Child Placement Through Clinically Oriented Casework 9780231879675

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CHILD PLACEMENT CLINICALLY

THROUGH

ORIENTED

CASEWORK

CHILD

PLACEMENT

THROUGH CLINICALLY

ORIENTED

CASEWORK by ESTHER

GUCKMAN

COLUMBIA UNIVERSITY PRESS

NEW YORK

1957

COPYRIGHT ©

1957 COLUMBIA UNIVERSITY PRESS, NEW

YORK

PUBLISHED IN GREAT BRITAIN, CANADA, INDIA, AND PAKISTAN BY THE OXFORD UNIVERSITY

PRESS

LONDON, TORONTO, BOMBAY, AND KARACHI LIBRARY O F CONGRESS CATALOG CARD N U M B E R :

56-10783

MANUFACTURED IN THE UNITED STATES OF AMERICA

PREFACE

THE SEPARATION of child from parent is perhaps the most tragic occurrence in a child's life. Its unfavorable aftereffects are usually irreversible despite the sometimes successful experience of being reared by substitute parents. For the child who remembers the relationship with his natural family his loss of living with them leaves indelible scars. The scars are worsened when, as sometimes happens, both parents remain alive, and if they continue to have contact with the child, in many instances with unfavorable influence, the scars are deeper yet. The reason for placement when his parents are living is then not clear to the child, as the situation is quite unlike that in which the real orphan finds himself. In the former instance, the child's great pain over separation is compounded with the confusion arising from the inevitable question, "Why am I not at home with my parents?" Eventually, the painful meaning of his fate becomes crystallized into awareness in one form or another that he is different, and this leaves lasting wounds. Withal, the process of child placement truly may be termed a matter of major surgery, an irrevocable operation from which the child never fully recovers. Armed with a vivid realization of the significance of placement, social workers from all agency settings should consider this treatment measure a last resort. The child placement agency has the responsibility (from the direct experience of what placement does to a child despite the gains he derives from it) of screening out families for which placement can be avoided. The gains of placement cannot be guaranteed to balance the losses risked to secure them; the cost is sometimes too high in terms of irreplaceable family ties.

vi

PREFACE When the home situation is such that it makes placement of

the child inevitable, then the process of arranging the most suitable placement and of making the separation the least tearing possible, must have scientific attention. The welding of the child's new ties requires skilled help, not only on behalf of the child, but also on behalf of the foster family. The latter resource for children in need of placement is the only one whose work is given major focus in this book, although other necessary ones available are described. The foster family is still the most prevalent resource in use. Direct treatment of the child's separation trauma, as well as of whatever other personality disturbances he brings from previously damaging family relationships, is necessary in order to free him to use his new opportunities for healthier relationships and for amelioration of the harm already done him. Work with the parents to gain their cooperation in this venture and for care of their own needs is indicated so as to provide as much healing as possible of the broken family even while it is existing in parts. Sensitive work in helping the child when he leaves placement for whatever reason is indicated for his best integration in his new environment, new even if he is returning to his own family. T o these tasks the worker must bring as much clinical knowledge of human behavior as he can gain, shaping it to meet the specifics of human behavior which the realities of the child placement situation present. Further knowledge of personality dynamics and procedures for dealing with them is to be gained from improvising in the struggle in which the child placement worker must engage in order to meet most difficult reality situations. The steps outlined in this writing are techniques, and the danger in using them arises from lack of fully understanding their governing philosophy, which I have also attempted to describe. The techniques depicted are stated here only as examples of the guiding principles stemming from the author's philosophy. If the latter is not adequately appreciated, then the techniques cannot be correctly applied, nor can new ones be suitably drawn from those mentioned. Perhaps the reader will feel that too much has been said all at one time in the effort to present the clinical approach to child placement problems and procedures. T o this possible objection,

PREFACE

vü

I reply that the principles and techniques covered in this work are not intended for learning by reading. Rather, as each experience in an actual placement process is met and reflected upon, reference to a similar situation can be sought for in this writing to stimulate further thought or to supply confirmation to lend confidence; for the writing of this book is based on actual experience in child placement work, either in my own casework practice or in that of colleagues and those I have taught. The content of this material has been worked out in reality and tested in case situations. In addition, I have brought to my efforts in child placement the maturing of the professional experience which I gained from several different areas of social work—from public assistance agencies, state hospital and general hospital work, family casework, adult psychiatric clinics, and child guidance clinics. Although various other child placement agencies may present different conditions (such as those in rural areas), there is a framework common to all whose objective is to help the placed child, his own family, and the foster family make as constructive an experience out of the unfortunate need for placement as is possible. Appropriate methods can be adapted from those described here to implement the basic philosophy of this endeavor in situations of varying circumstances. There are no final answers here; some may be wrong for certain situations, and others may not have been tested enough. My hope is that other workers in following these principles and trying these methods, thus further testing them, and in improvising on them to meet other situations will bring forth new ideas to advance the development of casework, its philosophy, and its techniques. I believe that such experimental work is vital for increasing our knowledge and for developing new skills. The decision to write this book came to me after numerous inquiries were made of me during my teaching of institutes in various parts of the country as to where the discussions held could be found in written form. Members of the various audiences explained that they wished this information were available that they might read and study it for deeper consideration. The men and women in these audiences came largely from various state

PREFACE

viii

departments of child welfare and from the county or regional sections of these departments. Their experiences revealed that they work with much heart against the odds of as yet undeveloped settings, travel long hours over great distances to bring whatever surcease possible to children with broken lives. Rural workers and urban workers together impressed me as sharing alike a dedication to their work with children, which inspired me to put into writing what I have learned to date. And it is my hope that this writing will contribute to their search for ways and means of increasing their help to children and families. In preparing this manuscript, I had the concrete encouragement of Mrs. Mary Lawrence, Executive Director of the Jewish Children's Bureau of Chicago, where the casework material was worked out and where the greater part of this writing was done; and also the encouragement of Mr. Joseph H. Reid, Executive Director of the Child Welfare League of America, Inc., New York, to both of whom I am grateful. I am especially indebted to Mr. Sylvester Adessa, Director of the Lakeside Children's Center in Milwaukee, for extensive editing and counsel, and for valuable suggestions as to content as well. My deep appreciation is extended to my past colleagues, who include: Margaret Brevoort, Evelyn Fogel, Celia Freemond, Helen Hagan, Mary Harms, Draza Kline, Helen MacGregor, and Susanne Schulze, for valuable suggestions given after reading parts of the manuscript, and, beyond this, for their encouragement. My gratitude goes also to the workers I supervised, who taught me much from their own work, and to my colleagues who informally shared their casework experiences with me, from which I learned too. Some of the case examples in this book were contributed by both these groups. ESTHER GLICKMAN

New London, July, 1956

Connecticut

CONTENTS

1. DIAGNOSIS AT INTAKE,

3

Purpose and Extent of the Intake Study, 3; Questions to Be Answered by the Intake Study, 5; Content of the Intake Study, 6; The Presenting Problem, 7; What Parents Expect, 8; Explanation of Agency Services, 9; Drawing a Tentative Diagnosis, 12; Ways of Getting Diagnostic History, 13; Workers' Subjective Attitudes, 16; Counseling Parents about Placement, 18; Testing Parents' Readiness for Their Child's Placement, 19; Conclusion, 22

2. AN ATTEMPT AT OF PARENTS, 23

CLASSIFICATION

Psychosocial Diagnosis of Parents, 23; Emotional Economy and Location of Pathology, 2 3 ; Four Categories of Psychological Framework, 26; Ego-Defective Parents, 2 6 ; Parents Who Feed on Their Child for Mental Survival, 29; Narcissistic Parents, 4 1 ; Parents Whose Neurotic Equilibrium Has Broken Down, 50; Conclusion, 63

3. TYPES OF PLACEMENT

FACILITIES,

64

The Role of Family Life in Our Culture, 64; Orientation to Placement Resources Needed, 66; Substitute Family Care, 68; The Adoptive Home, 68; The Free Permanent Home, 69; The Private Foster Home, 69; The Boarding Home, 71; The Professional Foster Home, 71; Subsidized, Contractual, and Agency-Owned

χ

CONTENTS

Foster Homes, 72; Facilities for Group Care, 74; Institutional Facilities, 74; Aggregate Institutions for Dependency Care, 74; Specialized Institutions, 76; Group Homes, 78; Residential Treatment Centers, 80; Hospital and Social Agency Settings, 80; Treatment in the Hospital Setting, 82; Treatment in the Agency Setting, 86; Other Differences between Hospital and Agency Centers, 92; Group and Individual Approaches, 94; Conclusion, 101 4. PREPLACEMENT

WORK WITH FAMILIES,

102

Purposes of Preparation for Placement, 102; Transfer of the Case from Intake Worker to Caseworker, 105; Development of a Dynamic Relationship with Parent and Child, 109; Steps of Action, 115; Telling the Child, 115; Meeting the Foster Family, 129; The Actual Moving to the Foster Family's Home, 136; Preparation for Replacement, 139; Replacement from Foster Homes. 139; Replacement from Institutions, 140; Easing the Separation Trauma for Children in Other Situations, 146; Emergency Placements, 146; Conclusion, 151 5. WORK

WITH FOSTER

FAMILIES,

152

The Scientific Approach to Foster Family Care, 152; Knowledge of the Child and His Family Sketched In, 154; Knowledge of the Child, 155; Knowledge of the Natural Family, 159; Knowledge of Interrelationships in the Natural Family, 161; Study of the Foster Home, 163; Preparation of the Foster Family for the Study, 163; The Life Situation of the Foster Family, 167; The Emotional Content of the Foster Family, 171; Interrelationships in the Foster Family, 177; Motivations for Becoming Foster Parents, 178; Matching Child and Foster Family, 189; Workers' Subjective Attitudes, 195; The Worker's Relationship with the Foster Family, 200; Preplacement Work with the Foster Family, 205; Work with the Foster Family after Placement, 210; Advice and Guidance, 211; Dynamic Supportive Work, 212; Working within the Dynamics of Character Structure, 219; Direct Treatment of Underlying Problems in the Foster Family, 224; The Work of

CONTENTS

xi

Uncovering in a Partialized Area, 226; Over-all Supervision of the Child in the Foster Home, 233 6. WORK WITH PLACEMENT,

CHILDREN 243

AFTER

Direct Work with Children in Placement, 243; Development of the Casework Relationship with the Child in Placement, 245; The Worker's Dual Role in the Relationship, 247; Planning and Supervision of the Child's Life Situation, 251; Direct Treatment of the Child's Underlying Problem, 252; Explanations of Reasons for Placement, 259; Case of Paula, 281; The Need for Treatment of All Children in Placement, 328 7. WORK WITH PLACEMENT,

FAMILIES 332

AFTER

Importance of Work with Parents after Placement, 332; Workers' Subjective Attitudes, 334; The Meaningful Relationship with the Parent, 335; Diagnostic Understanding of Parents, 337; Concepts of Ego Energy, 338; Goals of Placement, 344; Levels of Treatment, 345; Treatment Approach to Each Category of Parents, 346; Emotional Holding of Ego-Defective Parents, 346; Emotional Feeding of the Parent in the Symbiotic Tie, 349; Dynamic Handling of the Narcissitic Parent, 351; Dynamic Support and Remedial Work with the Neurotic Parent, 358; Contacts between the Child and His Relatives after Placement, 371; Contacts with Parents, 372; Contacts with Siblings and Other Relatives, 381; The Importance of Family Relationships in Our Culture, 387.

8. TERMINATION

OF PLACEMENT,

388

Termination by Agency Plan, 388; True Rehabilitation of the Family, 388; Premature Termination as a Treatment Measure, 389; Termination at Parents' Request, 394; Preparation of the Child and His Family for Reuniting, 395; Termination by the Child's Coming of Age, 410; Parents' Distorted Use of Their

xii

CONTENTS

Child's Coming of Age, 410; Gradual Weaning by the Agency, 411; When the Agency Remains a Parent-Figure, 417 NOTES,

419

BIBLIOGRAPHY, INDEX,

429

425

CHILD PLACEMENT CLINICALLY

THROUGH

ORIENTED

CASEWORK

In child placement the greater part of the work done with parents is with mothers. But in this writing, wherever the reference is to either a mother or a father, no matter which is predominant, the neuter use of the masculine pronoun "he" has been introduced. This applies to both natural parents and foster parents. Similarly, social workers in general are called "he," and only when a specific one is a woman is the pronoun "she." The child is also "he," except where the specific child is a girl.

I

DIAGNOSIS AT

INTAKE

PURPOSE AND EXTENT OF THE INTAKE STUDY

It is axiomatic that sound casework proceeds from accurate diagnosis and that the diagnostic process begins with the first contact at intake. Where separation is decided upon, diagnosis is continued during the preplacement work and, as in other casework, is augmented and tested in the later treatment. Although only a small number of workers actually participate in making intake studies, workers who subsequently enter into contact with clients have a direct concern with the information derived from the intake process. In the placement agency any worker who assumes the contact after intake needs to know at the outset why the decision for placement was made and what brought the parents to this point. Moreover, the worker is guided by this knowledge not only at the beginning of his contact with the client, but throughout the placement. The intake study in the placement agency is of greater and more lasting importance than that in an agency giving service to the child who remains in his own home, for the placement worker counts heavily on the information secured then to plan every aspect of the child's life. When events occur in the future, a better understanding of what plans ought to be made is based on the diagnostic information contained in the intake study. For the family the intake process is most important in helping the parents decide whether or not placement of the child is the best course or the only one left, if the choice is theirs to make as in

4

DIAGNOSIS

AT

INTAKE

voluntary placement. This decision is the most fateful of any for a child's life, and whether it is made entirely during the intake process or not until later during the preplacement work, the implications of its far-reaching effects cannot be overstressed. Because of this neither the referral nor the parents' request for placement should be taken at face value; rather, a careful evaluation should be made, with the parent when feasible, as to whether or not placement is needed, either for psychological or for social reasons. Even in a forced placement ordered by the court, the placement agency should first conduct an intake study to determine the advisability of such a step and should attempt to plan with the court other measures, if indicated, of helping the family. The lifetime significance of separation from parents during childhood is so ominous, 1 as described in the Preface, that reaching the decision may be considered too weighty a responsibility for one person to bear. For this, as well as other reasons, the extent of the intake process varies from agency to agency. In the above instance, the role of the intake worker would be to gather pertinent material as guided by disclosures in the intake process for deliberation by an intake committee which helps the intake worker to reach a decision. This method, however, does not permit of the parents' ongoing participation in the deciding. Another intake method may comprise a protracted intake study during which time the parents are being helped to arrive at a decision. But this process can evolve into a treatment situation where there is an intensive relationship between intake worker and parent. With little time to help the parent move from such a relationship to a new one with the worker who follows, a barrier is created to the further help needed by the parent at the time he relinquishes his child for placement. It is necessary to keep the relationship between the intake worker and the parents at a minimum in order to make the transfer of the parents to the regular worker easier for the parents. If the parents require intensive help in deciding about the placement of their child, then the family should be referred to another agency where this can be treated as a part of the total family problem. Either the parents' motivation, or their reality situation, or both may lean heavily in the direction of placement and their

DIAGNOSIS

AT INTAKE

5

need is largely that of clarifying their decision before preparation for the step of separation. Then the intake work should be brief and most of the help given in the preplacement work done by the regular worker. The governing principle should be to attempt to maintain continuity of the parents' relationship with the same worker. By avoiding the development during the intake process of an intensive relationship, either positive or negative, which would have to be transferred to a new worker for the most crucial part of the parents' experience, that of actual separation from the child, the way is left open for them to gain the help they need. To observe this principle some agencies have an intake process which consists only of the briefest of screenings as to whether or not the application falls generally within the agency's province and is in accordance with any agreement between community agencies. After that, the application is assigned to a worker who will carry the responsibility of making an intake study, doing the preplacement work, making the placement itself, and finally carrying out the supervision and treatment after placement. This plan is followed of necessity by agencies in rural areas where geographic distances make impossible contacts with more than one worker. There the worker who travels into a given district has to be responsible for all the work in the entire process of placement. Because the trips of the worker must be few, due to distance, his intake study has to be condensed yet should never be omitted. QUESTIONS TO BE ANSWERED BY THE INTAKE STUDY

Whatever the plan for the intake study, there are two main questions it should answer. First, should the child be placed in view of what such a move will mean to him and in the light of the unpredictability of foster family care? And second, if placing the child is indicated, is the parent ready to move in that direction? To arrive at the answers to these, the basic material of intake, generic to all agency settings but shaped to apply to the question of placement, is secured. But who finally gives the answers? In voluntary placements it must not be forgotten that the right to place a child is legally the parents', and the decision ought to be

6

DIAGNOSIS

AT

INTAKE

made jointly by worker and parents. However, when a trained worker understands from the nature of information secured from the parents and others and from discussions revealing parental attitudes that placement is the only treatment measure possible and the best course to follow even with consideration of its implications and when the parent is unable to move toward reaching a decision, then it behooves the professional worker to make such recommendation and to help the parent accept it. This is comparable to the role of the physician who makes a recommendation for treatment after arriving at a diagnosis and attempts to help the patient accept it by explaining the need for the measures he has advised. Parents coming to a child placement agency can leave as well as can the doctor's patient, if they do not wish to follow the advice proffered. Yet advising prematurely of such a treatment measure as placement, whether done by the intake worker or by a referring source, can bring unnecessary hardship to parents and child, since the diagnosis may have been incorrect or the parents not ready to "hear" it. It is always desirable for the referring source, be it an agency, a private physician, or a psychiatrist, to discuss the recommendation of placement with the placement agency before telling it to the parents or child. Even if the referring source has reached such a diagnosis, it may not be found acceptable by the placement agency which makes its own diagnosis on the basis of its experience in placement work.2 Content oj the Intake Study. Generically, the content of an intake study follows the sequence of learning first the nature of the problem at application (or the presenting problem) and then what the client expects and wishes the agency to do to help him. This is followed by the explanation of the agency worker as to what the service offered by the agency can comprise. The worker can proceed to a diagnosis on the basis of the information gathered through the foregoing discussion and by taking at its conclusion whatever additional history is necessary to complete the diagnostic picture. Finally, the worker can counsel according to the conclusions reached about a plan and the knowledge he has gained of the dynamics of the person wishing help. Each of these aspects

DIAGNOSIS

AT

INTAKE

7

of the total process is shaped to meet the specific need indicated by the particular presenting problem. For instance, if the problem carries a request for placement of a child, then the intake study will focus on material needed for the examination of this request. The Presenting Problem. Before needlessly embarking on the intake study proper, it should be determined whether or not the application falls within the scope of the agency's service. If the parents have not indicated clearly during the screening that placement of the child is being sought, then it may be necessary to ask directly if they are seeking to board the child "overnight" for a period of time. Sometimes the parents wish help with the child with the latter remaining in the home, not having "heard" the recommendation of placement given by the referring agent. Such emotional blocking by the parents is indicative of their unreadiness to grapple with the idea of placement. Clarification of other points is also necessary at the beginning. Public child placement agencies have requirements of residence and of financial need as well. In general, private agencies are set up along sectarian lines and either by mutual agreement or state law, where applicable, follow the religious preference of the family. Where such division between agencies is voluntary, deviation from it can occur should the agencies involved so agree. And some of these private agencies determine acceptance of the application according to the treatability of the child. Factual information about these points can hold diagnostic meaning, so they should be noted for later exploration, should the application be accepted for intake study. The family's frequent moves from one part of the country to another, ascertained when legal residence is being determined in a public agency, or the parents' preference for an agency whose religious auspices are different from the religious identity or observance of the family are such. To comprehend the nature of the presenting problem, the parents' spontaneous presentation of information should be encouraged first, allowing much of it to be free-floating and nondirected. Such information, even if not fully understood by the worker at the time the study is made, really portrays the parents' motivation most truly. Later review of it in the light of subsequent

8

DIAGNOSIS

AT

INTAKE

information will reveal patterns and meaning in such an interview having the least amount of coloring; whereas what appears when information is secured directly has much more. When the information required does not seem to have been sufficiently supplied by this spontaneous flow, both factual and descriptive information should be sought in other ways regarding the specific request and the circumstances surrounding it (for example, a divorce or the loss of a parent). When the precipitating cause is not clear-cut, one has to seek seemingly unrelated facts but facts which may prove to have unconscious connection. The social situation in relation to the family's current functioning and the dynamics operating within this should be ascertained. If the underlying causes for the request are still not clear, then the time at which the surface difficulties first appeared may link them to yet other reasons, possibly the true ones. Thus, although this is not the time to take extensive personal history, some, unavoidably, will have to be obtained to complete the understanding of the presenting problem. If the child's behavior is disturbed, a full picture as to how this manifests itself in all areas and the date of its onset is essential. The parents' expressed as well as unconscious reactions to the child's behavior and their manner of handling it will not only give clues as to its causation but, together with the parents' attitude about placement, will help in understanding the parents' motivation. What Parents Expect. It is then necessary to explore what the parents expect and wish the agency to do in regard to the problem. Bringing out the parents' ideas as to how they think the agency functions, what it can do for them and the child, and any other impressions they hold about the agency will reveal further diagnostic information about the parents' dynamics and motivation. Practically, it is advisable to help the parents disclose these fantasies before explaining the agency's service and the manner of carrying it out. Giving factual information first may serve to cover over the parents' own anticipations, and, if these have not been elicited previously, the feelings and hopes stemming from them continue to operate, sometimes in contradiction to the reality of the service. The parents will be less apt to tell what they really

DIAGNOSIS

AT INTAKE

9

expect if they first hear the reality, as they may be ashamed or otherwise blocked. They may repress their earlier expectations and then the anxieties stemming from them will continue without knowledge of their source. Or resentment over frustration of their original wishes may create another barrier to clarification in the intake study and even to cooperation later. If the parents' underlying wishes remain as they were originally, without clarification, they may feel cheated by the agency and distrustful of it. Possibly feeling dissatisfied with what is offered, they may go from agency to agency seeking their impossible goal. Explanation of the unrealistic basis for the parents' expectations can better help them give up their initial wishes than can what they construe as a refusal. The airing of their anticipations will help somewhat to free parents from them emotionally as tensions are thereby released. If a woman is seeking aid from the agency to effect a reconciliation with her husband in order to obtain support for the child, sharing of the painful material around the marital situation will leave her less tense to "hear" why this cannot be done for her in the placement agency. Flexibility should be exercised in following this plan of procedure. If the parents are at first unable to tell what they expect of the agency and in regard to placement, it may be necessary to impart some information as to what the agency is equipped to do. This may serve to push the parents' fantasies into the open as the information given may stimulate the fantasies and reassure the parents enough to share them. If parents still cannot share their earlier expectations, then direct questioning may be attempted with reassurance through ancedotes which suggest mistaken attitudes commonly held by parents considering placement of their child. At the same time, too much participation from the worker has to be avoided so as not to block the expression of the parents' real feelings. Explanation of Agency Services. The worker's description of the agency's services and how they are generally applied naturally follows the elimination of any misconceptions held by the parents. Supplying correct information now helps the parents to perceive the agency's functions more clearly, brings clarification out of

