflict itself sharpened and focused by the worker's question. He stops at the door as he leaves, to put his bewilderment and concern back to her in these words: "Some of the things I had said really had him worried. Was it possible that he might never be able to get out of this hole?" She leaves the question open, repeating only that coming to an agency was no solution, but could be just as much of a rut as anything else. The worker's courage in putting her question and leaving his unanswered rests upon her conviction that his previous relation with the agency obscured his problem and sustained his pattern of dependency. In refusing to continue to play the role for which he had used agency, she separates him from his tenacious hold on agency and at the same time she moves into a new role in giving him immediate understanding of the fear this separation arouses in him. Here he has actual experience with the kind of help this

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worker can offer him if he wants it. The choice is left with him. The worker's acceptance of her responsibility for carrying on this process she has initiated with him is indicated by the way she responds to his letter, informing her that he has lost his job, with a note to let him know her vacation time. She will be ready to make an appointment on her return if he wishes it. On his side two months have elapsed since the first contact before he gets back to the agency, but it is clear at once that during this period he has been working on the problem she left with him. She accepts his return as indicating that he wants to work on something here but leaves with him the task of defining what it is he wants. "I indicated that I was really asking him to help me understand how our service was of any value to him." He struggles in genuine confusion. It is not the money, he says, nor just the help which the connection with this agency gave him in the use of a vocational service. The clarity of the worker, her refusal to go beyond him in asserting her capacity to help before he has asserted his will to use it, finally bring him through to an admission of fear at beginning this contact and apprehension about his ability to hold a job. The worker's genuine human response to his feeling gives him immediate relief. She is convinced now that he really has faced his conflicting attitudes and has staked himself to an earnest effort to make a move in a new direction. She puts into words for him then what he has succeeded in convincing her he wants: "I said that perhaps what he really wanted was to be sure that he could have us go along with him in this experience, at least until he was sure he could go on by himself." This has real meaning for him and one feels sure it truly expresses his attitude, but when she sets up this service in terms of time and offers him an appointment, his ambivalence again overcomes him. When he raises objection to any specific time she suggests that he wait and think further before deciding whether he wants to go on here at all. This brings him out of his hesitation; it is not an open question, he insists, and he makes an appointment. It is broken when he is referred for a job by the employment service. When he makes this explanation, the worker again says that perhaps he would want to see how he could manage without help, but he insists on another appointment. Again he does not ap-

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pear but sends a card of explanation, indicating that he would call later in the week. When no word comes from him, the worker writes giving him an appointment, saying that it is important for her in planning her work to know what he intends to do. He comes on the date set and the change in him is startling. He is disheveled, depressed, but not in conflict as before. The worker records, "I had the impression that he had reached some initial decision for himself that if he were ever to come out of his difficulties it would be through his own efforts." He had taken a job as an unskilled laborer, doing hard dirty work, different from anything he had ever done before. With this fundamental test of himself, so seriously and deeply undertaken, his resistance must at the same time hold on to the old and try to make agency yield to his need. He is earning very little at this point, though he expects to work up to much more. Will the agency supplement his earnings and will it help immediately with enough to get his overcoat and watch out of a pawn shop? He can accept the refusal to supplement on the basis of agency budget policy, but he mobilizes his fight to get help on the watch and the overcoat. The worker's understanding of his fundamental struggle here and his genuine need of help in doing so difficult a thing, brings tears to his eyes and an acknowledgment of how hard this all was for him. But she leaves with him the full responsibility for his task when she says with sincere feeling for him: "Frankly I did not know how he could have the strength to do what he was doing. . . . I did not know whether that kind of living would be worth the effort it cost him." So fundamental a realization of his problem is more than he can deal with at this moment. He turns aside to point out a very practical way in which the worker can make it easier for him. He had to lose a half-day's work and pay in coming here at this hour. The worker meets this criticism as practically and realistically as he presents it, offering to share the responsibility for this loss today and to give him evening appointments in the future. She carries his criticism to a more fundamental level by questioning whether in this hard thing which he is doing, so much alone and so independently, these appointments are worth the price. Are thev helpful? It is she again who states the doubt and again we see how this