10

DIAGNOSIS

AT

INTAKE

bewilderment, and tends to dissipate anxiety. When the parents are told that they can visit the child regularly at intervals worked out to help them and the child, their fears that giving up the child for placement means no further contact are alleviated. A general, pervasive anxiety, from sheer lack of knowledge about placement activities, can be allayed by a general description of the agency's method of finding and studying foster families or of its experience with other placement facilities, of the continuing supervision of the foster home placement, the provision of medical and dental care, and other general over-all arrangements for meeting the child's needs. Specific methods of treatment cannot be discussed as the child is not yet known sufficiently to predict these. If an agency supplies direct treatment of a child's emotional disturbance, it is inadvisable to inform some parents of this service at this point, for they are likely to feel accused of creating the disturbance; or they may be fearful that treatment will so change the child that he will be able to free himself from his neurotic ties with them which they wish to keep. On the other hand, parents may expect the agency to cure the child of behavior distasteful to themselves. When placement is planned specifically, at the parents' request, to provide treatment of a child's emotional disturbance, they may wish to know the nature of the treatment. Then the explanation is given, first in generalities, later in more detail, framed as the parents can best accept it according to their own needs. A partial report of an intake study is given here to show how eliciting a parent's wishes and expectations first and then telling him later what the agency can or cannot do can bring about his sounder cooperation and planning. Mr. G., referred by another agency, came to request placement of his baby. He sat bowed in discouragement as he told how his wife was suddenly found to be tubercular, necessitating her stay in a sanatorium for at least a year. For his four children, aged six, four, and two years, and five months, he had found a suitable housekeeper who had been in his home since he began work a few days before, after four weeks of unemployment. The housekeeper left in the evening, when he assumed the care of the children. He

DIAGNOSIS

AT INTAKE

11

stated that the other agency advised him to place the infant so that he could manage better to care for his family and keep his job. Having just begun his new job, he dreaded time away from work due to the needs of his family. He described each child briefly and told of how the oldest was hit recently by a car but was not seriously injured and of the illness of the next-to-the-youngest, Davie, who had never seemed right. Having stated his problem of needing service, he was asked what he would like this agency to do for him. He blurted out that it was the next-to-the-youngest child, Davie, who needed to be placed and not the baby. The latter slept most of the evening and through the night and did not disturb his sleep. Davie, on the other hand, had been a sick child since birth, unable to sit or stand until late, with weak motor control; he did not talk or eat well, and he cried most of the time both day and night, especially if left alone. Mr. G. could not get enough rest during the night on account of him, and he feared the housekeeper would leave if she had to tolerate this trying child during the day. He needed her sorely to keep his home together, especially since it was difficult to find a housekeeper who was religious enough to be entrusted with the care of his home, to abide by the religious rituals observed there. When Mr. G. was advised that his views would be discussed with the referring agency as a reasonable plan which the placement agency could meet if it tied in with total planning, he responded as if he felt supported in his burdens. He brought out much of his bitterness over his recent series of bad luck, apologizing for his complaints. He disclosed further that he might have to place the other children, but only later if he found that he could not manage their care. Should that happen, he wished to have a home for them which strictly observes religious practices in keeping with his religious tenets, including observance of dietary rules. He was told that sometimes it is not possible to find such homes, and, further, that if all the children were to be placed, there would be no home where all four could be cared for together, as this amount of responsibility is rarely undertaken by foster families. Consequently, it would be necessary to use two or more foster homes and there might not be that many religious homes available at the time. He

12

DIAGNOSIS

AT

INTAKE

replied that he could see this, and stated that for a sick child like Davie, and also for an infant, the religious requirement in the fos· ter home could be waived. (Placement of all the children did become necessary later as Mr. G. could not get along with the homemaker due to his personality problems.) Drawing a Tentative Diagnosis. The worker in coming thus far in the intake process sees that it should be continued and should at this point attempt to formulate a working diagnosis of parent and child and of their relationship to one another on the basis of information already secured. This information can later be supplemented by whatever further history and exploration is deemed necessary to complete the findings. But to reiterate an important principle, full history should not be taken prematurely before previous steps have been cleared to show that the study should proceed. The parents will feel they have revealed much of themselves needlessly if such material is fully gathered and they are then sent to another agency for help. However, it can happen that extensive exploration is necessary before it is known that referral elsewhere is indicated, but the intake worker should develop keen diagnostic skills in interviewing so that he can, in most cases, grasp the significance of information early enough to prevent excessive uncovering of history and other emotionally charged material. Emphasis on the present functioning of the parents, the child, and the total family can help determine, together with their history, the presence of resources and lacks and the nature of each, so as to arrive at a decision as to whether or not the child should be placed. The meaning of a diagnosis of the character structure of the parents and the child and the quantitative aspects of the psychological diagnosis are discussed in the following chapter, "An Attempt at Classification of Parents." To collect the pertinent information needed to make a total diagnosis, description of behavior, past and present, is vital. A quick survey of an adult's current adjustment requires exploration of at least three major areas: libidinal or close interpersonal relationships, as in the family; sublimative or social interests, as in social relationships and activities; and realistic or work life, which may also include aspects of the former

DIAGNOSIS

AT INTAKE

13

two. In the child's life adjustment, comparable areas are his relationships with parents and siblings, his play activities and peer relationships, and his school situation. WAYS OF GETTING DIAGNOSTIC HISTORY

In securing the parents' personal background information some of it may be given spontaneously by the parents as they discuss their present adjustment in terms of the above-mentioned areas, which can lead them to memories of past performance and experiences related to those under discussion. This manner of obtaining information about the past is less distressing to parents than is the direct approach, and further, it discloses a history more valid. In attempting to deepen this history, the leading questions used should be directed at first at less threatening areas. The experiences leading to pain and bitterness will be revealed more readily and more truly when the questions are not too pointed even though they be directed toward possible sources of such memories. A question about the size of the family in which the parent grew up is the least charged. Inquiry into its composition as to sex and age differences again is not too threatening and yet it brings the focus closer to the heart of the matter. Questions as to which were the favorites and as to whom as they grew up the parents felt the closest in their old families begin to bring out revealing information. When asked who did the disciplining and what the nature of it was, the parents divulge much about their own parents' personality and relationship with the present parents who are now requesting placement. These relationships are the most telling and therefore the most threatening for parents to discuss. By using the methods suggested or similar ones, the approach is so gradual that parents find it easier to participate in giving information valuable for diagnostic understanding. A history of the child's development is most essential in assessing the present problems for which placement might be found the necessary answer, and then if placement is decided upon, it will also be of value in orienting the foster mother and in charting treatment of the child after placement. It is used for weighing the child's experiences after placement against knowledge gained through the history of the basic ego formation. Because of this, it cannot be

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sufficiently stressed that a clear picture must be obtained of the child's first year, since what happened to him during that time explains his basic ego integration. Information should be gleaned as to the extent of warmth given him by a mother-figure and as to what she was like; what changes there were, if any in motherfigures and at what age they occurred; his reaction to loss of familiar ones; the adequacy of substitutes; and the consistency of care —all of this whether he spent his first year in his own home or in an institution. The meaning of these events for the mental health of the child is included in later chapters, and has been written about extensively by other authors and research workers.1 Some parents are reluctant to recount the developmental history of their child, as they are fearful of exposing their mistakes in the handling of the child. Other parents are afraid that the information they give will make the child appear so disturbed that the agency will not accept him for placement, and therefore their material is colored with palliative hues which obscure the true picture. Yet other parents may wish to justify their request for placement by exaggerating the child's behavior. The parents' inability to remember the child's developmental history can be due to blocking out of fear of disclosing their part in the child's disturbance. Whatever the basis of the parents' resistance, a more reliable picture can be secured, especially of the current adjustment which can suggest past experiences of the child, by asking the parent to describe in detail and in chronological order a typical day, even the day immediately preceding, in the child's life. The machinations of the child as he goes through the day are inquired about—for example, his reactions on rising, dressing, and eating breakfast; toward getting to school on time; to the incidents along the way, the activity on the school grounds, later meals, and the afterschool play; to the differences that occur when the father returns at the end of the day; to the evening meal, bathing and bedtime, toilet habits; and whatever other areas are pertinent to the life of the specific child. Working back from descriptions of everyday performance or lacks in it, earlier aspects can be reconstructed, thus revealing the developmental history. Parents can also be guided from the present to compare and tell about the past.

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15

Contact with the child by the intake worker is indicated only if he has to observe the child to gain a clearer understanding for aid in diagnosis. Sometimes the child is interviewed for this purpose by the agency's consulting psychiatrist or by one in a community psychiatric clinic. In this event, the child should be prepared for such an interview by the parent with the worker's help. The preparation should proceed (as far as possible) on the basis that he can discuss his troubles and worries with someone who likes and understands children. It is not necessary to tell the child at this point of the impending placement if he does not already know of it, since that is not yet definite. Other contacts with the child by the intake worker would expose him unnecessarily to painful suspense as to what is in store for him. The possibility of placement, however, is usually known to the child as the parent frequently uses this either in a disciplinary manner or in some other unfavorable fashion. The child will have created some sort of defense to tolerate this threat, even to believing it only an empty threat. Reality given the threat by contact with the agency worker will break down his defenses and needlessly disturb the child. If the parents have not previously told the child about possible placement, and if a decision is taken in favor of placement, then the child should not be told of the placement plan until during the preplacement period (unless divulging it cannot be avoided should the intake worker have to observe him). By the time of the preplacement work the parents' decision has been fairly crystallized and a worker's contact with the child properly begins. In summary, the worker's knowledge of behavior and needs at the different levels of personality development, of what results are probable when these needs are not met, and of the nature of deviations correlated with these deprivations will serve as his best guide in securing pertinent information to fill in the diagnostic picture. The diagnosis of the need for placement is a psychosocial one, with integration of social factors and their psychological implications and that of parents and child's behavior all given quantitative consideration. In the face of reality difficulties and sometimes without these, what purpose placement holds for the parents according to their needs and motivations should determine the decision about

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4

placement. The meaning of the child to the parents, and most important, the parents' capacity to be parents, especially the mother's capacity for mothering, are further important factors in this determination. In evaluating the parent's rejection of the child, if this be the case, careful attention should be given to its relative weight and its compensations, as well as to the nature of it, whether primary or basic, secondary or reactive to a given situation connected with the child. Anna Freud gives a most meaningful description of the concept of rejection to elucidate the use of it in evaluating the need for placement. 5 WORKERS' SUBJECTIVE

ATTITUDES

During the deliberations to determine whether placement should be the decision, albeit they are based on the material learned about the family and their individual members, the worker's subjective attitudes nevertheless play a role in evaluating this information. Despite professional training, workers do react at times first with their feelings, and some are repelled by the parents, especially by a mother who is considering "giving her child away," as it is popularly phrased. Some workers who react in this way do not strive to become aware of these feelings in order to handle them, to understand the parents' needs and limited capacity. Their scorn of the parents usually communicates itself to the parents and increases the latter's guilt. Some workers in appraising the negatives in the presenting problem see the pathology in the home as comprising the entire situation for the child. They thereby fail to take into account the positives which may exist for the child and the value parents may hold for him despite their negatives. These intake workers can then be influenced by such subjective attitudes as to wish to rescue the child from his family, and thus their evaluation of diagnostic material is weighted in that direction. Moreover, there are still too many workers especially from referring agencies, who have not had first-hand experience with placement work over a period of time long enough for them to realize sufficiently the unavoidable hazards in store for the child in foster home care. The many changes of foster family, a matter not always under the agency's control, leave the child without stable ties and

DIAGNOSIS

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17

with a lack of incentive to invest in close relationships again. These serious drawbacks and the pain he suffers in the separation from his family and again from each replacement may result in little if any gain for him by placement away from an undesirable home situation. Even with the new measures now utilized by some child care agencies to obviate the numerous replacements of the child— setting up, for example, professional foster homes, agency-owned homes, group homes, and residential treatment centers—similar disadvantages may ensue. The child does not always have the close relationships in some of these facilities that he would in a family, and thereby loses much in his development. Turnover of staff in these facilities interferes with the stability of the child's ties to the personnel. Even when a child is placed there more because of his disturbance than for lack of adequate foster family care, he cannot spend all of his growing years in such placement resources as space is needed for other disturbed children after he shows enough improvement to leave. When this happens he is again faced with the prospect of uncertainty in foster home care. Workers participating in a decision about a child's placement away from his family certainly need to evaluate carefully his present home situation in view of what lies ahead. They can do so more accurately, not only by realizing the uncertainties of foster family care, but also by being aware that they may be searching for a perfect home for a child out of their own unresolved search for something similar for themselves. A more beneficial alternative might be found in attempts to help the child remain with his family through family casework, even with limited goals within that effort. The intake worker with an open mind toward the request for placement does not reach a diagnosis at any given point, such as at the end of a suggested outline. But as stated before, the decision about placement is not arrived at by the worker alone to be handed ready-made to the parents; rather, the parents' participation in the intake process, at whatever level, revealing their needs and motivation toward the child, is necessary for reaching a conclusion. Attaining the conclusion is not a separate act; it develops out of the continuous, accumulative process which moves in such a direction that the decision will finally crystallize.

DIAGNOSIS AT

18 COUNSELING PARENTS ABOUT

INTAKE

PLACEMENT

During this process the parents are counseled by the worker in a manner designed to point out the many facets of their situation and those of the unknown placement situation for their consideration and to elicit their reactions to them. Support is given to enable them to view these difficult areas. Such discussions aim to help the parents see the child more realistically and to see what placement will mean to the child. The content here is directed by what has already been learned about the parents' character structure and defenses and about the family situation. If a child is grossly neglected both physically and emotionally by a depressed mother, the latter is advised of the child's needs first in terms only of her own welfare, in order to meet some of the deprivation underlying her depression. She can be told that she should have a rest from responsibility and that the child's care will be arranged for elsewhere while she rests. If the guilt this may still evoke handicaps the mother in accepting such a plan, then further counseling to allay the guilt is indicated. On the other hand, if the parents' background information has demonstrated that they formerly possessed the capacity to give enough in the care of the child, but that this capacity is now reduced, then counseling is given to help them see what the child would suffer by placement, and advice which will help to restore their former capacity (such as help from a family agency or a resource like their relatives for the purpose of keeping the child at home) is suggested. Their reaction to this will be diagnostically useful, if not applicable to such planning itself. If the parents flounder too seriously in the confusion of their feelings, and their history and current behavior suggest their chronic dependency with an inability to make decisions, then the intake worker has to make a definite recommendation one way or the other, as indicated. Then the intake worker should handle the parents' feelings about the decision only enough to help them bear it until the regular worker begins more intensive work in this area. If parents with rigid, controlling needs show high ambivalence, then the worker cannot give them direct advice, as this sort of character structure demands that the individuals make their own decision for which they require

DIAGNOSIS

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19

much room. There are also many other character defenses which will be present, each to be met in accordance with the understanding of the manner in which it operates. Neither exploration nor counseling of the parents during the intake process should be extensive, as the parents' anxieties increase by talking about the move when nothing is being done about it. An early transfer to the placement worker to begin preparation for the separation from the child is therefore indicated. This will show how ready the parents are to move toward the child's placement, as the preplacement work mobilizes the parents' realization of their decision. Should the parents decide to withdraw from their initial request during counseling in the intake study, or from their decision during the preplacement work, they should be helped to feel that this is their right, even if the worker has advised differently, and that the worker and agency do not hold it against them, so that they may reapply for placement if they change their minds. The parents should be helped to leave the agency in such a way as to make it easy for them to return, should this become their wish later. TESTING PARENTS' READINESS FOR THEIR CHILD'S

PLACEMENT

The readiness of the parents to move in the direction of their plan of placement needs to be assessed as far as possible before they begin to participate. The self-blame and other discouraging feelings which the parents take away from such an experience as embarking on it and then running away might have been avoided by an appraisal of their readiness to carry out the plan. For this, beginnings of changes in their life situation, and whether these aim to include or exclude the child, should be noted. Discussion of the parents' financial situation, their income and other assets, together with expenses and liabilities, should be held about this time to ascertain how much, if anything, the parents can contribute for the child's support outside the home. This topic should not be discussed until decision to place is reached, although if the parents inquire earlier, they should be briefly answered that payment is expected if possible and as they are able. Since money

DIAGNOSIS AT

20

INTAKE

is very meaningful to people in our culture, reactions to this subject will be diagnostic of the parents' attitude toward the child, while the settlement of an amount of payment might indicate their readiness to proceed with the placement. In some cases the parents' referral is made at this point to the local court on a dependency charge to obtain public funds for the child's financial support if the family's income does not allow enough for a contribution equivalent to the amount granted by local authorities. Such a referral requires the parents to appear in court on their own initiative to apply for the funds on the basis of the placement. T h e parents' move in that direction will indicate their ability to follow through with the placement plan. The referral of the parents to the juvenile court during the intake process to petition the court for the agency's right to place the children even if public funds from the court are not involved may provide some later protection of the placement and tests the parents' readiness as well. When either or both parents wish to remove the child prematurely from placement, then the fact of the court order may have a restraining effect on the parents. They can be told that the agency is not refusing the child's return, but that this is a matter to be decided upon by the court, a legally sound statement. There is then an opportunity to discuss the total situation with the court before the hearing is held. In many instances there is no court hearing as the parents had not really wished the child's return but were acting out against the foster family, or some own relative, or against the agency. T h e parents do not always carry it further to the point of petitioning for a court hearing for the child's return, and this device acts as a cooling-off measure. It should be noted, however, that a worker cannot depend only on such a court order to protect the placement, for if parents violate the order and remove the child without court approval, little can be done about it in most cases. Bringing the parents into court on a contempt charge may permanently disrupt any possibility of working with them and the child, and should be resorted to only in extreme situations such as when a parent is dangerous to the child and cannot be reached by the casework method. In such a çase, upon receipt of the agency's report of termination, the court

DIAGNOSIS

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21

may act on its own initiative, however, which is preferable as it leaves the agency in a more neutral position with the client. Parents whose financial income makes them ineligible for public funds for the child may nevertheless be requested to petition the court for their child's care outside the home, if these parents convey a strong impression that they would take their child in and out of placement on whim. The request is explained to them on the grounds that the agency cannot work without this condition but that the choice is still theirs. If they decide they must have the placement, if not now then after another period of trying their own methods which prove inadequate, then they will acquiesce in this request. The task for the intake worker is to decide whether or not the risk is too great that these parents will never make an adequate plan for their child should they decide against acceptance of the agency's condition for giving service. It might be more wise in some cases to accept an application for placement of a child who is seriously in need of protective care even if the parents refuse to apply at court so that the agency may gain guardianship with its limited restrictive powers. Efforts would have to be made to abate the parents' disturbance through a persuasive relationship with them. Sometimes it might even be necessary to permit them to take the child home from placement impulsively only to have them return to ask for replacement, at which time they may yield to the request for court action. With divorced parents, the one who has been awarded custody of the child is the key person in applications for placement; for this he must have the consent of the divorce court. Even so, the other parent should be consulted by the intake worker, if that parent is available, and his consent secured, as well as his evaluation of the plan. Otherwise, this other parent might find the placement inadvisable and prefer to make other plans for the child's care. This may include the parents' return to the divorce court for further proceedings regarding the child's situation. Or the other parent, not having custody, may use the request for placement in a manner destructive to the child in order to retaliate toward the former spouse. If each spouse has married anew, the new spouse of each becomes involved, even though not legally, and their views on thç

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matter of placement should be learned from them directly as these will influence the decision as well as the later course of the placement. If both parents have equal rights under the custody award, this situation may have to be referred to the divorce court for decision as to which parent has the right to arrange for placement, if there is dissension on this matter. Any steps taken for court action, if such is necessary, on the part of the parent who is applying can mean readiness to move on with his decision to place the child only if it is ruled out that court action is not merely a vindictive exercise between the parents. CONCLUSION

Diagnosis at the point of intake has a strategic value as it is here that the first step is taken by the parents in a momentous decision for the child. The groundwork is laid here, not only for this decision, but also for the goal of making placement a constructive experience for the child and his family if such a measure is to be used. Those parents who come by court order for an enforced placement may give evidence that placement is nevertheless not indicated, and again, the strategic place to find this out is before steps are taken to prepare the child for placement. Therefore, the best interviewing and diagnostic skills and extensive knowledge of the dynamics of behavior should be mobilized for this task. And with this, the questions to be answered are whether the negatives outweigh the positives in the family for giving a child parental care; whether the child will gain more from placement than by remaining in the troubled home; whether it is necessary that he live elsewhere so he can have treatment for some serious emotional and mental disturbance which is more handicapping than the scars of separation and the unknowns of placement; and whether there are reality factors which make it impossible for the child to be cared for in his family. The parents' readiness to carry out their wish for the child's placement requires assessment before steps are taken to help them separate.

2

AN ATTEMPT

CLASSIFICATION

AT OF

PARENTS

PSYCHOSOCIAL DIAGNOSIS OF PARENTS

In determining the psychosocial diagnosis of placement of a child, it would seem that confusions would be reduced, uncertainties lessened, and the diagnosis made more accurate if some specific personality dynamic or constellation of dynamics could be isolated in parents and child, which would point toward the need for placement, whether that was by request of the parents or by court order. Furthermore, even tragic reality situations by themselves, as in the death of both parents, do not create this diagnosis as the orphaned child does not always require placement through an agency, for close relatives may assume full care. Actually there seems to be no distinctive psychological mechanism or specific character structure in parents of placed children or in the children themselves which is not also found in families met in other agency settings. The differences which are present in the families who are seen in placement agencies lie first in the quantity of the disturbance and in its lack of compensations, and second, in the location of the pathology in the parents' personality or family relationships. EMOTIONAL ECONOMY AND LOCATION OF PATHOLOGY

The first instance, quantity, is concerned with the emotional economy,1 which consists of the number of resources in the personality and the extent of the disturbance there. These determine the amount of emotional energy available for the job of giving in the role of

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parent, and also help to determine the integrative capacity of family members, as well as how much stress can be borne before the family balance will be destroyed. The emotional economy comprises the account of how many or few, how rich or meager are the positives in proportion to the negatives in both of the parents and in the child also, wherein lies the cause of the parents' rejection of the child. Disturbances of the same psychological nature can be seen in parents who do manage to rear their children, but these disturbances are of a milder degree, since both emotional and financial resources are more ample than are those of parents who placed their children. For example, the former parents may have depressions, but the latter are more superficial and infrequent, and of briefer duration than those suffered by parents whose children had to be placed on this account. Or even if the disturbances were of greater severity, there might be adequate compensations either within the same parent or in the other parent of this family, in a close relative, or in yet some other source; this would be a leavening force or balance for the deficits. Such a parent may manage with sufficiently strong defenses, which, though they take their toll of emotional strength, yet may prevent serious danger to the family unity. When this is the case, other arrangements can be made and the placement of children avoided, even in the face of reality situations which threaten the continuance of the family group together. The differential in parents which makes for the need to place their children lies in lacking these factors which comprise a sounder emotional economy. In addition to the nature of the emotional economy, there is the matter of the location of the disturbance in parents and children; this too is a determining factor in causing placement. It is known that emotional deviations can exist within a family without destroying its organic unity, even though the unity is based on neurotic ties. The disturbance can be so encapsulated or defended as not to disrupt the family or as to impair only certain relationships and not others. A woman can be a better mother than wife because of the location of her early trauma; or the parent can be an adequate marital partner while unable to be an adequate parent, being able to relate only if given to first by a solicitous spouse,

CLASSIFICATION

OF PARENTS

25

again due to early experiences in old family interrelationships. The location of the disturbance in the structure of the personality and in the structure of the current family's interrelationships is here more important than the nature of the disturbance itself. Therefore, it would be only of limited value in examining the need for parents to place their children to attempt to classify them merely according to a description of their behavioral déviations or the nature of their character structure. A total diagnosis with consideration of factors already outlined insures individualization in evaluating each parent's motivation for placement and his capacity for parenthood for the practical purpose of adequate rearing of his children. A description of the psychological dynamics is essential within the evaluation, chiefly to provide the framework of a diagnosis from which to proceed in order to qualify it according to the other differentials needed to establish a total diagnosis. For example, the psychological diagnosis of depression, with knowledge of its clinical aspects and dynamics would provide guideposts for exploration as to how severe the depression is in terms of its phenomena and as to how it affects the social situation. Accordingly, information to be gathered would be based on such questions as: Is the parent suicidal in the depression? What is the history of previous depressive attacks, suicidal attempts made, the nature of the latter, and how they were averted? The extent of withdrawal should be learned—to the point of sleeping most of the day, of failing to provide meals and other physical care for the children. Or does this parent, ordinarily the mother, manage the rudiments of physical care at a great effort, only to become so depleted that she screams in rage when slightly more burdened by the children, or is she only chronically irritable? Is she everlastingly patient with the children, venting her hostile depression only at her husband? The knowledge that such reactions and behavior are among those typical of depression constitutes the psychological framework. Qualifying this with information as to the extent and location of such reactions and behavior fills in the economic and structural aspects of the total diagnosis, respectively. The error of assessing a parent's capacity on the basis of the weakest part of his personality is avoided by making a comprehensive evaluation.

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OF

PARENTS

FOUR CATEGORIES OF PSYCHOLOGICAL FRAMEWORK

To provide a framework for securing a fuller picture of various families, an attempt will be made here at classifying parents and their particular parent-child relationships in categories according to their psychological dynamics and ensuing behavior. They fall tentatively into four categories, for in assessing the behavior and history of a parent, it will be found that features from one group overlap with those of another. In each group, however, a distinctive pattern will be discerned, and this will cause the parent to appear to belong chiefly to only one of these groups. Keeping in mind both the emotional economy and the structural implications of the emotional disturbance, together with these categories of psychological dynamics, a sounder, more utilitarian diagnosis can be reached. Ego-Defective Parents. Beginning with the more obvious pictures and going to the more obscure and complex in regard to assessing the need for placement of children from variously troubled family situations, one group of parents seldom conveys any doubt but that placement is necessary. In their homes there has existed chronic violent abuse, both physical and emotional—from the wild rages and weird behavior of excessively alcoholic parents; the activities of the parent with a malignant criminal record; the criminal neglect of the children, springing from the dazed and confused mental state of actively psychotic parents with dangerous delusions; to the behavior of the prostitute mother who is indiscreet and flagrant and that of the confidence man who exploits even his children in his machinations. The disturbances in these parents are both so great in quantity and so destructive in location that they are either inaccessible to help or cannot be helped soon enough to spare the children their destructive influence. If this abuse were allowed to continue throughout the children's growing years, such damage would result to the children's personality that not even mental health for marginal functioning in society would emerge. These children come to placement, for the most part, as a result of court action following their parent's arrest for a criminal offense, if not for direct neglect of their children, or removal of the children from the home is the result of court action on the complaint of

CLASSIFICATION

OF PARENTS

27

neighbors or some such civil authority as the school or juvenile police officer. Protective casework went out of fashion with the changing of concepts about the determination of behavior from psychoanalytical principles, especially that concept that behavior is not altogether consciously willed but is also unconsciously motivated.2 There seemed to follow as a substitution for protective social work the worker's dynamic understanding of behavior, shared sometimes by the client, and it was at first left entirely to the client as to whether he would seek such understanding and then act upon it or not. With due respect for the principle of self-determination, it still seems valid that neither the individual nor society can afford destructiveness in vital matters, especially where children are concerned. Therefore, it behooves the social worker, who (much more than a neighbor) is in a better position for being informed as to the disastrous results from the abuse of children, to take an active part in protecting the children in such situations when these come to their attention. A physician is responsible for reporting to local health authorities certain communicable diseases which he may discover because of the danger of contagion from them. There is contagion to society also when children are left to the fate of destructive influences such as those from parents like these. Yet the social worker's report to local juvenile officers for investigation or for possible removal of children by the court may not be the best answer as families also need protection against the possibility of being needlessly broken." Some families have enough value for the child's growth even when negatives exist, and some of these families can be reached to be helped to use and increase the positives while the negatives are being diluted or contained, sometimes even modified by treatment.4 The growing trend toward youth boards or commissions functioning together with or, as in some states, in lieu of juvenile courts, with the aid of local social agencies or with casework services within their own jurisdiction, as in New York City, is a step in the right direction for protective work.5 The "aggressive approach" in such agencies to families who represent a community problem attempts to serve to buttress them against deterioration and to pro-

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OF

PARENTS

tect the children from detrimental parental influences and abuse so as to preserve family unity, if possible, before placement, the final step, is even considered." When parents such as those described in this first group are found to be unable to use help to ameliorate their handling of their children, then it can be assumed that placement of the children through the intervention of those outside the family is being made on a fairly sound basis, so far as present knowledge offers. A case example of a family in this first group, indicating the need for placement of the children, follows.1 Although it was without court action at first, that was later used for the children's protection. Janet, age five, and Lester, age three, were referred for placement by their mother with the consent of their father, from whom she was separated. Before the release of the mother from a mental hospital in another state, the father had moved with his two children to the home of his aged parents, who soon found they could not manage the care of two young children. The children's mother arrived there a few months later in a fairly good mental condition, but she was fearful of becoming mentally ill again due to a family history heavily weighted with mental illness. Her fears materialized as her mental condition subsequently worsened. Prior to her first hospitalization she had stuck pins into the children's arms until blood was drawn in the belief that she was warding off evil spirits from the children. She had also locked the children in a closet for a whole day at a time to hide them from imaginary pursuers, and finally had attempted suicide by slashing her wrists and throat after having cut the older child's wrists also. Removal from the parents was indicated in this case for the children's protection from the mother, especially since the father was neglectful and used poor judgment in planning for their care, by, for example, leaving them alone in the care of his seriously disorganized, psychotic wife. Since relatives on both sides of the family were unable to take care of the children, placement was the only solution. Although the request for placement had come voluntarily from both parents, it was nevertheless necessary to deny the mother unrestricted visiting privileges after placement to protect

CLASSIFICATION

OF PARENTS

29

the children. The court's authority was obtained to support the plan that she never be given their address, and by this device she saw the children infrequently, only at the office, and then in the presence of their worker. An illustration of the diagnostic differential in the factors of compensation in the emotional economy and in the location of pathology which can avert placement even in families of this grossly disturbed group is given in the case classical in social work and in literature. The instance of the very hard-working, longsuffering mother with the alcoholic husband who does not support the family, rages when intoxicated, and contributes thus to the family's instability is well known. The mother, however, has learned to handle her husband when he is intoxicated and to protect the children from him at such times. She works outside the home for the family's support, at the same time keeping house for the family. With these compensations, even though they stem from her neurotic needs, this parent keeps the family together. Her ability to prevent her husband's abuse in his drunken rages from seriously affecting the children physically and her explanation to them of their father's drinking as an illness keeps his disturbance out of the parent-child relationship sufficiently to allow the children to escape from gross damage from it. The mother's masochistic needs are met in the marital relationship and are therefore usually less exploitive of her relationship with the children. Considering these factors in this family, it can be seen that the children here do not require placement and that the family can be preserved. Parents Who Feed on Their Child for Menial Survival. The next most seriously disturbed group includes those parents whose mental health equilibrium is maintained at the cost of feeding on their child emotionally. They do not give a child the sort of emotional attention which would help him become a separate entity, an individual self. And some of these, especially mothers, do not give enough physical care, not even enough for the child's essential well-being. Just as during pregnancy, mother and child live together mentally after birth as if they were a single unit or two undifferentiated organisms, which leaves no room at all for the

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CLASSIFICATION

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PARENTS

8

child's personality to emerge and relate to reality. This sort of parent-child relationship is referred to as symbiotic. There are two types of mothers with which the symbiotic parentchild relationship generally occurs. In the character structure of one of these the child is not seen even as an extension of the parent herself, for that would imply some partial recognition of the child as an entity having feelings of his own though he were being used for the parent's gratification. This mother views her child as a mechanical gadget instead of as a human being. The child is used like a piece of furniture or clothing; it is to be washed, stored away for the night, fed in order to make "it" go, used as a mechanical item in the environment to lean on in her frozen feelings. This mother does not visualize her child as being distinct from herself, with needs of his own. There is no relatedness between them since the mother has little or no feeling readily accessible to the child or to anyone else, for that matter.8 She is actually cold and detached, even though she seems to participate to a limited degree, for her participation is really only a learned social response carried out with rigid exactness. This parent usually exhibits no bizarre behavior and often functions quite well on a social and vocational level where emotions are not called upon, but it is probable that she has an underlying psychotic structure. Were this precipitated into the open, it would be found to be schizophrenic in nature. From this parent-child relationship results the autistic child, with mental illness beginning in infancy, if it can be said that illness has occurred where no differentiated mental life had developed. The drive present in each individual toward development of a self was itself so emotionally starved that such a child would be incapable of making any attempts to grow as an integrated personality.10 This child's gaze is vacuous, he is not responsive, and he does not cuddle; his cry is frequent or even almost constant on account of the fact that the actual physical needs of his body are not being filled. When his drive to survive is wearied by extreme deprivation, he gives up longing for gratification and even gives up the wish to live, so that there is a peculiar emptiness or hollow sound to his occasional cry. There is another instance of this sort of attitude in the mother

CLASSIFICATION

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to be noted. When there is a large constitutional factor causing the development of an autistic child who has been born to a mother capable of warmth, the latter may become inhibited in reaction to the child's innate failure to respond right from the beginning.11 The mother's inhibition then makes her attitude with regard to this child appear superficially similar to that of the basically cold, mechanical mother. The basically cold mother seldom wishes to place her child in order that he might get the emotional nourishment needed to foster the glimmer of strivings to relate from which, in turn, he might be helped to gain the capacity to adjust better to reality. Not only does this mother require the retention of the child as a crutch for herself, but also she cannot tolerate recognizing that the child is in need of living away from her. Recognition of the child's own needs in terms of himself is so completely lacking in the first place and his difference from others so severely blocked out later to avoid a sense of failure that the mother sees no problems in the child. Such awareness would be a tremendous threat to the defenses by which she has been able to function even superficially as it is the child who has served to maintain her mental health equilibrium. The father in this kind of family is too detached himself, or irresponsible, or too much under the domination of the mother to come to the aid of the child. Sometimes his warmth, if present, makes itself felt to the child sporadically or with much inconsistency, and if so, it does give some help though far from enough. Further, the father's warmth does not fall within the primary relationship with the child as does the mother's, and hence, even if it were otherwise adequate, it could not provide sufficient emotional sustenance for the child by itself. Placement of this child is usually considered only after society has brought pressure to bear on the parents because of the child's bizarre and destructive behavior. Frequently he is excluded from school where he acts with no conception of himself in relation to others. He has never been helped to learn the concept of self with limits or ego boundaries. He will walk around the classroom at will, sing or talk aloud without any thought for class order, not on a deliberate or knowing basis, but because he is unaware of the

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needs of others. He is heedlessly destructive with supplies, is unable to learn academically at any level. As he grows older, the law steps in to protect others from his random destruction of property, his assaults out of intense rage. He is often confused with the innate mental defective designated as feeble-minded, and is at times dealt with accordingly by society. The responsibility for making some plan for more adequate care for the child to protect society from him is forced onto the parents by such authoritative agencies as the school and law enforcement officials. By this time, however, it is too late to help him through placement as he is rarely placeable outside an institution, usually of custodial nature. Where signs of reaching out toward reality are seen early enough in this sort of child, he might be helped to become at least a marginally functioning human being, if his treatment is begun while still very young, as in the preschool years or before. It can be said, theoretically, that this child should not be placed away from his parents even when this is possible as his link to reality is very thin and only through them. Separation from them, especially the mother, can cause weakening of this slight link, resulting in a greater gap between him and reality and in crystallization of his psychosis. It might be preferable in cases of very young children to provide treatment, before the gap widens, of the child and his mother in the home. Part of this might consist in bringing a supplementary mother-figure into the home who will provide warmth and affection for the child at the same time he has his own mother with him. A grandmother or some other female relative living in the home or a resident housekeeper might be in a position to give the child much warm mothering. Nevertheless, placement of the child is often still warranted because of lack of success with this sort of plan. The trend toward placement of such children in special facilities, like residential treatment homes or as the only child in a professional foster mother's home, is now more often thought to be the better plan of treatment. The autistic child requires more expert handling during his waking hours than can be furnished by most of the adults mentioned who might be brought into his home. Further, the child must be given

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permission eventually to express in his treatment his enormous hostility toward the mother before he can free himself sufficiently from the symbiotic tie for growth. The child cannot be sufficiently convinced that this permission exists to try it in the presence of the mother in the home, nor would she be able to brook it anyway when, inevitably, it spilled over from the treatment onto her personally, unless she were intensely involved in a treatment relationship herself, which is most difficult to achieve. Hence, for these reasons placement of the autistic child becomes a necessity. In that event, there should be extensive preparation of both the child and his parents for the separation in order to cause the least possible amount of trauma and regression from the placement. New knowledge is currently being gained of the sort of casework relationship and approach needed by this child both before and after separation to obviate some of the regression he must suffer on account of separation from his parents. In some instances where the parents, especially the mother, are immersed in a busy intellectual and social life, they will agree without attendant conflict to the placement of the child on their understanding intellectually that this is prescribed for the child's problems which they do not see as having anything to do with themselves. But even here, if the mother does not require preparation for the separation, the child does, since unfamiliar situations are doubly terrifying to him without her. Details of this preparation are described in the chapter "Preplacement Work with Families." Speaking practically, it is not possible to secure treatment in the home rather than placement, even when the former is strongly indicated for this sort of disturbance, for more than a very small number of families, from either social agencies, clinics, or private psychiatric practice. The kinds of skills and extensive time needed for this work over a long period preclude its availability to the number who need it. Resources for such treatment work are limited and the investment which has to be made by the treatment agency is too tremendously costly, while results are slower to appear and less likely to make for adjustment than in other therapeutic areas. And sometimes, when the parents' neglect over too long a period

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has made for complete irreversibility, it is deemed impractical to expect the results of treatment to render the child any appreciable benefit even for minimal functioning. The other type of mother in this group who feeds on the child for her mental health equilibrium is primitively possessive, illogically infantile in her demanding, voraciously hungry for dependency gratification. Unlike the cold and aloof mother just described, this mother has intense longings and openly seeks satisfaction of them from her child. Fierce in her animalistic mother-feelings for the child, she deploys these feelings not for the preservation of her young for their own sake, as do the other mammals, but for possession of them in whatever condition they are for her own needs. This mother has suffered excessive emotional deprivation in her own early childhood, usually after having been given enough affection to create a craving for it, and without later compensations, she has never been able to develop the capacity to secure for herself enough to fill the gap even to a small degree with defenses. She continues to grieve for her early loss, and chronically depressed, she is a severe neurotic depressive character, if not psychotic. A schizophrenic process may be going on under the depression, and this breaks through sometimes at middle age, especially if the child is gone. When she bears a child, she lives on him to satisfy her great need for the emotional warmth which she misses so intensely on account of her early deprivation; her longing is insatiable. In order to procure this warmth for herself, she will cuddle and play with her child in the first months before he becomes mobile. In this way she secondarily meets some of the child's own needs, but beyond this, there is little else she can do for him. Like a little girl playing with a doll, she provides some care; but the similar care she gives is sporadic and superficial, because, like doll play, baby care loses its interest in favor of other immediate pursuits for gratification. Since the child cannot meet the mother's great needs, and since she seldom makes other such close relationships to obtain satisfaction, she feverishly seeks superficial gratification elsewhere, leaving the child alone and neglected for long periods at a time. The consistent and detailed daily care of feeding, bathing, changing, and picking up the child even at times

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inconvenient to the mother proves too large a task for this childish mother. If the infant's persistent crying disturbs this mother too much, she is capable of beating him uncontrollably at times, despite her otherwise intensely affectionate display. If she does not resort to the beating, she becomes instead overwhelmed, confused, and panicky in her realization that the child requires more care than she is able to give. Such responsibility is too great for her to carry in her childish state, and either she takes flight through disorganized activity or else her depression retards her activity to the point where she feels too weighted to move. She may leave the home for hours at a time either to seek gratification elsewhere or to escape this burden, while the baby is left alone in his crib, extremely hungry, cold and wet, lonely and frightened. Or she remains in the house in a regressed vegetative state, neglecting the child's care in the same measure. As the child gains motor power which allows him to explore, his care becomes heavier and more complicated, especially for this kind of mother. The father in the family having either type of mother is either indifferent or ineffectual, or himself depressed and anxious to such a degree that both his care of the child and his ability to earn a livelihood are limited. Of the better functioning fathers in these families, one type can be as detached as the cold mother in his intellectual preoccupations outside his family. Another father might be warmer in his approaches to the child, but he would not be in the home long enough during the periods of daily care to offset the serious lacks to which the mother subjects the child. And sometimes he can be more protective of the mother than of the child, even though he realizes her defect. Small wonder that an infant who experiences such long, painful frustration of the basic needs for survival withdraws from a world he finds absolutely terrifying and becomes autistic. There seems to be a different quality in this child's autistic behavior from that of the one described earlier in that there is more direct expression of feelings—in rages and in depression, or in both, and even in bizarre behavior, though bizarre in understandable ways, such as not eating solids even at the age of four or more, nor talking until that age, or in eating excrement. These attempts to express feeling

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toward the world even at the level of hostile oral aggressions and their reactions as described occur because the intense warmth given him by the mother sporadically causes him to make some rudimentary investment in the world about him only to suffer enormous frustration through neglect. The above situation could hold a slightly better prognosis than that of the child whose cold, mechanical mother made no emotional contact of any kind which could serve as an inducement to the child to respond. Nevertheless, some features of both the withdrawal and the incipient relatedness may be found in the autistic children of both kinds of mothers. This can be explained in the case of the child of the cold, detached mother through the history of the presence of some compensatory influence in the child's first year from people in his environment who supplied some warmth though no sustained warmth. This might have been a grandmother who visited for a few weeks or months at a time, or a maid who was employed in the home briefly, or somebody who intermittently gave him attention in a household where the mother lived. An example of the family with the second of the two types of mother, the one who feeds on her child for her mental health equilibrium, is shown in the following case history.12 Mrs. F.'s family was helped during her youth by a family agency, and she was able to achieve two years of high school education and employment as a clerical worker. At age twenty-two, shortly after the death of her father to whom she had been overly attached, she was hospitalized for a month due to manic-depressive psychosis. After that she became involved with a man to whom the family thought she was married, and while this relationship lasted several years, it did not result in marriage. At thirty-one she finally married an ineffectual man who ran a second-hand clothing store. With the birth of a son, Henry, within a year, she again became depressed but did not have a breakdown. She became more confused and overly burdened with the birth of a second child, a girl, a year later. Placing the girl at four months, she nevertheless steadfastly clung to Henry, even though she found the responsibility for his

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care overwhelming. The father left her and sought a divorce, which she resisted by spending many hours chasing after him. She slept most of the day and went out only at night, leaving Henry alone in his crib all day and either taking him out at night or leaving him by himself in the dark house. Often, to have his company, the mother would awaken him when she came in. He was seldom changed and bathed, was fed at erratic hours, and was given baby food out of cans to avoid cooking and dishwashing. At four years of age he was afraid to chew solids, especially meat, could not talk, was extremely fearful, and appeared generally retarded. When the mother at the age of thirty-eight became illegitimately pregnant and then married the putative father, a dull youth of nineteen, she was finally able to permit Henry's placement, which her relatives anxiously sought for the child's welfare. It can be seen that the mother had centered chiefly on her own father for gratification and that with his death her underlying psychosis had come through. She subsequently tried to substitute other men for gratification to keep her mental balance. When she was losing her husband, she fed on her male child, Henry, since in his helplessness he could not abandon her as the others did. She was able to relinquish him for placement only after she found a dull young man half her age whom she could possess to feed on to maintain her mental health equilibrium. Placement of a child from such an intensely devouring parent, be it father or mother, is necessary, as any amount of help offered this parent can never be enough to permit him to give care sufficient to avoid endangering the physical and mental health of the child. There is great difficulty, however, in effecting the separation, first in the parent's refusal to place the child and later in his not allowing him to remain in placement. This parent, and usually it is the mother, may reach a point of desperately wishing for the child's immediate placement when she finds the burden of his care intolerable, as little as she does give. Yet the primitive hunger she has for the child makes her too unhappy to endure the separation, and she will impulsively take the child home unless a court order has been placed which may hinder her from doing this and unless

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there is an abundance of warm support for her from the worker. The symbiotic tie she has with the child causes the parent to feel as if she herself had been placed. Out of her loneliness for the child she thinks that he is not receiving adequate care since she herself feels neglected by his very absence. That is why she requires a great deal of warmth from the same worker the child has and from his foster mother as well. Before she is able to give up the child for placement, this parent has to have much emotional nourishment from an outside source. Usually, another person appearing in her life serves this purpose, as in the above case example the remarriage so served, and also, the worker's attentive and strongly supportive relationship during preplacement work with both the parent and the child can help make the separation possible. The latter will be fully described in the chapter, "Preplacement W o r k , " with an example of a family from this category of parents in the case of Miss H. and Bill, emphasizing the work done with the mother. The following case, which has the same psychological framework as the earlier one from this category of parents but with less severe symptoms and with the presence of compensations, presents a situation where there might be a chance for the possible preservation of the family and less damage to the children through casework help for the parents. Here again it is the factor of emotional economy which makes the difference as to whether or not the children have to be placed. Mr. M. requested placement of his three children, Frank age seven, Sandy age four, and Danny age two, because of their neglect by the mother. He described her as being lazy and dirty, seldom bathing herself or the children until he made her do it which was about once a week. She slept till noon, did not feed the children on time, and did not do her housework until late at night when he stood over making her do the ironing. He said she was "mentally sick" because she stared blankly into space. She refused intercourse, and he forced this twice a week. First he wished to provide for the care of the children and after that he wanted to leave her. Mr. M. was the oldest of three children and his mother's fa-

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vorite. According to an old record, he was brought to Boy's Court at eighteen for allegedly molesting a small girl sexually, and was found then to have an I.Q. of 49. He now related that he had been "slow" as a child until his father told him he would never get ahead if he continued that way. Mr. M. had suffered from "blood poisoning" as a very young child due to an infected syringe of smallpox vaccination and had also had diphtheria, requiring a tracheotomy. He now had a speech defect, evidenced by a lag in beginning his sentences. After his father's warning, Mr. M. worked hard in order not to be "slow." Although rather simple, he was now alert and energetic, appealing with his humor, and possessed of some sound common sense, all belying his old I.Q. He worked as a laborer, did the shopping for his family, and washed the family clothing at night, when he also helped with the children's care. He always appeared well-kept, with his work clothes clean and in good taste and with attractive dress clothes of good quality. During the ten years of his marriage, he had descended on the family agency at least four times for help in getting a divorce and placement of the children, but he had never followed through. Twice he had come there recently with the children, who, it was noted, were clean, well-groomed, appealing, and contained, asking for housekeeping services while his wife was hospitalized. He had on both these occasions subsequently made his own arrangements adequately with relatives. Mrs. M. did not wish to place the children as this would mean the breakup of her marriage. She had sought reconciliation with Mr. M. after two separations and her neurotic tie with him persevered. After explaining that she objected to placement because she would "miss the children" since she is "used to them," even though she had not wanted to have children, she said, lastly, that the children would be hurt by placement as the oldest, having heard the parents quarrel, had already upbraided them for not loving him as they "want to put me away." Mrs. M. denied her husband's charges of such gross neglect of the children and home. She said she never went out, never left them alone, to which he agreed; she blamed the poor housekeeping on her ill health and on the great amount of work involved in the care of three small children; and