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releases him to feel and state his own affirmation. He does need, he says, someone who understands what he is going through, to share this experience with him. In the next contact, which turns out to be the last, his strength and purpose are obvious from the moment he enters the office. He describes the hardships of his job but in a way that indicates he has mastered them. The worker comments on the difference she sees in him and he agrees without hesitation. He has learned, he says, what it means to be a worker and the cost and the value of a dollar. In essence he seems to be telling her, she comments, that he has grown up. But not without some remnants of the old childishness left, as his struggle to get from her one last gift—money for shirts and a hat—so amusingly illustrates. He has some awareness that he is not really asking for this and that she will not give it and he is prepared to accept refusal, so long as it rests on the external objective grounds of agency policy and budget. But the minute she implies that perhaps he doesn't really want this help, he rejects her too constructive suggestion and begins to try to refute her. She sees her error and returns to the acceptable ground of agency necessity, on which he is willing to leave it. The worker takes advantage of his withdrawal of his request, to say that he seemed to be getting rid of agency—"perhaps he was glad of this opportunity to tell me we did not count for so much." The burst of uproarious laughter which greets this reveals how right she is. He goes on to admit freely how resentful he has been for the way he has been treated in the past by the agency—as a child, not as an adult. He sets off the experience of the present with this worker as different. She has been frank and direct with him and he appreciates it. But for her, too, he has some criticism. She could have "pushed" him more. As he discusses this he comes through to the valuable admission that it was really he himself who had been to blame for letting himself be treated as a child. The worker then states for him her belief that, even though things are not yet settled for him, what he wants most is to be finished with agency. He agrees this is true and asks if he may have the chance to return if he should decide he needed vocational retraining. The worker grants that this might be a need the agency could consider with him in the future. She offers him another appointment in a week or two, if he wanted to think this over before

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ending, but he feels ready to leave now and he does so with a warm expression of gratitude for the worker's interest and help. The follow-up note describes how he came back exactly a month after this last interview to tell that he had been fired and to ask for relief in a temporary job-hunting interlude. It was obvious to both him and the worker that the job had served its purpose and that he had provoked the discharge. He was given the slight relief he needed and used no further contact. It was learned from the Federation Employment Service that he had been placed in a full-time permanent job as cashier. In both of these cases, personality change has been effected with the aid of case-work help. That help is offered on the conviction that the individual in coming to a service agency is seeking a way of breaking into the chain which his own pattern and circumstance have forged between himself and external reality. Something in this connection no longer works for him. The problem this presents to the case worker is that of determining whether there is a real will-to-change in the client and whether he can use the particular form of case-work help she has to offer in accomplishing change. Convinced of that will-to-change, the worker's skill in assisting it to move with direction and increasing strength and sureness rests on her capacity to recognize the forces in this movement as they are projected on her, as they struggle both to make use of and to resist agency service and agency conditions, and upon her ability to respond to them sincerely and immediately. In the Lee case, the movement toward change had in feeling accomplished the abandonment of the old self and its associates before coming to the agency. But there seemed little more than a timid hope to have things different, without capacity to bring that change about. The worker carried the conviction that change was possible until the client could gather strength to take it over as her own. Through the relationship with the worker who believes in change and who offers the tangible means whereby a new physical environment can be found, life flowed back swiftly and surely into the self and expressed itself in reality attachments with father and job. In the Marks case, on the contrary, the worker stood for the neurotic self of the dependent boy who had never regarded him-