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she felt that the children were more attached to the father than to her because of his devotion to them and because he played with them a great deal. He agreed, adding that he loved his children and therefore wished them to receive adequate care through placement. It appeared that the M.'s marriage was based on severely neurotic ties which they enjoyed as evidenced by their forgetting themselves for a moment and beginning to smile at each other in the middle of a quarrel during a joint interview. She clung to him despite her complaints of his bad temper and his tyranny over her, and meanwhile she told of her father's harsh treatment of her and of her mother who became mentally ill. After that happened, Mrs. M. was reared in an institution from the age of thirteen. She pleaded against having her children reared by strangers also. Mr. M. had been enjoying a sense of superiority since his marriage as seen in his references to his wife's inadequacies despite her superior education. His role in his own family was different from that in his old family where his siblings had become educated and successful. At the same time, his wife represented his own old inadequacy in his family for which he was striving to compensate. He was able to achieve some compensations as described because of his mother's great devotion to him, which continued in a lesser degree even now. Mrs. M. was not so well-groomed as her husband, but yet was not so unkempt as he had depicted her. However, the real test of the degree of disturbance in her parent-child relationships came in the observation of the children in the home. They were seen to be bright, alert, and appealing, with definite neurotic traits but not psychotic or withdrawn. Though the older two were playing actively with other children outdoors, they came in readily. Guarded in answering questions, the oldest was, however, direct and psuedomature, with an anxious and depressed expression. T h e little girl related too readily, was impish and manipulative, but tractable. During this unexpected visit, the baby, having an adequate lunch although it was midafternoon, was seen to be responsive in play and in his facial expression. There were many flies in the house, while the dust and newspaper accumulation was of about two

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41

weeks duration. Some clothes were strewn about the furniture but only what was in keeping with having small children around, and no heaps of clothing or stacks of dirty dishes were seen. The mother moved about with slow, disorganized motions, but there was warmth in her manner. The couple decided to accept family casework to help ease the situations causing tensions. With this support, it was felt, the mother would be able to give more to the children, as her care of them was not so grossly inadequate as to make the children more disturbed than they would become through separation by placement. The father's role in the family was a large asset, even though he was essentially ineffectual, because he had developed constructive compensations for this. And although the mother fed on the children by using them to maintain her marriage, and wished to have them at home to "keep her company," she was not altogether neglectful of their needs as seen by their personality development. She did have concern for their pain over placement, even if it was only out of her own experience with placement and even though her feelings for them were stated last of all. Withal, the family agency felt that there might be enough resources in this family through which they could be helped to conserve their unity with its concomitant values for the children and that the children would benefit from improved handling by the parents, should the latter respond to efforts to help them. Narcissistic Parents. A third group of parents who come to the placement agency is composed of predominantly self-centered, immature individuals who appear to have greater adequacy for taking care of their child than actually is the case. In contrast to the two preceding groups, they are always well-groomed, better poised, and functioning adequately in areas other than as parents, and they usually wish to place the child without the clinging characteristic of the other groups. It is their superficial adequacy which leads the worker to expect greater capacity in them for being adequate parents than in those who are grossly and openly disturbed. Actually, there is some adequacy in these parents not found in parents of the former categories, but it is of a limited amount and

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utilized by the parents for themselves first. Then there is not enough left over to provide care for their children. These parents are highly narcissistic, pleasure-loving individuals, whose primary goal is their own direct self-gratification. Having only minimal capacity for gaining gratification through relationships placed ahead of self, even as in the subjective need of parents to give to their children, let alone the sacrifice parents make for children through altruistic surrender, these parents are instead rivals with their own children, not only for the other parent's affection, but for attention and gratification in general. Because of their self-centeredness, coupled with their seeming adequacy, they provoke irritation more readily than do other parents. Understanding what has gone into the formation of such character structure may help reduce the worker's irritation in contacts with these parents concerning their children. The parents have been greatly deprived, although not so extensively as the parents of the first two groups, during their own childhood, under conditions which taught them to give to themselves first, and thus the altruistic elements usually developed with a growing personality were stunted. In fact, their general personality development was arrested at so early a level that they are immature to an astonishing degree, their reasoning relative to the importance of their own needs, similar to that of a child, evidencing a striking unawareness of selfishness. They were given to by their parents to a point in growing up at which a child can no longer serve as a toy without being deprived of feelings of self-worth. If the child failed to please the parent and the latter in turn did not give enough, the child learned to give to himself in his helplessness. Without further gratification from others sufficient to help him outgrow the place in childhood where self-centeredness is natural, the child remained fixed at that point, and could not learn how to give to someone else first. And even if the child was indulged during childhood, he probably was not given to in terms of his needs. He was not loved for himself, but rather was shown love only after he filled some need of his parents. Usually, this fulfillment consisted of some performance of his which would enhance his parents' prestige—showing off skills, amusing with childish pranks and wit, or acting out to provide some vicari-

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ous pleasure to his parents. Not being valued for himself primarily by those close to him, he came to place high value on himself in terms of this exhibitionism in order to feel secure, in this way covering over deep feelings of inferiority. As adults, such people as these have a highly exaggerated sense of pride and their sensitivity to affronts is especially quick because of this original unmet need to be valued as an individual. They attempt to keep up a "big front" both in manner and through material assets in order to bolster their sense of importance and achievement. When they become parents, their children serve as toys during infancy and perhaps the first few years, as they did themselves. Through this sort of relationship, the children receive enough warmth at the beginning of their lives so as to make a fairly good start, at least a start away from mental illness. As the growing child's expanding needs or the number of children increase, or both, the parents' emotional economy cannot meet the demands either of these situations places upon them as parents. The parents' freedom to give to themselves is then impeded, and the children become excess baggage to a large degree. Usually, the child approaching adolescence becomes a rival, and this the parents' excessive vanity and deep insecurity cannot tolerate. Generally, however, the children are placed while very young, especially if their number increases beyond the first one or two. Placement of the children is actively sought by these parents who wish to be free to pursue their own happiness as individuals, not as parents. Many then do manage to carve out acceptable places for themselves, either in a remarriage which is childless, or in a job, spending most of the earnings on themselves. The type of disturbance in these parents leading to their request for their child's placement could hardly lend itself to modification to avert placement because of the pleasurable nature of the defense, namely, self-centered pleasure. This aspect of the disturbance creates an obstacle to any involvement which tends to threaten loss of the defense. The symptom of the character disturbance, bringing gratification rather than anxiety, is hence not conducive to any motivation for treatment and change. This situation may be compared to that of the alcoholic or other addict, before he comes

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to grief, whose initial drinking, serving as a defense, gives him pleasure as well as release from underlying tension. Because of this, the pressure which would lead to a search for help before reaching disaster is obviated. If the children of these parents are not removed because of the agency's attitude that the parents can take care of them instead of spending so much time, effort, and money on themselves, then the parents will use the children as pawns to badger and threaten each other in their maneuvers to gain their own ends. Finally, the situation will deteriorate to the point where the children are actually abandoned or dumped in some other manner by the parents, causing them far greater injury than if they had been removed at the initial request. The children themselves, if reached when young, will still be sufficiently anxious and frightened because of unmet needs to be accessible to treatment for the development of healthier personalities than those of their parents. Otherwise, they will have become replicas of their parents by identification with them and out of their need in reaction to their parents' use of them, just as the children's parents did with their own parents. In coming to placement late, they appear to be impulse-ridden and self-centered, with a hard shell of narcissism through which it is difficult to reach them to develop a meaningful relationship. Abandoned by those who were most important, these children have no tie to figures of authority to deter them from delinquent behavior in their pursuit of pleasure. If left alone in placement without frequent contact with parents to fan the hope of returning to them, however, the child who does not have too fixed an identification with the narcissistic parents to be modified can learn other means of functioning from new ties. An example of such a family is described in the following case situation.13 Mr. and Mrs. B., the parents of four children, separated due to friction over the responsibility for the children's care. Both parents insistently demanded the placement of their children, with the mother openly stating she would return to her husband only after the children were placed. Following the birth of the last child, she

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suffered post-partum hemorrhages, for which she was hospitalized twice and given three weeks' convalescent care in a rest home. A housekeeper was provided by the family agency upon her return home, but she refused to assume responsibility for the children after 4 : 0 0 P.M. when the housekeeper left. During the day when she was supposed to rest, she visited friends and relatives. The father was also irresponsible, would not keep a job, and having been pampered by his mother, went to her home to eat and sleep instead of reporting to work. Finally, the mother, goaded by her mother for having the entire responsibility for the children, left them in the hallway of the paternal grandmother's house, and "deserted." Thus the children were used as pawns in the parents' friction, which included spite and revenge to the respective grandmothers. Placement was not made soon enough after the parents' demands to prevent the trauma of the children's abandonment in the grandmother's hallway. It came only after the situation had deteriorated thus. After the children's placement, the parents remained separated but continued to date each other as if they were single and had never had a family. The mother worked and spent all of her earnings on herself. Visits to the children, sporadic on the part of both parents, occurred mostly on the initiative of the agency when the children asked to see their parents. On these occasions they presented numerous gifts, promised many others—lavish ones, such as bicycles, fountain pens, and so forth, which never appeared— and again absented themselves for months at a time. The narcissism in each parent was derived from his own deprivation in childhood from the experience of being used by his parents for gratification and not loved for himself. Mrs. B.'s mother, a loud, rough, domineering, and "fast"-mannered woman, tied her children closely to herself. Although not immoral herself, her children acted out in immoral ways for her vicarious pleasure. One son, for example, had a long criminal record, and Mrs. B.'s first child was illegitimate and not by her husband. Mrs. B. herself was an attractive woman although very thin, immature, and very shallow, with some anxiety, but was largely self-centered in it, all of which attested to her emotional starvation from her mother. She needed

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to give to herself first in order to manage and had nothing left over to give to her children. Mr. B. was a handsome man, immature and irresponsible, always boasting of illusionary achievements and constantly trying to be witty. This latter trait was so much a part of his character that it could readily be seen how he learned to act the clown in early childhood in order to win a place with his mother, who always overindulged him then as now. His boasting of great achievement covered feelings of worthlessness which existed because he had not been valued for himself. The following case situation will show the same character structure (that of parents of the third category) as is illustrated in the foregoing case, but will reveal the difference possible in the outcome of a request for placement when more resources are present in the parents' emotional economy. It will also show what happens to the child, despite the greater assets, when the parents' influence on him is not negated while he is still young, how he develops delinquency patterns in pursuit of self-gratification. Both the parents requested help at the placement agency with their son Robert, an only child, age sixteen, whom they had not been able to manage at home for the last two years. He was insatiable in his demands for money for recreation and extravagant clothes and for a car. The parents bought a car which he was to share with them, but he wished to have it all of the time. He forged three checks in a total of $135.00 with his father's name. When frustrated in pursuit of his pleasures, he raged, frightening his parents. In a physical struggle with his father, Robert broke the latter's rib. The father has been able to frighten Robert off only by brandishing the kitchen knife. Robert kept his mother locked in the bathroom for four hours, with the house barred against his father, until his mother gave him the car key. He has carried on so in school that he was expelled or transferred from three high schools, and he would not follow teachers' instructions if it pleased him to act in his own way. A prominent feature in his case was his fringe posi-

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tion with his crowd, in which he was eminently insecure though trying feverishly to gain real acceptance by them. The current parent-child relationship as revealed by the situation described was that the father had entered into sibling rivalry with his son for the mother, who sought to placate Robert. The father quarreled with Robert on the sibling level as to whose night it was to have the car. Poutingly, the father described how it was the turn of him and his wife to have the car for "our night out" and how he hid the car from Robert who had insisted on having it. The parents said that until Robert entered high school two years ago he was an extremely conforming and neat child who gave them no trouble at all. Later, they disclosed that he had attended a private school in the first three grades because of his hyperactivity. The parents felt that this activity was no problem at home, and it then could be surmised that his performance as a little boy to amuse his parents in order to win them did not appeal to his teachers in the public school. From the fourth grade until the middle of the eighth grade, he attended a public school where the principal singled him out for positive recognition. Here, it appeared, he had felt valued for himself, and during this time he presented no problems either at home or in school. All this while, the parents did not see that he had needs of his own, for he gave them no trouble and kept his room and clothes "immaculate," which left them satisfied. They took him with them everywhere, to shows, polo games, restaurants, and other adult activities. On some of these occasions they had him ask a friend to accompany him. Their feeling was that perhaps they had overindulged him. When Robert was in private school, his mother always had brought a cake to his class on his birthday, and she did many other proper things for him, stressing throughout in telling about it the nice friends he had then. The parents blamed his change of personality on the loss of the school principal in the eighth grade and the new principal's failing to handle him correctly. It was then that he began to feel picked on and to associate with undesirable companions. Throughout the story ran the thread of the parents' need to give to themselves first. Their activities, to which Robert was taken

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along, were planned solely to satisfy their own interests. They strove to keep up material appearances, and they stressed doing the proper thing, not for any intrinsic value, but rather to achieve prestige and to bolster their pride. Now that their son was a problem which could not be glossed over, they displayed injured pride and shame rather than guilt over and concern for him. They kept reiterating, " I never thought this would happen to me." The father was a middle child in a family with eight children, and his father had died when he was thirteen. He did not enlarge on why he of all the children had supported his mother, but this was the reason he and his wife, whom he married when he was in his middle twenties, had waited five years to have children. It seemed, however, that he was afraid not to continue to support his mother in terms of his lifelong pattern of trying to win her love. In other areas he covered up his early deprivation and feelings of inferiority by boasting of his high connections and the influence he carried as a precinct captain, which he could use with the teachers when his son failed in his studies. The mother's history also revealed deprivation due to her mother's hard work in a store in a poor section of the city after her father had suffered financial reverses. She offered with embarrassment that her father has previously made a fortune in real estate even though he could not so much as write his name at first (this much her mother had later taught him). The source of her great narcissistic pride and of her material values was revealed in the history she chose to give. During the two years just past, before they came to the agency, the parents had shopped around for a quick solution to the problems presented by Robert; they had had contact with four psychiatrists, a mental hygiene clinic, and two judges reached through the father's political connections. Coming to the placement agency, they sought to check on previous advice given by the clinic which was to place Robert in a near-by private boarding school. They would not consider any foster home placement or any treatment institution, but wished ready information as to what would help Robert change, as he could not remain at home as he was, and they were unable to reach him through his "hard shell." Specifically, they asked for confirmation as to the suitability of the plan to

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place him in a private "prep" school and whether the particular one advised would help him before they spent the large sum required for tuition there. A week later, before a study at the placement agency could be completed for making recommendations, the parents entered Robert, at his wish, in the boarding school referred to previously. This was a psuedo-placement, as he could visit home on weekends. Predominantly, the same psychological features existed in this family as in others in the third category already described. However, the parents in this case had greater ego resources, even though in the form of defenses, to keep them from acting out as blatantly as did the more immature and unintegrated parents of the first case illustration of this category. The financial means of those in the second case example, although at average income level, were another indication of ego achievement. This, together with their handling, even though not constructive handling, of their own great dependency claims, made it possible for them to avoid placement in the usual sense, where an agency takes the responsibility for making the placement. As a matter of fact, they kept the semblance of a family which was not broken at the same time they got their son out of their way, and this without hurting him as much as would placement. Yet it is regrettable that he would not receive the help for his personality disturbance which could have been made available through the placement agency, since the parents made only a pretense of securing such help. There are many families like these who never appear at placement agencies. Their character disturbances would probably reveal the same dynamics as those of families in such need that they do come to ask for the services of the placement agency, but in their emotional economy, they have, like the family described in the last case situation, more assets, which enable them to keep their children. While the character structure of the children which results is undesirable, it is difficult to assay how this could be avoided. T o avert such character formation, the child would have to be placed while still very young in order to escape the full influence of the parent-child relationship; yet he would then incur other

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disturbances from the separation. Such parents, however, would probably not permit placement anyway as long as the child did not present a hindrance to their own needs for gratification. An approach that might be made before the child reaches the predelinquent stage would be treatment of the entire family in another treatment setting if the family were accessible to such a plan. The growing influence of public opinion in favor of a scientific approach to delinquent youth through early treatment may serve to orient such families toward more serious and earlier use of such help. Parents Whose Neurotic Equilibrium Has Broken Down. The fourth category of families who come to placement agencies consists of those in which there had formerly been some sort of neurotic equilibrium in the parent-child relationship affording an atmosphere somewhat conducive to the child's personality growth, but in which the equilibrium broke down. There are at least two sources from which this breakdown might have stemmed—from without, as in a reality crisis, or from within, due to inner conflicts. A tragedy or some combination of unfortunate circumstances, such as the sudden death or serious long-time illness of either parent, may in and of itself make placement of the children necessary if other reality resources are not available within the family or among the relatives. However, with the enactment of the Federal Social Security law providing aid to dependent children within their own families, many such situations no longer reach placement agencies. When it is the mother who remains and her subjective needs do not permit her to adjust realistically to the low standard of living provided by such aid, she may prefer placement of the children instead. Or, if it is the father who is left, homemaking services can make it possible for the family to remain together. If such assistance is not available, placement of the children may be necessary but only because of gaps in community resources, not because of lacks within the parent himself, providing he does not have personality problems which interfere with the plan. When the case is other than financial need, or lack of community resources, the tragedy may have consumed the available personality resources and reserve energy of either parent, which was marginal to begin with but which had kept the family going. The underlying problems

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in the parent and in the child, adequately repressed and defended before this, now break through to add to the stress of the current crisis. The parent's new tensions arising out of this combination react unfavorably on the child, who must also face a new adjustment. The difficulties in the situation gain momentum and accumulate greater tensions, whereupon the ensuing symptoms aggravate the original hardship so that the parent feels helpless to cope with the care of the family. The parent's resources, truly depleted for normal functioning by the loss, are called upon to enable him to carry greater responsibilities occurring as a result of the crisis itself. When the child reacts to the parent's floundering as well as to the reality tragedy in the family with the formation of new or the exacerbation of old conflicts bringing behavior deviations, another burden is added to the parent's load. The parent may then seek a way to reduce the load by requesting placement of the disturbed child or of all of the children. Sometimes placement is necessary on a temporary basis until the parent recuperates and realigns his defenses so as to be able to manage the care of the family once again. Often, however, placement at such a time may hurt rather than help the situation, as this act in and of itself adds to the sense of loss and discouragement in both parent and child. A dynamic supportive family casework service can in some instances help keep the family together until recuperation occurs. Or, and only if absolutely necessary, a plan of nursery school or day foster care for the children to relieve the parent of the overwhelming pressures of the situation may also afford the family the possibility of remaining together. If the mother is gone from the family, then a homemaker provided while the breadwinner works gives him time to rally and make more definite plans (for relatives to move in, for example). Financial help given when the breadwinner is missing can furnish time and surcease from worry while the mother recuperates and becomes ready to plan other means of providing for her family. It is this concrete help—in whatever form it is given according to the need —which, applied in due time after the crisis, may prevent the total family breakdown. If this material help is made available by an agency on condi-

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tion that the parent indicate a wish for help with underlying conflicts also, then few of these families will be acceptable to the agency at such a time. The parent's underlying conflicts, released by blows which shattered his defenses, are not accessible to such radical treatment at the height of the dissolution of the family balance, nor can the parent even show interest in such a plan when integrative measures are so urgently needed. His inability to use such help as exploration of underlying material discourages some agencies from attempting to aid in salvaging the family unity. It is understandable that a person struggling with the load of functioning just to maintain the family in the face of bereavement and havoc has little, if any, energy for motivation to seek insight into underlying causes. In fact, if such insights reveal themselves spontaneously or appear with the help of a therapist, they are too great to bear at a time of current reality trauma. Supportive help, either emotional or concrete or both, to weather the crisis is needed first, with or without the later inclusion of treatment aimed at strengthening capacities by reducing inner conflicts. Careful evaluation of the recent reality situation, with special attention paid the strengths and values which operated in such a family until now, will help determine whether or not the family can be kept together in terms of the neurotic balance, which had kept it going. T h e adjustment of the children, allowing for some neurotic traits, is a measure of the value this family has as a unit and the amount of health implied therein. Later examination of the individual parent's history and the nature of his earliest trauma, the defense reactions, other resources, and later compensations on all of which he has managed since may indicate whether or not treatment may proceed to an optimum goal. In the meantime, emotional first aid and whatever nursing is needed must be rendered to preserve the family's weakening ties whenever possible. Whatever previous strengths can be discerned need to be bolstered, and the question of placement should be considered extensively only later, even though the parent has requested it, for he did so in a state of upheaval. If the family's history does not show previous breakdown, or shows it threatened only at times of unusual reality difficulties, it

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is fairly safe to conclude from these signs that the balance of values in the family is uppermost and that placement is not indicated. When placement is made nevertheless, despite these contraindications, sometimes because the preventative help was not available or feasible, then work with the parent should be undertaken after placement for the possible restoration of the family. Such a course will be discussed in the chapter " W o r k with Families after Placement." Often the restoration of the family occurs without treatment, simply as a result of the course of natural events in which former equilibrium is restored by the healing passage of time or in which remarriage occurs and the children return. The temporary breakdown could have been avoided in some instances, however, as described in the case presented in a paper by Draza Kline. 14 This tells of a mother's grief and bewilderment over her husband's sudden death to which her child reacted with symptoms of disturbed behavior. When he did not improve after clinic treatment was focused on him, placement was recommended, causing the disturbances in both child and mother to become exacerbated. At the placement agency, however, they were told that placement was not indicated but that family casework would help, and both mother and child began to improve. When the neurotic equilibrium of a family breaks down without any apparent cause like a reality crisis, then it may be assumed that it is the result of emotional exhaustion due to the grinding away of internal conflicts. The energy used to keep these conflicts repressed and defended has reached a point of depletion, with the neurotic gratification no longer replenishing it sufficiently. Whatever ego energy is available is wasted in the attempts to combat these conflicts and their symptoms as they surge up toward consciousness. This leaves insufficient ego energy for the care of the children, and so the children become too great a care for the parent. Added to this are the behavior deviations in the children themselves, which spring out of the parent's disturbance, and this only makes their care the more difficult. The children's disturbances may nag the parent's feeling of guilt, as he is dimly aware and feels accused of causing his share of the children's problems. This parent, ordinarily the mother, may therefore attempt to solve her own conflicts by

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placement of the children, for such a parent may project her problems onto the children, and consciously believe that placement will solve her problems. The belief is strengthened when the parent feels relief through the child's placement, simply because there is less responsibility for her to cope with in her depleted emotional state. She struggles to fight the guilt over placement with many rationalizations. Sometimes she will seek placement of only one child in the family, keeping the others with her. The child to be placed either has particular significance for her because he stirs up her conflicts in connection with past circumstances; or this child is the one on whom the parent's basic conflicts are projected, and he reflects them to her discomfort; or he is merely "the last straw" which makes the load too heavy for her to carry. In the last instance, it is usually the youngest, the one who requires more physical care and closest attention. There is a higher ambivalence about placement in parents of this group than in those parents whose request follows a reality crisis. In the latter group the stronger force in the ambivalence is that which tends toward keeping the child at home, as the conflict in the parent's ambivalence is largely created by reality and not so much from within. The ambivalence in the parent whose internal conflicts precipitate the request for placement gives rise to greater guilt over his own failure. This ambivalence, however, can be reduced by some resolution of his basic conflicts, thus lightening the effort it takes to care for the children, or by rebuilding his defenses so that they can serve to keep him going for a while longer. The latter goal has merit if it will mean that the parent can keep the children at home in an atmosphere that is predominantly conducive to healthy personality growth for a few years longer until they are past their most vulnerable ages. Whether the personal problems of the parent should not be given deeper attention, instead of just rebuilding defenses for the purpose of conserving the neurotic balance of a family, if a conflict of aims like that described above should occur, might, however, be quite a debatable matter among therapists. Yet such a parent often cannot wait to decide about placement until such help, if available, will bring him to the point of fuller self-realization. This

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goal may never be achieved even with time if the parent is not motivated to seek and use such help. Or the parent may be willing to settle for an adjustment at a less satisfactory level either personally or in regard to the children. An example of this is where a father attempts to handle his dependency conflicts and the handicaps emerging from this area by making ever-increasing demands on his spouse. Such demands on the wife may mean exclusion of the children if her emotional economy is not sufficiently rich to give both to the husband in such excessive demands and to the children at the same time. If such need for interdependence is mutual in the parents, placement of the children may to them be preferable to breakup of the marriage. Their motivation to save the marriage is foremost if the marriage gives direly needed mutual dependency gratification. Keeping the children at the cost of losing the marital partner would mean additional output by the parent in responsibility for the children without the kind of direct return of gratification which would appease her conflicts. With this imbalance in the latter choice, the family situation would worsen, and placement might eventually occur anyway. Thus the motivation of the parents with respect to their children helps determine the decision about placement. 15 In most cases, the parents' conflicts are not so clear or so readily resolved by compromise or other measures as in the above example. When higher ambivalence is present it may mean more positive feelings for the child, hence the severe struggle in the parent to try to decide about placement. Such strongly self-centered parents, as are described in the third group, would show less conflict over this matter. With their greater degree of self-preoccupation and of indifference toward the children, there is less pull in their ambivalence toward keeping a child. In the parents of the fourth category, however, there is greater concern for the child's welfare since they had greater capacity to give to the children before the neurotic equilibrium (that which made this possible) broke down. This positive aspect which heightens the conflict about placing the children is more prominent from time to time than the guilt feelings. At other times the guilt is great and runs in parallel amount in their alternating focus on their own needs and on whether or not place-

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ment will be too hurtful to their child. Even while the parent's selfjustification and rationalizations mount, his conflict over whether to place continues to rage alongside these attempts to reach a decision. The intensity of the parent's conflict about placement reflects the strength of her underlying basic conflicts. As stated earlier, even partial resolution of these may not be feasible. To deal with the parent's request, then, an evaluation of the weight in the ambivalence of the positives (shown, for instance, by expressions of genuine concern and not just guilt alone, or by signs in her actions) will help determine whether counseling should be in the direction of family conservation or placement. If, by the evaluation of the parent's motivation toward the child the former diagnosis is reached, then concrete casework help is indicated, together with therapy to reduce the conflicts, so that the family balance will become more stable. If signs indicate that the negatives have greater weight in the ambivalence, then placement may be needed for a reshuffling of family balances. A period of treatment might then follow, possible in some cases only if the parent is temporarily relieved of the care of the child. The parent's emotional economy can be tipped into a balance through removal of the child which leaves him enough energy to invest in treatment. Further, if this happens, the parent can be involved in a treatment process through his tie with the agency about his child in placement, since parents with such high ambivalence usually do have positives toward the child and are more apt to keep in close touch with the agency. An illustration of such a situation requiring placement, with a description of the mother's treatment after the child's placement, is given in the chapter "Work with Families after Placement." If the parent's ambivalence is so high that he is unable to follow either course just described, he should be referred for treatment to some other setting. There he will better be able to concentrate on his underlying personal problems, and will cling less to the discussion of placement as a defense, which being in a placement agency encourages. Moreover, such extensive work with a parent at this stage in the processing of his application not only exceeds the function of the placement agency, but also may leave the parent with

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the impression that the agency is anxious for him to place the children, thus impeding the treatment process. An example of the parent in the fourth category whose neurotic equilibrium was upset by exhaustion from inner conflicts, but whose emotional economy showed a balance of assets pointing away from placement of the child, is given as follows, again to stress the diagnostic differential brought into the picture by this quantitative factor. 14 At the referral of the hospital, Mrs. D. requested placement of Steven, age ten, a dwarfed boy with yellow skin due to a congenital malformation of the heart and liver. His ears protruded grotesquely, and he continually scratched himself. Mrs. D., divorced five years before, occupied a one and a half room apartment with Steven and a seventeen-year-old daughter. Mrs. D.'s salary was low, her home was overcrowded, and there was no privacy or space for entertaining. The daughter, who had just been graduated from high school, planned to work part time and attend the state university located in this city. She now spent less time at home and did not bring friends there, as Steven's bizarre appearance made her uncomfortable. Mrs. D. received no alimony, since her husband claimed that he had ill health and was largely supported by his second wife. He lived in another state so that Mrs. D. was unable to collect anything from him. Steven's medical condition at the time of the request for his placement was no worse than before, nor was his behavior difficult, as he was conforming and tried hard to please. Despite his unusual and unattractive appearance, he had been found to be a very winning child who responded readily to adults and children, as both school and camp had reported. As the mother described Steven to the worker, she mentioned with affection many positives about him. She was also frank to state that he was a great burden to her, about which she showed guilt and wept. She had to get up at 5:00 A.M. to get herself ready for work and him ready for the bus which called at 7:00 A.M. to take him to a school for the physically handicapped. As Steven needed his rest and the apartment was so small that he slept in a closet off the living room, she had

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to retire at 8:00 P.M. On weekends, she had no time for herself, as he monopolized her. In her ambivalence toward her son, Mrs. D. showed much real concern for his welfare along with secondary rejection of him. Because he sometimes forgot his lunch on the school bus, and then would be reluctant to ask his teachers for money for lunch, his mother decided to have him buy his lunch at the school cafeteria despite her limited finances. She also made a practice of placing a candy bar or some other snack in the valise in which he carried his school supplies. She worried over the fact that he was alone in the home after school from 4:00 P.M. until her return from work, and would telephone him from her job during that period to ascertain how he was getting along. She was also worried that he was not getting as much care as he should have, both physically and socially. Why then, did Mrs. D., after such devoted rearing of this sick child for ten years, under adverse circumstances most of this time, decide to request placement, after having discussed it at the hospital for the past year, at this particular point? It appeared that both basically and neurotically—the latter as evidenced in her guilt and need to make restitution—Mrs. D. was a good mother at a sacrifice to herself, not only to Steven but also to her daughter. Although they had been living in California at the time of the divorce, and Mrs. D. found it easier to maintain the family there, she nevertheless returned to this city at the daughter's insistence, since the daughter was lonely for old friends here. Mrs. D. managed to sustain her family until her neurotic equilibrium was upset by her daughter's recent independent plan to use her earnings for college while her mother continued to support her. The mother had conflicts over supporting the children at such cost to herself, and her neurotic balance was achieved not only through a masochistic sacrifice, but also with the feeling that she was making an investment in the children who would in turn help her. She also hoped to remarry and needed some freedom to reach this goal. Resenting her husband's total desertion, especially in the financial sense, which left the support of both children solely to her, she claimed she needed money to rent a larger apartment where she

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could bring friends, including a possible suitor. She needed help with Steven, so that she would have some time free for seeking out friends and contacts with eligible men. She knew she was still young and attractive and that this was the time to make such plans. These conflicts between her own needs and the needs of her children which she had to meet, laden as they were with reality difficulties, had been grinding away in the past year to leave only a thin defense. During that time she had been intermittently discussing Steven's placement with the hospital worker all the while she saw her daughter withdrawing more and more from the home and responsibilities there. This latter made her feel she would not get the help from her daughter she had hoped for. With the daughter's "desertion" both socially and financially, on announcing her plan for college, Mrs. D. took the step of applying for Steven's placement. She had expected the daughter to work full time and be self-supporting, in this way sharing household expenses so that they could move to larger quarters. When this did not happen, the neurotic equilibrium on which she had been operating successfully until now broke down, and with it the family balance. Because there was a preponderance of assets in the parent-child relationship, placement of Steven was believed to be contraindicated. The outcome was as follows. Mrs. D. decided to permit her daughter to proceed with her plans for college, continuing in her role of the good if masochistic mother, which had more value to the children than what would be available to them in placement. The worker, who was a man, gave her much recognition for her adequacy as a mother on this evidence. She broke down and wept, claiming she could not go through with the placement of Steven. With this brief ventilation of her internal tensions and with support from a male worker, she decided to continue the care of her children as before. To help her maintain the neurotic equilibrium which she was restoring with this brief help, and also so that she could be given some means of easing her realistic burdens to enable her to meet some of her own needs, or to work through her deeper problems, she was referred to a family agency. The decision as to whether or not to use that source of help was left to her. She did not go there immediately, but said she would consider

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it if she felt the need of it later. The brief help given by the placement worker may have averted some motivation to seek more thorough treatment, but her material indicated at this point that she needed help toward deciding to maintain her family. Using this latter goal appeared more desirable, in order to save the child from the trauma of separation and the mother from a sense of failure, than striving for the goal, instead, of the mother's accessibility to more extensive help. Further, she still would have the opportunity to get the deeper help at a later time. Other parents of the fourth category whose neurotic equilibrium breaks down due to stress from internal conflicts may need to place their child, at least temporarily, because their ego energy is so depleted at this point that they do not have enough for rallying to a better adjustment while carrying the care of their child. Again, it is the quantitative element which is the determining factor in the placement, as illustrated in the following case example. Panic-stricken and guilty, Mrs. K. requested placement of her ten-year-old daughter, Betty, whose whereabouts she did not know. Mr. K. had left his wife and child when the latter was four, and Mrs. K. had been struggling to support and keep Betty with her as her husband contributed only half of the small amount the court had ordered for Betty's support. First, after the parents' separation, the mother and Betty had lived alone in back of a small clothing store which the mother operated in another city. When she had to close the store due to poor business, she left Betty in a day nursery while she herself worked. When the mother was hospitalized for six weeks because of a back injury, Betty, then seven, was left with parental relatives, who kept her out of school all that time. Upon her return, Mrs. K. found Betty very unruly and unmanageable, and she kept talking about her father's absence to annoy her mother. In this way Betty was probably retaliating at her mother for deserting her during the mother's hospitalization, which had stirred up Betty's fears of and reactive anger over losing her mother as she had lost her father. Then they went to live in another city with Mrs. K.'s widowed mother who owned a store in which Mrs.

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K. helped. Because of friction with her mother over Betty and because Mrs. K. wished to emancipate herself, she came to this large city to work, leaving Betty in the grandmother's care. The latter soon requested Betty's removal and at the instigation of her domineering mother, Mrs. K. left Betty without warning at the home of a paternal uncle where she thought Mr. K. was living. When the mother called there two days later, these relatives told her that the father did not live there but did come for his mail. He had taken Betty since they had no room for her, and he had not left any information as to his own or Betty's whereabouts. Mrs. K. at this point looked helplessly to the worker to help her find Betty. At the agency's instigation, the relatives assisted in locating her, and the mother did not continue with the request for placement. Two months later Mrs. K. again started out with a request for Betty's placement, as Betty was living with her grandmother but was unhappy there, as was Mrs. K. on spending each weekend with them. Mrs. K. was living with an uncle and aunt in this city while employed here as a salesperson. She withdrew this request for placement when she learned of her husband's whereabouts, as she hoped to obtain more support from him for Betty, so that she could work out some living arrangements for herself and Betty together. After all these attempts to keep Betty with her, eight months later, the mother again requested placement of Betty who was now living with her in the home of the aged uncle and aunt and their grown invalid daughter. Betty's behavior was so difficult—she had severe temper outbursts, was defiant, and made too much noise with her constant yelling, and this made the aunt especially irritable and harsh—that, withal, Betty could not remain there. Mrs. K. finally faced the need of placement for Betty with her uncle's support, as he was a warm and understanding man to whom the mother felt close. She expected that Betty would remain in placement until well into adolescence, when she could live with her without afterschool supervision. The mother appeared to have become a little less helpless by this time, but she was still extremely dependent on the worker, fearing participation in the plans. Mrs. K. was fearful, also, with respect to her job, even when she had to take only an hour off. She presented the picture of an unhappy

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woman who thought of herself as a little girl and wept readily. Throughout the contacts with her and Betty together, it was noted that they were extremely attached to each other, with the mother stating she did not wish to be separated from Betty and weeping over the prospect, and with Betty doing the same with excessive kissing and clinging to her mother. Despite the helpless manner of the mother, however, she had managed to keep her child with her for eleven years, working and supporting her almost by herself for seven of these. The neurotic equilibrium which they had established and which kept them together lay in their great mutual interdependence. From this Betty did receive love, as was evidenced by her good adjustment at school, where her grades were high and her behavior acceptable. Moreover, Betty was proficient and responsible in many routine duties, as well as skilled in hobbies. She bossed her mother, who, while not liking it, accepted it from Betty because of her unusual degree of dependency on Betty, and because of her inability to be firm out of her fear of expressing anger. The neurotic equilibrium broke down when Mrs. K. was caught in her dependency conflict, in which her wish out of her own dependent needs to keep Betty with her, despite the struggles to do so, had been clashing since her husband had left with the wish of the healthy part of her to fulfill her own needs first by providing for herself through a new marriage. Chafing in the role she had been playing with Betty, she did not have enough ego energy to give as a parent to her daughter and to create a new life for herself at the same time. After years of characteristic sacrifice, for which her unexpressed anger consumed much of her ego energy, she reached both emotional exhaustion from internal conflicts and a dilemma in her life situation pointing toward placement of Betty, and unconsciously, on an instinctual basis, she chose to help herself first. Therefore, she needed to be relieved of the responsibility for Betty which was accomplished through placement. The mother's need for dependency gratification, which had formerly sought an outlet in Betty, no longer supported the balance in their relationship, as Mrs. K. had begun to feel that this was not meeting her needs when her underlying anger over this

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and earlier experiences, after years of grinding away, left her depleted. CONCLUSION

These are the chief diagnostic categories most frequently found in families who come to the attention of placement agencies. Features characteristic of one group will be found to overlap into each of the other groups. A basic character structure will encompass patterns of other character structures: for example, the depressive depicted in the second group might have as a character defense the excessive narcissism described in the third category. The various types of defenses will appear to be interchangeable. Compulsions may be used not only by the schizophrenic but also by the narcissistic character and others. Those with defective ego structure, especially those conspicuously lacking a superego, as in the first category, may have large quantities of one kind of anxiety, while parents of the fourth category show another. Recognition of specific psychological phenomena is imperative for carrying out treatment, but in order to arrive at the most nearly correct diagnosis as to whether or not placement is indicated, total diagnosis is necessary, including the nature of the most prominent features of psychopathology with consideration of their quantitative and structural aspects. Of great importance in this is the evaluation and weighing of strengths and weaknesses, whatever the character structure may be, as these factors constitute the assets and liabilities in the emotional economy. For this reason, two case examples were presented to illustrate each diagnostic category, each case selected to show the state of the emotional economy, one requiring placement and the other not warranting it despite the same psychological nature of the disturbance. Also, the location of the disturbance must be determined in order to know whether or not it impinges on the parent-child relationship in such a manner as to impair it seriously. Therefore, quantitative and structural considerations of the dynamics will provide the best guideposts for reaching an understanding as to the desirability of placement.

^

TYPES OF PLACEMENT

FACILITIES

WHEN THE FAMILY is DISSOLVED during the life of a child through the absence of one or both parents, or when parents fail so greatly in their responsibility that the child cannot remain in their home, or the child becomes so disturbed that he cannot be treated there and his parents' problems causing this are not amenable to change, then it follows that the child needs to have other living arrangements made for his care. 1 Having established during the intake study and comfírmed during preplacement work that separation from the family will afford the child greatest benefit, or if separation has already occurred through loss of parents, then it is important to decide what sort of facility will best serve the child's needs from what is available. The consideration may include the possibility of foster home care and the type of foster family to be sought, or it may involve a plan for some other type of care. THE ROLE OF FAMILY LIFE IN OUR CULTURE

It is axiomatic in work with children in our culture that sound personality is developed during childhood through healthy relationships in family life. Therefore, it might follow that the child who cannot live with his own family could have most of his needs met by a substitute family, since there are definite qualities of personality developed through this usual mode of rearing children in our society. Sometimes, however, the child has been so hurt by the experiences within his own family that he is not able to make

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use of the experience with a substitute family. This may be true for a brief time immediately after the family's dissolution, or it may continue for a period lasting years. He may not even be able to use other community sources like school and resources for play. Without this background he will lack the attributes it produces; he will find himself different in basic patterns universal within the culture. Whatever the situation, only total diagnostic understanding, including that of the parent-child relationship, can determine the type of placement facility which will best serve the child's needs. This writing will concentrate on the work involved in foster family care for the child and not on work done in the care of children in other placement facilities. However, as this is the point in the placement process at which determination of the kind of care the child requires, based on knowledge of the child and his family, has to be made, all existing placement facilities will be described here so as to show what each can offer a child. This is presented for guidance in attempts to select the one which will be most helpful to the child instead of proceeding in a routine fashion to placement in a foster home. Even if facilities other than foster homes are not available to the placement agency, it is well to know what could be of greater help as offered by other placement facilities. This would guide attempts to meet gaps in present placement facilities by improvising through the casework method, and for purposes of future over-all program planning. Awareness of the placement needs of every child and not only of those obviously disturbed, at the time of the first placement and also when replacement is necessary, is vitally important. If the worker is skilled in all areas from diagnostic appraisal on, numerous replacements can be avoided. It is not advisable to permit the child to be moved from one foster home to another several times before deciding that he needs a special setting. If this happens, the child will cease to care, being too tired emotionally and too embittered from repeated rebuffs of his possibly distorted attempts to invest dependency longings in adults. He then avoids relationships which call for investment of himself, and learns instead to manage by manipulating and exploiting people, which sometimes leads to delinquency patterns. Workers despairingly watch this process

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evolving before them to create what Dr. Adrian Vander Veer calls "the agency-made psychopath." Such a child may benefit from a special setting, unlike a substitute family, where no demands to form relationships are made on him and where he can test out whether or not adults can be trusted with his feelings. However, it is often too late for reversal of the damaging process, or, if not that, an exhausting and expensive program lies ahead which might well have been averted by careful planning earlier as to the type of placement, including the kind of foster home, most appropriate for the given child. ORIENTATION TO PLACEMENT RESOURCES NEEDED

Having discussed why careful selection of a placement facility is needed, it remains to describe the different facilities and what they have to offer. To decide which type of placement facility is needed by a specific child is first the responsibility of the agency under whose care he is left, even though any special facility, if it is required, will have its own intake policies. For both reasons it is necessary to have some knowledge of the nature of such special resources and of the over-all current pattern of operation of a particular facility, as changes do occur from time to time. Such knowledge permits of the establishment of criteria for selection. In addition to aiding in the selection of the appropriate facility, however, knowing how a given facility functions also enables the worker in the placement agency to relate herself adequately to it in her work with the parents after the child's placement there. Further, and especially important, when the child is placed in a setting with an approach not composed entirely of the casework method, as in an institution, and the worker continues casework responsibility and treatment of the child, she must learn its philosophy and understand its policies and procedures so that she can play her appropriate role on the team there. Her best contribution can be made to the child's care only if she is geared to the team's work.2 If the child's needs according to the diagnostic picture can be met in the substitute family type of care, this resource should be given first consideration, as it has the greatest potential for yielding results in personality growth.8 As long as the disturbed child can

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manage in the regular school system, even if he is not working at capacity and is moving slowly, and if he is not a proven or potential hazard to the community and does not offend authorities there so as to make him socially unacceptable, there should be a careful evaluation made of his capacity to lend himself to the one-to-one relationship before deciding on any placement facility other than substitute family care. If the disturbed child can keep within these limits in the community and has in addition related either to a worker or a teacher or scout master, it is fairly safe to assume that he can use a relationship in an educable foster family and find therapeutic benefit in extramural psychotherapy. That part of his ego which is developing through the usual competition in the regular school system and in the usual facilities for social activities and in friendships with neighborhood children can be encouraged further with appropriate help. Simultaneously, the child is given understanding care and affection by the foster family and help for his disturbance in the therapeutic relationship with his worker. At the same time, the latter or another worker can also provide the kind of help needed by his parents, as described in the chapter "Work with Parents after Placement." In the appraisal of the child's needs, however, even in such a picture as described above, it is necessary to look for the subtle possibilities that exist which would contradict caring for the child in the community. For instance, there is the child with a schizoid personality, who has no manifest disturbance as in the schizophrenic child, but who makes only a thin emotional investment of himself in interpersonal relationships. He may manage to make his way fairly adequately on the surface in social groups in school and in organized play activities, but the foster family finds him unresponsive and unrewarding in the closer relationships there. There is also the child with the narcissistic character, comprised of a shell to cover deeply underlying pain and anxiety, beyond which is an emptiness resulting from the child's early hard-learned resolution not to invest in people except for self-aggrandizement for security. These children make an appeal to adults for these purposes, only to frustrate the adults thus involved by offering little or no response. Both these types of children are frequently unacceptable to foster

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families, who request their replacement. What other sort of living facility can care for them is difficult to decide, although some facilities can provide better than others for their more consistent dependency care as they are growing up, if not for the treatment purported to effect character change. Therefore, an attempt will be made here to describe the kinds of placement facilities now in existence for children of varying needs. There are two broad major types of arrangements for the care of children who must live apart from their own families, the substitute family plan, and the group plan. Within each type of care there are variations, and in addition there is another plan with aspects of each, namely the group home. In considering each facility, what is needed for the child's personality growth while in dependency care and for treatment for his emotional disturbance has to be borne in mind. SUBSTITUTE FAMILY CARE

In the area of substitute family care there are the adoptive home, the free foster home, the private foster home (either supervised or independent), the boarding home, the so-called professional foster home, the subsidized, the contractual, and the agency-owned foster home. The Adoptive Home. The adoptive home is the home of a private family who wish to adopt legally a child who will become a full member of that family in terms of the social, emotional, financial, and legal aspects of family relationships. The child who is relinquished for adoption by both legal parents, or in some states and countries by the court when parents and close relatives are not available or are deceased or are deemed inadequate, is referred to this family, with agency contact usually but not necessarily ceasing after legal consummation of the adoption. If the child's status with regard to adoption is not clear at the time of the initial placement, it is advisable to place the child with a foster family who is interested in adoption should this possibility materialize and willing to take the risk that it might not. The case of Dorothy, described in the chapter on preplacement work, illustrates such a choice of placement. The selection of a particular adoptive family for a given

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child is a matter for discussion in a work on this subject alone and will not be carried further here. The Free Permanent Home. The term foster home implies care by a substitute family in their home where family living is sought as the medium for the child's dependency care (such as board and room, medical care, clothing, and supervision) and emotional experience for a board rate. Occasionally, there is found a free foster home, usually on a permanent basis, where a child is reared by a family without pay in much the same spirit as if he were adopted, but where some legality makes adoption impossible. The motivation of both these sorts of foster families for rearing children other than their own in their home, the content of the study of these families, the basis of selection of a child—even of an emotionally disturbed child—for a given foster family, and the work with the child and foster family after placement are discussed fully in the chapters "Work with the Child after Placement" and "Work with Foster Families." The Private Foster Home. In private foster family care, placements are also made independently by the natural parents on the basis either of newspaper advertisements or referral by an acquaintance, or from a list of licensed foster homes available in the state department of public welfare. The child remains in placement without agency supervision, except for infrequent visits by the public agency to the home for licensing purposes, with all transactions carried on directly between the natural parents and the foster parents. Since all foster homes are required to have a state license to board a child, investigation of the independent foster family is made by the official licensing agency, which in most instances focuses mainly on determining the physical and moral fitness of the foster family and their home. Licensing of a home for more than ten children's care in most states, and for as small a number as six in some states, brings this facility into the category of small institution, which necessitates meeting other requirements concerning the physical aspects of the facility and the number of adults rendering care. There are practically no scientific criteria used in the selection of the independent foster home according to the needs of the spe-