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self as a man nor been treated as one by family or agency. Here the worker had to initiate change for the reason that her own sense of function could not permit her to be a party to the use he had made of agency. Her question to him—did he want to try anything different?—while it disengaged his hold on agency, at the same time offered him a choice if he would take it. It penetrated his inner conflict, setting off one trend in a new relation to the others. That new trend engaged with the worker and struggled at the same time independently, finding himself a harder task in job conditions than any the worker would have set him. When he had met this self-imposed test and proved to himself that he could do it, he was through with agency help. He could leave in possession of a new self which had learned how to work and which had measured the value of a dollar. The worker could permit him to leave with his expressed criticism for the past, knowing that he was parting from his old neurotic self in so doing. But in spite of the amount of negative feeling so characteristic of Joseph Marks, one can never doubt that he, too, no less than Miss Lee, was able to effect this change because of the worker's understanding, which includes both sides of his struggle. In a case-work process of the kind described in these two records, where the client projects a part of himself into the contact, and the worker responds with immediacy and sincerity from her own deeply carried sense of function, there will inevitably be a sharp point of difference, painful and alienating (the sense of difference between Miss Lee and the worker when the worker says: "Why did you not marry him?"; between Mr. Marks and the worker when she asks him to question whether this agency can be of help to him). Such questions penetrate the client's projection and disturb the organization of forces behind it. Out of this disturbance of forces a new focus begins to form, a deeper and more powerful focus, with direction inherent in it. It moves inevitably into new projections, to which the worker continues to respond with immediate sensitivity to what is being put on her, with an undeviating sense of her own role which repudiates the false and unreal while it gives generous, sincere appreciation to the client's feelings and deep comprehension for the nature of the whole struggle. In both cases one sees the extent to which the client, while he is still caught in his struggle, really trusts to the worker's conviction, based on her

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experience with processes of change, that this movement will eventuate. For both these clients, once the movement to change has found its focus in the self, the tempo is unbelievably swift. Miss Lee in only seven weeks, using nine contacts with the worker, finds a job and is ready to leave the agency; Mr. Marks' movement is accomplished in two months, in contrast to a previous relation to agency of two and a half years, and with only three appointments with the worker after her penetrating question to him in the first contact. Many will question the depth and extent of the personality change effected in these two clients. I have no desire to go beyond the evidence of the records on this point. Psychological change is by its nature individual and internal, capable of description only by the individual who experiences it, defying objectification and measurement. But when psychological change is effected with the aid of case-work help and the use of an agency service which sets objective standards and conditions for its use, then the degree of that change can be measured in terms of the use of that help and service. Applying this test of use, I believe we have the right to say that psychological change can be considered significant when the individual succeeds in taking in and dealing with the difference expressed by the agency representative who carries a responsible relation to the process. T h e word "partial" has often been used to distinguish change accomplished with case-work help from therapeutic change. True, the definition of agency service and the client's own focus of his problem inevitably and rightly limit and place the problem in partial terms. But no definition and no particularization on the part of the agency can interfere with a client's necessity to place total value on the partial service. Furthermore, when the process of change is felt as inner movement in the self, the client truly risks a total change. This fear of being overwhelmed by his own unleashed forces and invaded by another who has the control, cannot be avoided. It may be reduced by conditions set before him, requiring the break-up of his activity into parts with which he can deal, but somewhere he must take in the shock of the realization of change. This shock involves the whole self for at least an instant of time. It is bearable and therapeutic, not because it is partialized, but because it is met honestly without evasion by a self that has

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the courage and organization to meet it sincerely. For this reason I would say that the case worker as well as the client must use her whole self if she meets her client's need. It is this sense of the courageous, spontaneous, and responsible use of the self in impact with the client's need and projection which, when all is said and done, seems to me to account for the experience of change described here. This meeting point constitutes the true focus for the process of change. That this focus is fundamental in the personality structure I have no doubt. How pervasive it can become in the total personality, and how lasting, will depend on factors outside the case worker's control—on the flexibility of the personality patterns, on the strength of the forces of reorganization, and on the nature of the connections with reality.