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cific child. A parent may choose the home of a friend or neighbor whom he knows well, and by chance and intuitive understanding of the foster family known thus, may find a favorable placement for the child, but more frequently not. Often the foster home is selected by the parent on the basis of a well-intentioned but erroneous homespun theory; for example, choose a home in the country to provide fresh air for a puny child. Actually, the puny child is probably so because of depression and anxiety. Instead of making him bloom, a home in the country may only make him more anxious on account of his loneliness there and then in his depression he will withdraw the more. Or a farm placement is sought to keep a disturbed, hyperactive child out of trouble, whereas it will serve only to enhance his need for excitement, as he will find life there dull. This will cause him to seek outlets in greater deviations of behavior to offset the lack of opportunity for the sublimation afforded by city life. A wise stable parent, whose reality situation forces placement, may know his own child's needs more intelligently than do those in the foregoing description, but the dynamics operating in an unknown foster family, or even in one thought to be well known, can be appraised accurately only by those expert in this skill. Also, someone unconnected with the family does not have the subjectivity which cannot help but influence the parent's best judgment. And even if an exhaustive study of the foster family were to be made by the licensing agency, the child would, nevertheless, not be dynamically studied by the agency in order to determine his particular needs when a parent decided to make an independent placement. Geographic location or other matters of convenience to the parent then become the determining factors in the selection of the child's placement facility. While the parent legally has the right to make whatever sort of placement he wishes, and without agency advice, the fact that he comes to a public agency for names of approved foster families shows greater interest in finding desirable care. Therein lies an opening for professional counseling of the parent beyond this routine service. Most parents when appealed to on the basis that they wish the best possible home for their child will respond in

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some measure. It can then be stated that in order to find this, it is necessary first to know the child, for otherwise a generally acceptable home may not be the right one for this child. In this way, the parent's cooperation may be enlisted for study of the child, of the parent-child relationship which is revealed thereby, and of the meanings this information carries in terms of the child's needs in a placement.4 The Boarding Home. The private family care usually referred to as the boarding home does not provide much more than board and room for a child. This plan is usually suitable for an older adolescent whose needs for dependency care in family life, both physical and emotional, are minimal, who is relatively stable so that close supervision is not indicated, and who first comes to placement at this late stage in childhood when he does not have the need to make new close family ties. He may not be ready, however, for totally independent living, and the boarding home is less impersonal and lonely for him than a rooming house or club living. This arrangement lends itself well also to any older adolescent who does not require close supervision but who needs distance in relationships, whatever the reason for that may be. The Professional Foster Home. The resource referred to as the professional foster home has particular advantages which are implied by the term "professional." Actually this term can be misleading as there is no formal body of scientific knowledge as yet established that fulfills the aspect of professionalism as applied to foster parentage. This type of foster home may or may not be agency-owned; the foster parents, usually a couple, may own their own home or rent their own quarters. There may be only one child here because he needs to have constant, individual attention, as may be required by an extremely disturbed psychotic or severely physically handicapped child, or by some other sort of severely disturbed child not able to brook sibling rivalry at first. Or there may be from two to five children there, similar in size to the average family unit. The characterization of this foster parent as "professional" means that he accepts more training and supervision than the average foster parent in providing the specific care required by a given child. The professional foster parent is trained

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by an agency staff member to observe, note, and report on the behavior of the child and on his interaction with other children, if there are any, in the home. From this information, together with some reading, lectures, and knowledge of her own personality assets, she learns and is guided on how to deal with the child constructively. Accumulating experience in this manner, she acquires a body of knowledge, though not formalized, which equips her to perform on a highly skilled level in the care of a child who has special needs. Through this greater understanding of herself, of the child, and of his parents than is found in the average foster mother otherwise motivated, and through greater interest in the mastery of skills for doing a creative job, the professional foster mother can handle herself better in the face of the child's troublesome behavior or his lack of progress and emotional response to her personally. Subsidized, Contractual, and Agency-Owned Foster Homes. The sort of substitute family care provided by subsidized or contractual foster homes, or in agency-owned homes, has as its advantage the insurance of stability for the disturbed child whose difficult behavior causes replacements from numerous foster homes. The terms applied here designate the financial methods used to gain greater security for the child. The number of children placed in each such facility is small enough to lend itself to a family mode of living. The premises of the subsidized foster home can belong to the foster family which is paid a sizable fee for occupancy by the children and for the extra operating expenses incurred by their care—for instance, laundry, housecleaning, and even the extra furniture needed. To make the effort of coping with difficult children a worth-while project for these foster parents, they are paid a board rate larger than the going rate, another form of subsidization. The contractual arrangement with foster parents is one by which a regular stipulated amount is paid for full foster home care of a given number of children. This sum is paid even when the number contracted for is not there, as the space not occupied is usually being saved for the unexpected placement of a child who would not be long acceptable to the average foster family. A home on this

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sort of plan is commonly referred to as a subsidized rather than a contractual home, even though the former term does not accurately describe the arrangement. Actually, both financial plans are often found in the same foster home. Greater stability in a child's placement is secured through the agency-owned foster home with foster parents either given a subsidy to operate the home over and above a salary for their services or paid a fixed sum to cover cost of both service and total operation of the home, as well as care of the children there. Unlike the situation in subsidized and contractual foster homes that evolves when foster parents decide to relinquish their undertaking, when this occurs in the agency-owned home, some of the disruption caused thereby in the child's placement may be allayed. Here, if the foster parent should leave, the child may at least remain in the same familiar physical surroundings, retaining his contacts in the neighborhood and the school. Granted that security from these sources is not so valuable as that from a meaningful good relationship with a parent-figure, it is some refuge in a changing situation and prevents the uprooting involved in his moving on to other living arrangements. It gives him something known to cling to until he can make a tie with the new foster parents who come in. The chief problem in the use of the usual types of foster homes being the numerous replacements, due either to unexpected changes in the foster family's circumstances or to their refusal to keep the child because of his difficult behavior, or to both, the establishment of these three types of foster homes was effected to avoid this. When the foster home is owned by an agency, control over admissions and discharges of the children there rests largely with the agency. The agency can also exert some control over this aspect of placement in the subsidized and contractual foster homes if the foster parents in these facilities regard the service they perform as a vocation or business venture and are therefore interested in cooperating with the agency in order to continue it. For this reason, foster parents under all three of these financial arrangements usually lend themselves more readily to training and supervision both in the care of the child and in the handling of

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contacts with his parents than do foster parents from the usual arrangement; in this they are somewhat like the professional foster parent. FACILITIES FOR GROUP CARE

Placement facilities rendering group care are those institutions which give only dependency care; specialized institutions for delinquents and for the physically or otherwise handicapped (for example, mental defectives and psychotics considered untreatable at present); group homes mainly for small groups of disturbed children; and residential study and treatment homes or centers for severely disturbed children who may be either autistic or acting out from another core of pathology. INSTITUTIONAL

FACILITIES

Aggregate Institutions for Dependency Care. The dependency institution provides a plan for rearing children outside the family, in a group whose total population can vary from a small number (approximately twenty-five) to a few hundred. Many large institutions have arrangements for housing the children in several small cottages or in small units or apartments within a large structure to provide care for smaller groups, each with their separate houseparents, thereby affording more individual and closer attention than was previously given in this type of institution. Such institutions intend to exclude the disturbed child, especially the one who acts out, but such children nevertheless are found in these groups. Either the serious nature of their behavior was not known to the institution before the child's admission, or it developed after admission either in reaction to separation from the family or to factors within the setting. Some of the smaller of these institutions, with a larger proportion of staff to children, will knowingly admit a few not too severely disturbed children who benefit from group influences and the controls of institutional regimes. Aware that serious emotional disturbance will appear in at least a few in the group, in addition to those knowingly admitted, the small institution will provide a program of treatment for those who are dis-

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turbed both in the approach used by the caretaking personnel and on the direct individual basis as well. Where treatment institutions are not available to some agencies for treating the needs of the emotionally disturbed child, and those of his parents as well, or when other community resources are lacking (such as homemaking and day care services), the large aggregate institutional facility is sometimes used to meet these needs in part, if a foster home cannot. It is regrettable that this must happen, because the institution then becomes a dumping ground where the child with respect to his special needs is abandoned, and the institution's usual program is hampered by the difficulties presented by the disturbed child with whom it is not equipped to cope. Such an institution, however, will provide shelter for the child when many foster families have rejected him. Some of the routines and strict regimes provide him with outside controls which at least help to contain him. His needs do receive rudimentary attention, and at the same time he has enough distance to allow him to tolerate the relationships there. He may settle down within these relatively remote relationships and then might again become ready for experimentation with closer ties such as in the foster family. But if this happens, it will be spontaneous improvement since expert help for this is not available in such an institution. The child may instead choose to do without closeness in intimate human relationships and to substitute other outlets for his feelings. He may, for example, come to function in a socially acceptable manner by avoiding explosive areas, like close human ties, and by receiving some gratification from investing most of his feelings in a skilled j o b or profession, or even in avocations. In this way, however, he loses out on the richness of close personal ties. Or the child may repress his old conflicts and yearnings, and with this repression much of his emotional energy is lost or at least not used constructively. This is a possibility if the child is able to lose himself in the impersonal atmosphere of the large institution, and although he may need some of this impersonality at first, he should not be allowed to withdraw within himself too much while outwardly conforming and taking on what

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appear to be patteras of improvement. The impoverishment of his personality follows. In some institutions, where the leadership is warm and personalized, inspiration from this influences the entire personnel to bring more personal attention to the individual child, and efforts are made to create a warm, homelike atmosphere. Attempts are made also to orient the house staff in mental hygiene principles in the daily care of the children, and the administration which strives for this is usually motivated to adopt routines and policies for the children's care structured on these same principles. Stimulation of the child's deeper feelings by a rich program and by closer contacts with personnel, even while he is in a group, may cause him to wish for change and even seek to try a foster home with the possibility of making a better adjustment there at this time than before. A child from a large institution who visits in a home of a private family, such as that of a schoolmate from the public school he attends or a member of the volunteer staff, remaining overnight or for a weekend, may view and be touched by aspects of family life which he realizes are lacking in his recent experiences in the large institution. If he is old enough, he may become anxious that he will not know how to participate in normal family life when he marries. This may prompt him to request foster family care for preparation for a fuller life with his future spouse and children. Specialized Institutions. The specialized institution today, such as that for delinquents, which is not a reformatory, and those for the physically crippled, the blind, the deaf, the cardiac, and borderline mental defectives, attempts during the gradual improvement of program to integrate mental hygiene principles into the special methods of care and of training these children to function with their handicaps that are used. The special skills needed for training handicapped children in how to handle themselves adequately and to develop despite the handicap have to date been most available in congregate care. Again, as for other types of children, it is essential that the decision regarding placement be evaluated in terms of the child's needs. These may require precedence for certain values in relationships available in substitute

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family care over the advantages available in the specialized institution for more refined training in terms of the physical defect. Some such training can in some instances be introduced into the care in the foster home. There are also the specialized hospitals, both private and state supported, for those psychotic children whose prognosis is so poor as to indicate little or no possibility for the construction of an ego that will ever achieve even minimal social functioning. Even if not congenitally feeble-minded, they function in the same manner as the feeble-minded as the result of severe emotional retardation or lack of integration which has blighted mental faculties. Prognosis can be said to be a matter of relative judgment and can be measured in part by the subjective feelings of optimism and resiliency or the too quick defeatism of the evaluator. Nevertheless, there is a tragic group of children about whom common agreement is held that nothing really adequately constructive can be achieved. These children show little if any capacity to relate meaningfully through any known device used to develop relationship. Nor can they make therapeutic use of any relationship, should one be achieved, in any form of treatment practice, nor of any treatment setting to assist toward better social functioning. They are not to be confused with those children who avoid relationships actively out of disturbed personality structure or with those autistic children who are still trying to relate to reality. The latter, however, if they cannot have help due to the great scarcity of facilities and if their behavior is too difficult for other placement facilities to tolerate, are grouped for care with those of the extremely poor prognosis, who have no spark or method, however distorted, by which they show that they care and are still trying to survive in the integrative sense. The mental and emotional life of the last group is, instead, a vegetative mass, similar to that before ego boundaries begin to be formed, but so severely scarred that there is little chance for growth. They are provided in these institutions with custodial care, including specific medical care with drugs, possibly surgery, and other medical approaches. Few institutions exist exclusively for such care of children, and more often these children are placed in state hospitals with adult psychotics.

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FACILITIES

GROUP HOMES

For some emotionally disturbed children even the most favorable substitute family care cannot provide the expert kind of environment which the degree of their disturbance requires. Relationships within his own family may have been so damaging that the child cannot tolerate the facsimile of family life with its intimate relationships, and a foster family can neither help him nor accept his disturbed behavior, which he also shows at school and in play. The disturbance he displays arises not only because he is enraged at the world, especially at adults, but also because he feels guilt over disloyalty toward his own parents when drawn to a parent substitute, in spite of what he suffered from his own parents. This sense of guilt, stemming from a conflict of loyalties or from fear of relating to others out of a belief that this would cause them to be alienated from their parents, will erect an insurmountable barrier in some children to making new ties in foster families, especially if the natural parents fan such feelings. The child may act out to defend himself from making ties so fraught with danger, or he may develop symptoms which repel or otherwise hinder relationships. For the withdrawn child placement in a foster family can stir such painful memories of his old family life that he may tend to withdraw even further, with consequent less investment in the foster family and in the world about him. Other children are so destructive or bizarre in their behavior as to be totally unacceptable in a more or less normal environment. If they are so placed, their unavoidable rejection will serve only to reinforce earlier unfavorable life experiences. Therefore, these various types of reactions require living arrangements unlike those in any form of substitute family life so that the children can tolerate the arrangement, and so that the living situation can contain them and provide the expert help they need.5 For the less disturbed of these children, a type of group home is most suitable if a therapeutically conditioned environment exists there. Not quite like an institution, but also not a plan for substitute family care, this type of group home cares for six to ten

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children. It is a partially controlled living arrangement in some ways similar to but smaller than the residential treatment center. Some of its features do somewhat resemble family life, but the group situation there negates the close relationships of a family unit. Therefore, it can be used for either disturbed growing children who cannot tolerate the one-to-one relationships of family life or foi those whcie parent i» tlirtatcned by another's sucn close relationship to the child. Such homes as these may or may not be integral parts of a placement agency, being either agency owned or agency operated, or separate agencies in and of themselves. In either event, the foster or houseparents there are in the employ of the agency operating the group home, and thus more of the control is left to the agency as to which child shall be admitted there or kept there, even if greater disturbance appears after placement. Obviously a child who is unacceptable to the houseparents cannot benefit from care there and would not be kept in order to avoid jeopardizing his own welfare and that of the other children in the group. Yet because of the houseparents' connection with the agency and their attitude in working with the children, which is similar to that of the professional foster parent, their acceptance of the more difficult child and of help in learning how to deal with him is greater. They are willing to invest more of themselves in the job skills required, and so will accept training and supervision in their work, actually a stipulation for their being hired. Anyway, with a group of children in the home, the housemother can elicit a response from one or another of them which will afford sufficient gratification to offset her possible frustration. Yet these professional foster or houseparents nevertheless require much support in their trying efforts, as well as guidance in the care of these children. They need to be educated in methods for handling the disturbances the individual child creates and for dealing with the many situations which group living presents. Other aspects of the care afforded the children and the significance of it in terms of dealing with parents in a group home placement are common to those found in certain special study and treatment homes or centers, which are discussed below. The other type of group home, for more healthy children, can

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be either owned by an agency or under contract with a foster family. The agency-owned home of this type can serve as a small club residence for adolescents who do not require much closeness with a parent-figure as they attempt to outgrow this need in their strivings toward maturity, whereas the contractual group home might provide an arrangement for keeping a large family of siblings together. This would otherwise be impossible since no usual foster family would be able to take all of them. RESIDENTIAL T R E A T M E N T

CENTERS

Although the value of special treatment centers has been proved, 8 experimentation continues in their programs and functioning as well as in their physical setup, so that standard forms have not yet been established. 7 The following description of residential treatment centers, as well as that already given of new aspects of substitute family care, is therefore very tentative because of the rapidly changing situation. The description of physical setups and programs, and especially of psychotherapy in the various settings, may be outdated shortly and even now may in some instances appear invalid since the various settings are in a state of flux. But a beginning has to be made sometime to provide at least a point of departure when newer aspects are introduced. And further, the information given here is not on authority out of experience in the treatment institutions, but from experience in working with the clinical team of a placement agency in determining selection of the proper facility for a given child. It is for those working from that point that this description is included. The scope of special facilities available in this experience of selecting among them was large, providing opportunity for wide orientation, since the particular placement agency noted here purchased care for disturbed children in institutions in other parts of the country as well as in some in its own city, and had besides a group of special facilities right within the agency framework. The clinical team in the agency provided diagnostic understanding of the child and his parents, with the child interviewed by the agency's consulting psychiatrist. 8 Hospital and Social Agency Settings. In the survey made by Reid and Hagan, 9 and from the author's first-hand knowledge, it

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is noted that residential treatment facilities fall roughly into two categories, not including professional foster and group homes. O n e type is in the form of either a hospital by itself or a ward connected with a hospital, while the second stresses a conditioned social structure and is usually a social agency. The first is usually under the administration of a physician who is a child psychiatrist, while the latter would be under the direction of a social worker. T h e hospital setting employs nurses and attendants—the latter usually wearing street dress—for taking care of the children, directed and trained by the psychiatrist or the chief psychiatric nurse, or both. The setting administered by the social worker employs social workers and others from related disciplines for group activities and for individual professional care, as well as lay people who, trained as houseparents, assume parental caretaking activities specific to the disturbed child. T h e description of these aspects delineates the important differences in approach by facilities in each of these two categories, both of which must be considered in order to meet the needs of the specific child. Occasionally there is found a residential treatment center with a unique plan, which does not fall into either category but employs some of the features of each in developing its own main program, worked out experimentally by its director. 10 But even with those facilities in the general categories, the significance of the program of each has to be understood individually before deciding on any particular facility for a given child. There is naturally some overlap in these structural administrative aspects as well as in the therapeutic approaches and emphasis in settings of each type. One area in which overlapping occurs is the controlled environment of institutions; within each group there are both totally controlled and partially controlled settings. The sort of environment generally referred to as totally controlled is that in which, whether locked or not, all of the needs of the child's life—housing, schooling, medical and dental care, and recreational activities—are met inside the grounds, with trips outside carefully selected and closely supervised. T h e preponderance of the totally closed settings are of the hospital type, but there are also some facilities in the social agency group which have totally

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controlled programs and locked or semilocked units for seriously acting-out adolescents, while still other social agency settings may have a locked unit for temporary isolation. The partially controlled environment, more common to the agency-administered setting, often but not always has a school on the premises to accommodate those children too disturbed for the public school system, and always provides an opportunity for those who can to attend the schools in the community. It also permits, on a discriminate basis, the child's participation in community social activities like scouts, Sunday school, and parties and visits to homes of schoolmates and neighborhood friends. Children here are also more often allowed excursions outside the institution with less supervision than those arranged in the totally controlled settings and sometimes without any supervision. Treatment in the Hospital Setting. The chief difference between the two types of residential treatment settings, however, lies in the relative weight given the methods used in the treatment of emotional disturbance. One approach is predominantly through the interpersonal therapeutic relationship. In the other, this direct treatment method and treatment through the milieu are combined. Accordingly, the type of child selected for admission to each setting is usually also different. The treatment of the child in the hospital setting is in general directed chiefly at the psyche, with concentration on the mental processes themselves. These are to be understood and analyzed as to their unconscious meanings through the symbolism in behavior and language, dreams, and fantasies during play sessions and through the expressions of transference. The study of the child's activities in and the dynamic manipulation of the immediate environment during treatment is limited by the nature of that environment, namely, the hospital ward, itself. To be sure, the hospital environment is carefully planned, aimed at keeping the child in a mentally hygienic atmosphere optimally adapted to his needs while he is receiving psychotherapy. The everyday life of the child, as well as the physical setting, bears little resemblance to that found in the community, even though it has some of the same ingredients, such as play facilities, "occupational therapy," school, and the "right" kind of movies. It

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does not aim to resemble a real life living arrangement any more than a hospital for physical illness attempts to resemble home life. The purpose of both types of hospital setting is to provide the kind of care not possible in the home because of the lack there of certain medical facilities like an antiseptic environment and intricate equipment. Similarly, the disturbed child who needs for his treatment the special equipment and antiseptic environment of the hospital, not available in the structured setting of the agency residential treatment center, is the one who, for the time being, anyway, is more likely to be in need of psychotherapy almost exclusively rather than the diversified approach. In one of the types of hospital setting for disturbed children, the environmental element which carries greatest weight consists of the large number of therapeutically oriented adults available. The child best served here is the one who cannot use the normal community environment nor the typical conditioned one, even in a destructive manner. He may remain inert or endlessly rocking himself in the same spot for hours without reaction to the environment about him. Even if he is mobile, he cannot do such rudimentary things for himself as dressing and eating, attempting to draw, play, or even passively participate, or his actions are so bizarre that he cannot make contact with others in order to be understood. Except in the hospital, he cannot receive adequate stimulation or contact from his environment, since he does not reach out for it. The other settings do not provide the sustained opportunity for constantly trying to reach the child that does the hospital with its numerous well-oriented nurses and companions who act as caretakers. It is the withdrawn psychotic child who requires this setting, for he is not sufficiently responsive to stimuli from reality to be able to derive active therapeutic benefit from the normal or even the conditioned environment. He requires the constant attention of adults in order to bring an "environment" to him as it is brought to an infant. The psychotic child with disorganized, bizarre, and also aimlessly destructive behavior likewise needs constant adult attention in order to restrain him from such activity at random so that an environment can be brought to him with which he can eventually make some connection.

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Helping these psychotic children become connected with the world of reality is achieved primarily through the most meaningful of his relationships with adults, that developed in the daily, or almost daily, therapeutic sessions. The relationships with the other adults in the setting supplement this eventually and in the meantime furnish a benign environment. It would appear that the hospital setting serves the same function for these children as does the crib for an infant, since the children's level of integration is generally about that of the infant under six months. Where unevenness exists in a given child's ego development, the treatment plan may even require induced regression to or focus at the infantile level where object relationships do not exist, so that some integration can be achieved as a basis for growth. Since this kind of child is not ready for object relationships, to subject him to them actively would only add to his burden and cause further withdrawal and psychotic behavior as defenses. 1 1 He will integrate these relationships only when he is ready, but in the meantime they should be made available to him, though not pressed on him, of course, while the direct psychotherapy helps him become ready to respond to them. Hence, this type of child needs the hospital setting as a crib to contain him while psychotherapeutic efforts are concentrated primarily on unconscious levels and on primitive stages expressed in symbolic language, for the facilities of other settings are not designed for this. However, when ego development has reached the level through therapy of that of the older infant who starts to reach out as he enters the crawling stage, so to speak, then the hospital setting is not as desirable as before. After the gains made thus far are crystallized, prolonged stay beyond this may even be harmful, as the separation there from real life situations will create a hollow, detached personality. An intermediate phase for learning how to relate to the outside world can be provided by transfer to a residential treatment center for less severely disturbed children administered by social workers or to a group home. 1 2 There are also other types of disturbed children for whom residential treatment centers in hospital settings are required, including, for example, those with severe psychosomatic disorders like

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ulcerative colitis in the acute phase. A t such times as these the children need, along with psychotherapy, the facilities of a hospital for the necessary medical attention, such as blood transfusions or carefully observed and possibly enforced diet. The child with extreme seizure reactions having a psychogenic basis may also need for a while the hospital setting for psychotherapy supplemented possioly by medical aids, including drug tnerapy, in his care. If the physical symptom is of severe degree, it requires the hospital setting not only for its medical treatment, but also because it points to great severity of the underlying psychopathology, which will have to be dealt with in therapy both concurrently and subsequent to the relinquishment of the defense, namely, the symptom. T h e hospital setting is needed as well for various disturbed adolescents, such as those with severe hysterical manifestations resembling a psychotic episode, those who have outbursts of dangerous fury, those in a period of mental confusion with incoherence, the runaways in a panic, the suicidal possibilities, and those with the seriously handicapping conversion symptom. All require a locked, totally controlled section, in order to provide them with adequate protection and to help them feel safe from the overwhelming threatening mental hazard they are experiencing. In these cases the treatment of the child after the disappearance of the symptoms may still require the hospital setting for a time in view of the severity of the underlying emotional illness, to the extent sometimes of being a psychosis. Since, in the course of the treatment, exacerbations of the previous illness or new symptoms may appear, this amount of protection is necessary. Still other types of disturbed children have to be treated in a residential center connected with a hospital. These include, for instance, extremely recalcitrant acting-out children, some of whom are chronically delinquent and would not remain unless detained in a locked ward. 13 This sort of child may be unable to respond to any structured control short of the closed institution, for, with anything less, anxiety will be repeatedly discharged through runaways and aimless wandering. A child who does not respond to the controlled but open treatment center through interpersonal communi-

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cation has to have the locked therapeutic facility instead of simply the controls of social structure. These facilities are found more often in hospitals than in agency-operated centers, but they should be set up apart from hospitals for more freedom in operating them. Treatment in the Agency Setting. Turning now to the residential treatment centers operated by social agencies, it is important to reiterate that there is a good deal of overlapping of functions both in the use of the settings themselves and in the direct psychotherapeutic efforts made in the two categories of treatment centers. The only marked difference is in the use of the milieu. In contrast to the role of the hospital milieu, that of the residential treatment center operated by a social agency is to furnish a therapeutically contrived living situation which provides not only acceptance of the disturbed child, but also seeks to understand him and to deal with his disturbance accordingly. Such a center's chief aim is constituted of an active therapeutic process for each child, both through a milieu especially conditioned to meet his needs and through a program of individual treatment interviews. Treatment through the milieu is expressed in the dynamically significant arrangement and handling of everyday, real-life events, like awakening from sleep, eating, dressing, relating to peers and adults and playing, as well as all other details of daily life in a group setting.14 The adults who live with the child are alerted to his special problems and guided in their manner of dealing with him both in general and in particular with reference to specific episodes. The child relates more actively here than in hospital settings, and there are several types of relationships for him similar to those which he might experience in the community. As important as that with his therapist but of a different quality is his relationship with his houseparents who may become his parents-surrogate. This relationship is more protected than one with foster parents would be, as it is diluted by sharing with a group of at least four to eight children and with a larger group if the children are older. The child in this situation has room to test out and draw close to the houseparents according to his own pace since demands are not made on him as they would be in a foster family on account of the family's expectations. His relationships with other adults in this program—

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the teacher, recreational leader, cook, or maintenance man—can afford him refuge should he not care for the houseparents at a certain time and then be able to find particular solace with any one of the other adults. The child has further protection in his relationship with the houseparent from the fact that when the houseparent is fatigued, overwrought or emotionally drained, he is supported or temporarily replaced by others on the staff who then participate in the child's milieu. In this sort of setting the child finds a corrective emotional experience vis-à-vis the world. Here, he tests the "world" around him which this environment constitutes from his base of past experience, and while there are limitations and sometimes discipline in it, he is nevertheless accepted and cared for after an acting-out episode as well as before or perhaps even more tenderly since greater understanding is sometimes thereby gained of him. 15 This helps to offset the impressions he formerly lived by—that the world is harsh, unjust, pain-inflicting, and not to be trusted. Such a therapeutic endeavor by itself is of limited value to most disturbed children, as however changed their impression of the world may be, the change is only superficial at best. Sometimes this is all that can be achieved,18 but efforts are made in any case to interweave it with an individualized treatment approach to the basic structure of the problem each child brings within him. The reason most children require more than this expert environmental treatment, however dynamic, is that they are no longer reacting merely to an undesirable situation. They have internalized their reactions to the former destructive environment and have also incorporated distorted images of the people significant to them in past environments. These children carry all this inside themselves wherever they go, and continue to act essentially according to it, even if the new environment is a highly favorable one. If their disturbance abates and changed attitudes appear within this favorable environment, the gains will remain for only a short time after they cease to be supported by this environment which is not duplicated in the usual life situation. Such children then must have help aimed directly at ridding themselves of internal disturbances which are manifested in symptoms and behavior interfering with their

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adjustment. The reality-oriented stimulation and handling of symptoms in this controlled setting, more than in the greatly effaced environment of the hospital treatment center, point up the areas in which his clash with society occurs and how it manifests itself. This heightened diagnosis is supplemented by valuable observations from various caretaking personnel who see the child in all sorts of situations arising from the many facets of his total life experience at the center. 17 Also, the distorted ways in which the child reacts are outlined more sharply against an environment which does not deal with him in the manner he projects onto it from the experiences of his past. Further, the child's frustration over this kind of handling may serve as a catalyst in the individual therapy. Although some withdrawn psychotic children can be helped in the setting of the agency-operated center, this type of child is apt to be given insufficient attention since there are not enough adults, unlike the situation in the hospital setting, to bring the environment to him. The agency-operated center seems better to serve children who use their environment actively, even if the use is acting-out behavior stemming from a psychotic base. However, whether their behavior stems from that or from some other cause of defective ego, it is such that they have been unable to function even with minimal success in the community. They would shock and frustrate, even frighten a foster family, as they did their own family, and neither could manage to control them. Worse yet, their behavior would continue to deteriorate rapidly with a foster family because the care provided, although appropriate for less disturbed children, would not be adequate to meet their needs. Nobody will keep these children, let alone help them. Knowledge from past experience cautions against trying placement of a child with this amount of disturbance even in an unusually skilled foster home, as it would sooner or later mean his replacement. In the school situation, his behavior is so disruptive that the classroom cannot tolerate him. Furthermore, his learning process is practically static as he is unable to contain himself long enough, due to subjective pressures, to apply himself to schoolwork, and he dissipates his energies in diversionary activity. His block against academic learning, apart from his inability to con-

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centrate, stems from the myriad fears and turmoil aroused in him by organized society which the school represents, and this too hinders him from learning. On the school playground and with his peers in his own neighborhood, whether they be his own siblings, foster siblings, or other children, he is a misfit, in either the oneto-one relationship or the group. He shows either dangerous aggression toward other children, or he bullies them, or fights them with lethal weapons; or, if less aggressive in leadership, he is excluded from their play when he tries to dominate it. He causes extensive destruction to property, shows other delinquent behavior, or withdraws into bizarre behavior. These children act out in almost every direction, owing to a lack of ego boundaries with impulses not sufficiently integrated for even minimally acceptable social behavior or functioning, which stems either from early gross deprivation or from extreme trauma, or both. As a result, they have been unable to learn how to manage in the community in the most important areas of their life—family living, school, and play. Therefore, it is necessary to create a community in which they can be helped to learn how to function socially, and the residential treatment center, especially the one set up as a community by itself, aims to do this. Frequently the children for whom residential treatment homes are designed cannot give up their core of emotional illness as this is all they have to keep them going. Without it, in their present state they could not function in any way, and might even go into panic with more serious consequences. Therefore, they fight every effort directed toward removing their illness and its symptoms with various resistances. Some have buried the sickness so deeply and are holding it down so firmly with numerous devices, such as acting out and blaming others for their behavior, that they are not aware that the problem lies within them. This is called lack of "sickness insight." Others need even greater escape; they do not even listen and will not remain alone in the presence of the person they believe has therapeutic designs on them long enough for him to reach them. These children fail to keep appointments with the therapist at the agency, or at the clinic, or with the psychiatrist at his private office, and otherwise refuse to participate in interviews in order to avoid

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possible involvement in a meaningful relationship. They require the controlled environment of the residential treatment home, at first without any attempts at individual therapy, for the corrective experience it supplies in and of itself. This they need over a long period of time, until the experience can take hold of them or at least induce in them changed expectations for themselves, before they can permit themselves to enter a therapeutic relationship with one who is a part of that environment. The residential treatment center is actually used to help make the mercurial child physically accessible. Because of the controls he has to be there in person, whereas previously he could and did commit many truancies. His presence is needed before attempts can be made to reach him, first through the environment, then through the therapist. In the meantime, he takes on some security from the controls of the institution so that his extreme defensiveness, which exists out of a need for safety, slowly diminishes. There is no high fence or locked doors to hold him in some of these settings, but he is provided with enough outlets, along with enclosure through constantly supervised activity afforded by the sharing and helping leadership of adults, to take care of his desire to run. Such a program supplies some of the controls which the child lacks within himself, and thereby some of his anxiety is reduced as he is helped to feel safe from himself and from others. Simply the diminution of the anxiety can leave some room for growth and for accessibility to individual psychotherapy which would help to integrate these controls. Whatever gratification the child gains from personal achievement at sports and other skills with the cushioned help of the residential treatment center also adds to his ego growth. 18 Further, such success may possibly yield incentives and strength for lending himself later to the exploration of underlying problems with the therapist in order to become capable of greater achievement. However, all these gains from the living situation constitute but preparation for individual treatment by causing some internalization of the child's reactions, for which previously there was no aid, since the incentives and social demands of his original environment did not inspire such a reaction. The controls imposed from without by the new environment help the child to get himself

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rooted, the prerequisite for him to tolerate any treatment which would upset his current methods of managing. In many instances, the disturbed child who attempts to run away from his pain by using acting-out defenses with little or no concern for consequences, making him inaccessible to change, finds these avenues of escape thwarted in the controlled environment. His rage over the pain, which he formerly vented at the world by stealing, wanton destruction, and other aggressions, may at first become exacerbated, but if so, it will be helped to come out in a direct expression of anger which only the controlled environment can tolerate until the child learns to handle it constructively. His pain is made bearable by a consistent supply of love, impulse gratification, and understanding, accompanied by firm limits to his acting out which supports him in his efforts to contain himself. Or, when the child becomes involved in treatment and is struggling with memories of old traumata and their effects, his disturbance may become temporarily intensified so that only this kind of understanding environment, with extensive supervision, can contain him and be progressively modified to meet his needs. Even with this, however, the pain may be so great that the child takes flight in actual runaways, but if so, he will be returned to the accepting environment without punishment. If the child should turn his rage onto himself and become suicidal, again the controlled environment can provide especially careful protection for him temporarily. Sometimes the internalization of destructive impulses and the creation of some inner control are achieved only after the child's repeated testing out in a loose relationship with the therapist of whether or not he can trust another. This is finally capped by his accepting a meaningful relationship with the latter.19 The therapist has during this period focused on achieving this important goal first without making any attempt to work out problems. After some of the latter is achieved, much is left to be done in treatment to make this change durable, but it need not be carried out with the child remaining in the controlled environment if the surface change in his behavior will make him acceptable to a foster family. If he is replaced, it is then highly important that he continue to return regularly to the institution for treatment on an out-patient basis,

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if it is at all feasible, in order to sustain the relationship with the particular therapist for whom he had internalized. Otherwise, he may relapse from the tenuous control he has achieved with the support of this relationship now disrupted, and his distrust may not permit him to form another treatment relationship elsewhere, if ego integration is too tenuous. Also, other children in the same institution, beginning to relate, may withhold their attachment in the knowledge of its possible loss when improvement is made, as seen in another's example. With regard to this particular child, however, there may already have been sufficient direct work accomplished in therapy beyond the establishment of a meaningful relationship within the institution before his need for testing reality or other signs point to the desirability of moving him out of the treatment center into a group or foster home. If this is the case, there is less danger of regression and more chance that the child will be willing to attempt therapy with someone else, if such need arises. Other Differences between Hospital and Agency Centers. The remaining differences between the respective programs of the hospital and social agency residential treatment centers do not, as previously stated, appear as clear-cut. For the most part, direct treatment of the child in the hospital is carried on by psychiatrists, although the social workers also participate in a small measure. The reverse is usually true in agency-operated treatment homes where the direct therapy of the child is done preponderantly by social workers under the supervision of a psychiatrist. There are exceptions, however, in those social agencies operating such homes which believe, traditionally, that the direct therapy should be given by the psychiatrist. In these situations, if the psychiatrist is not a full-time member of the treatment team of the agency residential center, problems can arise out of the possible inadequate integration of his role.20 In both hospital and agency settings, the social worker deals with the relatives, although in the hospital the psychiatrist does so too. The social worker in the hospital carries the bulk of this work as her chief responsibility, while the worker in most of the agency homes has equal responsibility for both areas of contact, unless the parents are treated by the referring agency, which method deters integration of treatment.

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Except for a few rare hospital settings, the intensity of individual treatment is not greater than in agency-operated homes. Actually, in some hospitals individual contacts with the children consist largely of diagnostic work for the teaching of psychiatric residents, and only a few children are carried in treatment, again solely for purposes of training the residents. These residents often rotate every six months or every year, thereby reducing the cumulative results of the therapy, even though more frequent sessions have been given. Depth of treatment by hospital residents still in their basic training in psychiatry is not ordinarily achieved, certainly not as much depth as is attained by experienced social workers working under the supervision of experienced analysts. Moreover, generally, the hospital-affiliated centers have as their chief interest, aside from training, research, so that the goal of the child's improvement is secondary to that of learning more about the etiology of the disturbance and about new techniques for the work, which do, it should be stated, ultimately yield results of high value for the care of such children. The agency treatment centers, on the other hand, more often function as community resources where research plans are subordinate to the immediate service effort of helping today's children. The physical aspects of residential treatment centers vary according to whether they are part of a hospital building or are separate structures. The latter type is usual among agency-operated centers, but some which are operated in a manner similar to that of the hospital setting also occupy separate, single structures or a group of individual buildings. Extra safety measures and durability of accommodations which are pleasant and colorful as well as useful are guides to equipping either setting. Most of the settings tend to avoid the presence of bars and other such restraints. Control of the particular restrictions in both the unlocked and locked settings is carried out by having a high proportion of adults for the care of the children, no matter in what capacity each adult serves. T h e child's daily life is so planned, with his participation in the planning as far as is feasible, that his whereabouts and activities are known by the appropriately responsible adult.

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GROUP AND INDIVIDUAL APPROACHES

Children in residential treatment centers other than hospital wards are cared for in small groups as in group homes, not because a disturbed child requires the group experience primarily for basic therapeutic benefit, but because the experience will be complementary to his direct treatment and will therefore enchance his total treatment. Lasting improvement of the child's disturbance will come from the one-to-one relationship with the therapist and with the meaningful parent-figure or some other adult in the setting. Yet there are implicit benefits in group living; it helps both the child's and the parents' acceptance of living arrangements, increases the child's adjustment, and creates aids in the individual therapy. For the child, some of these advantages in group living appear when he needs distance in interpersonal relationships, especially with parent-figures, while at the same time he needs to feel protected by being with them. A group of five to eight children, more of adolescents in some settings, which shares the parent-figure, permits such distance, especially when the group is not structured like a typical family unit. The children in group living are usually all of the same sex and approximately the same age. The demands for close interpersonal relationships imposed by an own family or a foster family, and which the disturbed child finds too stressful, can thus be avoided. The loyalties of the child to his parents can be maintained and relinquished at his own pace when he is not conflicted by too early close emotional pulls to other parent-figures, the essence of which might cause him to shun making new ties. While the social opinion of peers as a constructive force does not function in quite the same way with disturbed children as with others, yet it is present in varying degrees according to the extent of personality integration and the composition of the group not brought together naturally, and can serve helpfully in influencing a child. Pressures from the group cause the child to follow the lead of those already beginning to use the setting, as in keeping appointments with the therapist. An example of group pressure was seen in the early action taken by an already well-knit group of disturbed children of six- and seven-year-olds in a group home with a newly

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admitted six-year-old boy who drank his urine in the bathroom and belched and passed gas loudly and frequently at the table. After a few such-attended meals, two of the boys took him aside and told him seriously and with disgust that such things were not done here and that they wished him to stop those habits. Subsequently, the new boy did abstain from these habits in the presence of other children, both in the group home and in the public school. For the most part, moreover, it is quite fallacious to assume that the child with deviated behavior finds greater acceptance in a group of children in one of these settings simply because the others do not function much better than he and are so absorbed in themselves that they care less than groups of normal children how another child behaves. Sometimes the others in the group are quick to sense the differences and needs in another child, and will respond positively through empathy. 21 On the other hand, behavior similar or dynamics common to all acted out by one can stir up anxiety and resentment in the others in the group toward that child. Thus the influences of the group upon the individual child, a factor in selection for group composition, is a difficult problem and one not yet fully enough determined, though it is being studied further by specialists. Sometimes an anxious child gains support when he is constantly surrounded by the group. Another advantageous effect of the group situation is that one child of a given character structure may serve as a catalyst for other children in the group; for example, the actingout child may stimulate the withdrawn child, or the conforming, successful child (in some other way disturbed), whose achievements at school, at work, and socially may create envy, can be an incentive to acting-out children to emulate socially acceptable behavior. This may provide the motivation for a wish to internalize and subsequently to use therapy to achieve such behavior. In the group setting the distance afforded interpersonal relationships also provides a neutral setting for a child, which is sometimes necessary to permit healing from some acute shock. It can also permit conflictual feelings not accessible to individual treatment to settle down or be covered over, which is needed before the child is able to use foster home care. The neutral setting which the group

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home or the group in the agency-operated residential center can provide may also serve the older child v.ho, in the course of being prepared for adoption, requires a place where he is not too much reminded of his background before he goes to the permanent family. Some agencies maintain a group home or small institution exclusively for temporary care of emergency cases, as the professional houseparent there can adjust more readily to frequent and unexpected arrivals and departures of children. Since these houseparents are adept in observing and reporting relevant data, the home they conduct can be a source of temporary placement for the observation of a child whose needs are not known and who requires diagnostic evaluation before a placement plan can be formulated. Such a situation is especially true in the case of the deserted child who has no close kin to give information about him. This sort of group setting is sometimes known as a receiving home, and in some agencies all children coming for placement are routinely kept in the receiving home initially for a period of diagnostic study. However, whenever it is possible to arrive at a diagnostic understanding of the child without this period of observation, this is the more desirable course, as thereby a replacement is eliminated. A skilled diagnostic history and study of the child's current home situation or community contacts (if his parents are not available), or both, should provide the same understanding sought from observation in a temporary setting, and the interim observation period should be used only when such information is unavailable. Placement of a child in a group setting in terms of its succeeding is also advantageous from the point of view of its influence on the parents. Sometimes the parent who cannot lend himself to therapeutic help in order to bring about an improvement in his child's problems also refuses to accept the prospect of foster home care for the child, should the latter be susceptible to care by a foster family. Although the child himself, disturbed by his own family, may yet not require the group setting, his parents may not permit his placement in a foster home because of their inability to face their own failure as parents or because of their narcissistic pride, or both. Further, most parents fear the loss of their child's affections through attachments to a foster family. Such a threat to one's ade-

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quacy as a parent is avoided when the parent, projecting the cause of the problem onto the child, feels his attitude confirmed on the child's being sent to a setting designated a treatment facility. The parent then can believe that the child lacks something which substitute parents could not give him either. The threat of loss of the child's ties to them does not arise when the less personal interrelationships of the residential treatment home or the small group home are the ones to be established. If foster family care is prescribed and it is offered to but refused by parents, the child is robbed of an opportunity—his most favorable one—to gain help. Since he cannot improve under his parents' disturbed handling, and he is not permitted to live with any other family, his condition must at best remain static, and most likely will worsen. Some such parents then will try military or other boarding schools, although now less frequently than in former years. Others in lieu of, or some following failure in, such arrangements are willing to use the residential treatment center. The nature of this facility may threaten these parents in yet another way, but if it is located at a distance from their immediate community, their pride will not be jeopardized by neighborhood knowledge of their child's problem. Their guilt feelings derived from the need of their child for such a facility are either well rationalized or handled by entirely projecting the responsibility onto the child as problems which are altogether his own. If the parents' guilt feelings are not taken care of in these ways, then their nagging awareness of their share of responsibility for the child's disturbances can find appeasement in this sort of placement where they know they are providing therapy as well as different living arrangements for the child. Parents who are threatened by the thought of their child's developing intimate ties with a foster family can tolerate the small group or even the professional foster family home, and may accept placement of their child in either. Parents are prone to consider the professional foster home as a business venture of the foster parents and to feel that their child would not be too personally meaningful to the foster parents. However, this aspect of the situation can also bring objections from parents in the form of complaints that the child will not receive adequate attention when they consider the

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motive of the foster parents to be only financial profit. The agency's supervisory role can be pointed out in answer to such complaints while otherwise handling the parents' feelings. Placement in group settings, like the residential treatment and group homes or the professional foster homes has another advantage in reference to dealing with parents. Those parents who tend, out of their own needs, to disturb the child in placement and to disrupt the placement itself can be better tolerated and dealt with in their contacts with the child in such a special placement facility. Houseparents in the residential treatment homes and professional foster parents are helped to develop understanding, acceptance, and constructive handling of these parents through professional in-service training for their jobs. They are also less offended by parents' attitudes, since they are less rivals of the parents than are the usual foster parents. The parent who acts out unfavorably toward the child during contacts, or does not cooperate with policies in connection with the child's living arrangements, can be better limited in these institutional settings. The restrictions on the parents' undesirable behavior are in some institutions presented as "rules" of the facility for all parents, which may make the parent feel less discriminated against personally. Care is usually taken that these rules apply only to a minimum of the policies established concerning contacts with parents as having many over-all rules to cover all aspects of parental visits can make for rigidity with respect to the needs of the individual child. Hence, though the rules do provide some control of the parents' behavior, the referring agency which works with the parents cannot depend entirely on them to govern the parental disturbance at the facility, but needs to follow some casework method for reaching the parents for their cooperation. The choice of placement facility plays a role in the individual treatment of both the child and his parents after placement. When the placement facility is a part of the placement agency where the natural parents are known by virtue of their application for the child's placement or by referral of the court, then the collaborative work of treating the child and his parents, whether the latter be therapy or merely planning for contacts with the child, can be bet-

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ter integrated, as the agency's and the facility's policies and programs are equally well known to the workers concerned. It is more difficult to coordinate the treatment and guidance of parents with the programming for and treatment of the child in the residential treatment home if they are carried by different agencies. This is because each agency's approach may be based on a different professional philosophy and different policies governing practice. Such variances, together with geographic distances, present obstacles which impede the progress of the work with both child and parents, but especially with the child. Because the latter's tie to his family continues strong, even when he is separated from them, it is imperative to work with parents, at least to help make the child's placement successful and especially if he is to return to them. There is at present room for bias in the controversial area of family versus institutional care in a number of cases which do not indicate with certainty a clear decision as to which the child most needs. The reason for this being that it involves a still-experimental phase of the work of placement, the pendulum of emphasis will most likely swing from one to the other until definitive answers are found. Meanwhile, this writer admits to a current conviction that all known skills must be tried out and further developed in the direction of using substitute family care to serve the needs of the disturbed child. This bias is based on the mental hygiene principle that family structure is the source of sound personality development in our culture; for the greatest welfare of the child this method ought to be employed whenever it is feasible, as well, of course, whenever it is realistically necessary. Aside from the fact, however, that selection of the placement facility should be based first on the diagnostic needs of the child and his parents and then second on the availability of facilities, it is true that actually in most parts of the country today there are no such specialized treatment facilities as have been described here. Even where they do exist, there is still an insufficient number at this writing. The need for group homes and residential treatment centers of both the hospital and the agency type is a long way from being met in any part of the country. It is important to bear in mind when planning for a child's place-

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ment the differences between the ideal method being considered of caring for the disturbed child and its necessary modification in reality. Also, in shaping the best methods, it should be remembered that these do not always spring solely from the child's own needs, but from other forces as well, such as social and economic factors in a rapidly changing society. For instance, there are those placed children with some emotional disturbance who might have been adequately helped with extramural therapy while living with a skilled foster parent who was guided to meet their needs but who instead were placed in group homes because foster family care was not available. In the heavily populated parts of the country opportunity for foster family care is dwindling, especially in large cities where high rentals and property costs make space in homes very scarce and where the manner of living tends to be too hurried to permit the extending of oneself to include new experiences in relationships. In these urban communities, on the other hand, some agencies may have greater financial resources permitting the establishment of group homes and residential treatment centers. Then in the absence of a sufficient number of available foster families from which to choose and help struggle with the care of an emotionally disturbed child, there might be a proneness to seek prematurely his placement in a residential treatment center or group home. There is no question but that he would be helped in one of these facilities if anywhere, but yet with all the richness of programming there, something is lost. Ideally, the growth he could experience from the plan of care as described with a foster family would be far richer in emotional substance and in strength for reality adaptation, provided, of course, he could be helped to use the foster home placement constructively. Too often the child being discharged from a treatment institution past the formative years of his life may be clinically improved but quite empty in personality and unrelated to the real world into which he is sent to live all the rest of his life. His previous reality, the residential treatment, was artificially contrived and hence too protected, so that he is ill-prepared to meet life's true realities. For some disturbed children such a scientific environment is essential if they are to gain any help, but the plea is

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to avoid hasty decision in favor of such placement or creating fallacious thinking that such placement, if available, will be the total answer in the care of disturbed children to the neglect of applying and developing skills in the area of substitute family care. CONCLUSION

It cannot be too much stressed that the type of placement facility to be used as a treatment measure first be determined by the diagnostic indications of each individual child and his parents. Once these are established, the resources available must be assessed as to which will most closely meet the needs indicated. Reality limitations will exist in the most resourceful areas just as well as in those with fewer or no specialized facilities. It is therefore important to know the needs of the child and his parents as fully as possible to be able to face squarely precisely which needs the available resources can or cannot meet, as measured against past experience with them, and to select the most advantageous. In this sort of evaluation, the gaps in the resources of the community are recognized, not only to point out where efforts should be directed for creating new resources, but also, and of equal importance, for guidance in working out in the present some devices to compensate for the deficiencies in the current situation. With these factors well in mind, the selection can be made with wisdom of the placement facility where, it is believed, the specific child's needs, which includes the situation of his parents, will be met best.

^

PREPLACEMENT

WORK WITH

FAMILIES

PURPOSES OF PREPARATION FOR

PLACEMENT

To prepare parent and child for their separation is not only a humane procedure, it is also a sound one. Of the reasons for this, the most important is that adequate preplacement work helps the parent release the child to placement with the least amount of wrenching, so that the wound left for mending in both parent and child is less painful than a ragged tear. Separation is always an ordeal, and especially so if preceded by tragic events of unhappy relationships which have been responsible for the need for placement. Helping the child and the parent through this ordeal is indicated equally as much when a court has removed the child and ordered the placement as when the parent requests it, for feelings of longing still exist between the parent and child in either case. Although these ties were so abused as to force placement, the child's desperate need and wish for the relationship to be different and better makes him cling to it. As has been stated earlier, this same wish for a better familial relationship is also deeply buried even in the disinterested parent. The elaborate "binge" upon which such parents sometimes embark at the time of placement, ostensibly underscoring parental inadequacy, really occurs because their pain and discouragement at this crucial time are too great to bear. With some support prior to placement and during the actual moving of the child, this deterioration may be avoided. Although a child may wish to leave his family and although he is

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also supposedly destined for a better home situation, the unknown of the future can seem much worse than the known present. This is true even in those situations where it has been necessary to remove him by court action. He may shun the old ties and repress them, but he is nevertheless anxious at parting as he has little else on which to manage. Therefore, the false glamorization of his future home by a child desperately in want of a new home must be skillfully handled by the worker to minimize the inevitable disappointment that lies ahead. Not infrequently it happens that the destruction by reality of a child's fantasies of placement leads to the subsequent problems of his greater distrust of the world and his loss of hope. Beyond ameliorating the pain of the separation itself, the basis for much of the future success of placement is laid in the careful work done prior to the act of placement. Then is the time to begin involving parent and child in some sort of working relationship to be used later on for the important tasks of carrying through the placement, maintaining it, and making it truly productive for the child. In voluntary placements, a parent might abandon the plan just before the child is to be moved, unless preplacement work is adequately carried out. This is often the case where placement is most indicated, as in the second group of parents and children described in Chapter 2. Where the diagnosis of placement is not really clear, preplacement work can help in reaching a more valid decision, even though that might finally point toward avoiding placement. This latter could be especially true of families of the last group described earlier, where defenses crushed by reality crises release turmoil obscuring strengths which formerly counted and could still be salvaged. Equally important, the work done with parents before placement can often prevent their drifting away, in both voluntary and involuntary placements. Since the disappearance of parents after placement is a genuine loss to both child and parents, it is to be avoided if at all possible. The following example is a case where only brief preplacement work was done with the child due to the pressures from her circumstances, but where no preplacement work was done with the parent, thus permitting the latter to drift away. 1

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Mrs. B. requested immediate placement of her three-year-old daughter whom she had kept with her despite the child's illegitimacy while both lived with Mrs. B.'s mother. Several months before making the request, Mrs. B. married a man of a faith different from her own and brought him to live in her mother's home. Shortly thereafter a series of crises followed one another in rapid succession. First Mrs. B.'s mother died, leaving a mentally sick grown daughter and also a thirteen-year-old daughter to Mrs. B.'s care. They all went to live in a small flat owned by Mr. B.'s father, but a fire there caused them to leave, and since it was during the worst of the housing shortage, they could not find a place to live. They slept in parks, or in hotel rooms when they could afford it. Soon Mrs. B. had to hospitalize her sick sister whose mental condition had become aggravated and the placement agency consented to finance the younger sister's placement with an aunt. Because of her husband's inability to earn due to a severe depression over his mother's death a year before, Mrs. B. had to go to work. Although temporary placement of her three-year-old daughter certainly was indicated, the diagnosis of Mrs. B. herself was obscured by her poor history of dullness and possible delinquency and by her apparently urgent wish to get rid of her child. Because of this impression she was not considered worthy of attention during the three weeks of preplacement work with the child, who was seen at weekly sessions. Finally, the mother had to lie to the child in order to be able to leave her at the office. Mrs. B. telephoned only three times during the next year and a half, and she failed to appear at the appointment made on each call to discuss a visit with her child. The mother was allowed to drift away from contact with the agency, even though she lived only twenty minutes' ride from the office where she could have seen her child. There was a greater gap than geographic distance between Mrs. B.'s feelings and the agency which caused her not to see her child for a year and a half. When a new worker pursued her aggressively, a positive relationship was readily developed, and with this support and the working out of her guilt, Mrs. B. kept all appointments to visit with her child. She was also able to meet

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with the worker separately to discuss these visits and eventually to conclude work toward the child's return to the family. The importance of preplacement work must be matched by skills in casework understanding and techniques. Where to begin and how are important considerations, and these will be discussed in relation to the chronological sequence of the placement process. Preplacement work proper falls chiefly into two parts: first, the preparation of the feelings for action, and then second, the action itself with concomitant handling of the feelings about placement. The work is begun after the diagnosis for placement is made, either on completion of the intake study or on acceptance of the court's disposition after the agency's workup of the referral. TRANSFER OF THE CASE FROM INTAKE

WORKER

TO CASEWORKER

A good beginning of the preplacement work can be made in the transfer of the parent from the intake worker to the staff member who will be carrying the case for the remainder of the process. Although the intake worker attempts to keep his relationship with the family at a minimum, it is bound to develop meaningfully even with just a few contacts because of the emotionally charged subject matter. In the voluntary placement, account must be taken of a vital consideration, namely, the parent's degree of readiness to move toward placement, even if all doubts and guilt have not been settled. Discussions during preplacement work bearing closer on separation will test the parents' readiness for this step. The parent whose child is to be placed by court action brings to intake particularly strong feelings—of resentment, shame, and worthlessness covered by hostility and discouragement—which create greater irresponsibility. When this parent unexpectedly finds himself treated with respect, positive feelings charged with dependency needs can become quite intense in relation to the worker. Consequently, in all instances of attachment to the intake worker, a transfer to another worker constitutes for the parents a breach of faith, another "stall," or an inconvenience. The resulting sense of loss, of rejection and

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irritation, stirring up old wells of such feelings, brings stronger reactions than what the situation warrants. The parent's feelings about the transfer therefore require expert handling, as in all instances of transfers from one worker to another.2 Obviously, this would not be necessary were the same worker to carry the case from the beginning of the application throughout the placement, but that is a procedure seldom followed because of administrative policies governing assignment of cases. The intake worker effects the transfer by first assuming his share of the responsibility for the transfer, expressing recognition of the parent's feelings of attachment to him in measured terms befitting the extent of his work with those feelings. It helps the parents to hear the intake worker express understanding of how they feel about the fact that just at the point when they have become used to talking with him, they must start with somebody else whom they do not know. This worker can express recognition of these feelings, while his sympathy eases the sense of loss and rejection and his appreciation of the inconvenience reduces the irritation. Only after the parent's feelings are dealt with is the factual reason for the transfer stated, as the parent is then readier to listen and believe it. The intake worker can give assurance that the next worker will continue to offer help, thus showing that his interest is genuine by making provisions for the client's needs. He can also tell the client that written information will be passed on to the next worker of what was discussed in the intake study, and this helps the client to feel that it may not be necessary to recount his story all over again. Furthermore, the intake worker can personally introduce the client to the next worker, thus supporting the transfer in person, if it is known to whom the case is to be assigned and if geographic conditions permit. Yet despite all the preparation by the intake worker, the same ground must be covered again by the new worker. The latter should make known to the parents his sympathetic acceptance of their discomfort with a new worker and their sense of loss over the removal of the first worker. The new worker then indicates that he can make allowances for annoyance over this inconvenience and frustration and that the resentments will not be taken

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personally. It is necessary to stress here that the worker's expressions of concern and his understanding of the frustration and resentment must not become formulae which are used without variation. The worker's sensitivity to the degree of the parent's emotional involvement must govern the manner in which these expressions are offered, or their automatism will leave an impression of lack of real feeling. Although the intake worker has told the parents that notes of the previous discussions have been passed on to the new worker, the parents do not know how to commence with the new worker without being repetitious, and the thought of having to go all over their story again makes them feel overwhelmed. The gap is bridged when the new worker states that he has learned from the intake worker what the parent is seeking or why he is there, and this offsets the parent's feeling of having to repeat himself. The new worker should then begin quite soon to describe the next steps in the process in order to instigate discussion around the plan of placement. The worker outlines the course of action that is to be taken in the placement but without as yet instituting the action. He points out, for example, his need to meet the child, ascertaining at the same time, as far as possible what the child has been told to date. This is followed by advice either on how the parent should tell the child about placement or on how he should modify and correct what has already been told. Further concrete information is given here and in subsequent interviews as to how foster homes are chosen, how a child is cared for there, how parental visits are arranged, and how the child gets acquainted with the worker first and then with the foster family. The matters of securing a school transfer, a medical examination, and other arrangements for moving are planned. Permission is sought from the parent to contact the school, family doctor, and other pertinent resources for information to understand better the child's needs in order to be able to select the best home available for him. And although much of this information is repetitious of explanations given during intake, the parent on hearing it again grasps more thoroughly what he may formerly have been too tense to hear, or he feels relieved and reassured because the gist of it confirms the earlier data.

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The early introduction of such practical items to the discussion serves to make vivid to the parent the reality of placement. In the voluntary placements it can bring forth a new layer of reactions— of deeper guilt, fears, and remaining indecisions about placement In the involuntary placements, it can cause an increase in the bitterness and resistance. These feelings evoked by the imminence of placement precipitate out from deeper layers than those first expressed. It is beneficial to call them up, for with adequate handling, the emotional field can thereby be that much more cleared for action. In the course of this rediscussion, the parent will spontaneously repeat information from intake interviews and will give additional material as well, but now he will not feel that he is being repetitious because though the information is the same, it comes out with a rush of new feelings. Some parents who have voluntarily requested placement may in the face of what the practical planning has stirred up waver overlong without making any progress toward the decision to place. If this be so, it would appear that such parents require long-time treatment in a different setting to resolve the conflicts which becloud them from the decision. The placement agency is so threatening to such parents at this time as to immobilize them. Thus it is advisable that they withdraw from such an agency until helped elsewhere to be better able to face placement of their children or to make other plans. On the other hand, the parent who wavers largely because in his extreme dependency he is unable to make a decision which is obviously indicated by other findings requires the definite advice of the worker, just as he did under similar circumstances during the intake study. The parent will feel relieved when this decision is taken out of his hands, but he still will have other reactions which must be handled nevertheless. If parents seem only to need more time to settle their feelings in favor of placement, it is best to keep them in the setting of the placement agency where these feelings necessarily are in the forefront and cannot be avoided until they are resolved. Some signs of the parents' movement toward placement to watch for are to be seen in actual changes in their living, pointing toward contemplated absence of the child. Moving to a smaller apartment, the mother's

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search for a job, and termination of another's caretaking services, are examples of these signs. One mother and father made such spontaneous changes about half way through the preplacement work. The father, who had been driving a cab at night so he could be home during the day with his five-year-old son, applied for a transfer to a day shift, while the mother, who had been working three days a week as a dietician, applied for a five-day work week. Nonetheless, caution should be taken that not too much time is spent in handling the parents' feelings before action is begun, as again the matter of placement may become a theoretical exercise, or the anxiety and tension over the placement's hanging fire will be increased. In another set of situations the parents' urgency to place the child brings pressure on the worker for an immediate placement, even where reality circumstances permit time for preplacement work. The parents seek to escape the guilt and anxiety they feel over the placement by doing it quickly. This is seen especially with parents of the first three groups described who cannot endure any delay because of their low frustration toleration. In these cases it would be a grave mistake for the worker to follow the tendency to fall in with the parents' emotional need and to hasten the placement, for the very urgency of the need to be free of the burden of the child's care, even when reality pressures are present will bring greater reactions of guilt once the placement is accomplished. These guilt feelings can then either cause the parent to interfere and hence upset the placement or create in the parent the need to suppress the pain of guilt and avoid its recall by disappearing. DEVELOPMENT

O F A DYNAMIC RELATIONSHIP

WITH

PARENT AND CHILD

Before any part of the practical planning is actually undertaken, it is vital that a meaningful relationship with both parent and child be developed. The importance of this cannot be stated too often, as it not only helps cushion the shock and pain of separation and will permit the placement to continue, but it is also the vehicle for deriving from the placement the most healthful growth experience possible for the child. Further, in some instances the parent who

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remains in the picture gains simultaneously for his own growth.* If the goal is a more ambitious one, the parent can be helped from this relationship for himself as an individual in terms of his own personal problems. It is seldom that the effect of such positive relationships in either case is not to reflect eventually an improved parent-child relationship, whether the family is restored relatively soon or long-time placement results. In casework in a child placement agency there are particular qualities in the relationships established which evolve because the family is broken and the pathology of the parents is severe. These usually include a blend of respect shown toward the adult part of the ego, together with parental attitudes on the part of the worker toward the immature parts of the parent's personality, about which more will be written in the later chapter "Work with Families after Placement." At the beginning of preplacement work, the development of the relationship starts out as in generic casework, which means an offer of service with respect for the individual's right to self-determination. Where the latter is superseded by the court's authority, the principle can nevertheless still be followed within the limits of that authority. The authoritative force is presented to the client as a reality, painful as it is, over which the worker has no control. All the worker can do is to help within the limits of that reality to ease some of the pain stemming from it. Along these lines, respect for the individual can be shown regardless of his plight. Such respect to be truly sensed by the unfortunate parent must be based on a sympathetic understanding of the parent's needs, which have arisen out of his own early pain. These needs, though accepted, are not condoned, as has been illustrated in the discussion of the first group of parents in the chapter "An Attempt at Classification of Parents." Where a parent voluntarily requests placement, even though it may be apparent that this is not indicated, respect for the parent's need to wish it at the start will help him eventually to seek another solution. If the request proves to be a valid one and there really is a need for placement, even if it is in terms of the parent's emotional incapacity to give to the child, the acceptance originally shown the parents in their need to make the request will make

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for their better cooperation. This can apply especially to parents in the last two categories where capacity to be a parent does not seem to be grossly impaired, making the worker prone to feel harshly toward them as they seemingly are avoiding their parental responsibility. Such an attitude in the worker can create difficulties if placement is decided upon. The relationship between parent and worker is begun as in the intake process of a voluntary placement with the acceptance of the parent's need to place his child. Even when the court orders placement against a parent's wish, the parent's inability to give adequate care to his child constitutes his need to place whether he knows it or not, and consideration of the parent's feelings despite his inadequacy, should be shown here as in all other cases. The parent's history will show his own deprivations as a child, which caused his present inadequacy as a parent. A worker, in relating directly to that pain in the parent's childhood, can find compassion and understanding of him as he is now. Imagining the parent as he was as a suffering child helps the worker find empathy for the parent he is now. To develop the relationship further the specific needs of the individual parent and child have to be understood and met at the point where they are now. In order to make the relationship more deeply meaningful than could warmth and general kindness alone, it is necessary to know how to be giving and at which points, and also of what not to be accepting. Then the client will really be involved in a unique experience, as his present predicament testifies that he has seldom, if ever, been thus understood. An example of a dynamic relationship which gave the mother support to go through with a much-needed placement, kept her from having a breakdown when the child was moved, and prevented her from disrupting the placement is described below. From her history and current behavior, it is apparent that she was the kind of parent described in the second category, and although hers was a voluntary placement, parents of this group who have less ego energy than did she often are those referred by court action on a charge of neglect.

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Miss H. visited several agencies requesting immediate placement of her six-year-old son Bill, as she felt incapable of taking care of him. She had forced his father to marry her when she was six months pregnant in order to legitimize the birth, yet after she divorced the father a few months later, she reassumed her maiden name with the prefix "Miss." The father had not worked, was abusive and generally irresponsible. He saw the child only once when he unexpectedly met them on the street. Miss H. and Bill lived with her widowed sister and aged mother until the latter's death when Bill was over three years old. Miss H. requested his placement then but the family agency persuaded her to keep the child. She worked while both lived at a club for working mothers. Later she took an apartment and used foster day care for Bill while she worked. This arrangement became more than she could handle because the day-care foster mothers successively terminated Bill's care due to his bizarre behavior. She was overburdened by his care during evenings and weekends, and she gained increasingly less gratification from him. Miss H. was a tall, gaunt, extremely homely woman who talked in a shrill voice and was angrily demanding. Her background was one of great deprivation and her only achievement was her "marriage" and her child. Her sister said that Miss H. had always been a problem and was mentally dull. Miss H. herself gave this impression to other social agencies, but in the placement agency she was viewed as being chronically depressed and overburdened. For it is known that a chronic depression in itself is a burden of pain and guilt, which causes actual responsibility to feel many times heavier. The child, Bill, was infantile, obese, and nearly psychotic, with extreme tantrums. He had been excluded from school for inability to learn, for not heeding classroom order, for eating paste and paper. From the day-care foster mother it was learned that he ate feces. Miss H. defended him against these complaints and talked of him with primitive warmth and delight. She wished him placed because Bill's teachers, foster mothers, and social workers had made her life miserable, and she wished to be free to work in order to give him material things. In preplacement work Miss H. began with a direct attack by

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weeping copiously and saying she would do something desperate, like suicide, unless the worker placed the child immediately. The worker helped her to talk about her burdens, sympathized with her in all the various struggles she had had with people, and stressed that her love for her child would of course cause her to wish for the best arrangements possible for him under these circumstances. Miss H. softened at this, admitted that she was so tired after a day's work that she became irritable with Bill. In carrying out the other steps in the preplacement process, the worker described foster home care so that Miss H. would know what she was getting into, though this made little impression on her. She gave permission to the worker to visit the woman currently caring for Bill when told of the need to know him better in order to be able to decide upon the right kind of placement. Before this visit could take place, however, Miss H. telephoned, hysterically demanding immediate placement as she had lost her wallet and had no funds for Bill's support. This was handled through another agency which was giving temporary financial help. When the worker saw her a few days later, she told Miss H. she could have called that agency directly for money instead of demanding Bill's immediate placement. Miss H. then went into a tirade against all agencies in her past experience. T h e worker finally broke in and became authoritative and firm, after interpreting the mother's need to put pressure on the placement agency, by saying that she, the worker, would not rush Miss H. into any situation with so many unknowns. Miss H. calmed down then and talked more relatedly about the placement situation, rivalry with the future foster mother, visits after placement, and other practical matters. She brought out a point of disturbance in Bill, namely, his tremendous affection for her, which was so great that when he saw her talk to somebody else he would scream and pull her away. She finally offered that she was willing to wait until a wise placement could be worked out for him. Here the worker was giving to this deprived mother, but not in the manner demanded by the mother. When gratification is given in response to neurotic claims, the recipient finds no surcease. When given to in terms of his best welfare at points of need, he feels real

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satisfaction. At the same time, when he is limited in his neurotic acting out, he feels less distraught, less angry, and safer by not being allowed to lose too much self-control. After this incident, the worker focused on Miss H.'s own needs, telling her that she should have a chance to take care of herself as she was thin and that she should have some other pleasures. In the next interview the worker discussed with Miss H. the worker's visit to the day-care foster mother in order to learn how rivalrous Miss H. would be with a foster mother, but no feelings of rivalry were elicited. With the worker supplying a strong supportive relationship including control and direct gratification, Miss H. gave more revealing information about Bill. Finally she told the worker that she knew he dominated her and acted out, and that basically she wished placement to keep him from becoming delinquent. At this, she was given recognition for her understanding and desire to help him. During these contacts with the worker as before, however, Miss H. seemed desperate to place Bill but kept agreeing to wait until placement could be properly worked out. When Miss H. brought Bill in to meet the worker, she herself was most dressed up. After a brief contact with Miss H. the worker spent a half hour with Bill alone. Then, soon after this contact, Miss H. left her job precipitously, but kept running about as if in search of a new one. She was first told that this action of hers would not cause the placement to be made more quickly; then afterwards the worker tried to reach Miss H.'s pain over placing Bill from which she was shielding herself by her frantic preoccupation with job-hunting. She was given understanding, too, of her wish to be taken care of as was Bill, of her wish not to work but instead to stay home and keep Bill with her, if the agency would give her money for their support. Her love for Bill was recognized, and she was given sympathy for the hardship of separation. The worker appealed to this love that also made her be a good mother by placing Bill so that he could have a chance to get the training and education she wished for him. Finally, the worker focused on Miss H.'s own need to be free to work, to be active, and on her right to have things for herself.

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Soon after, when Miss H. asked if Bill were "emotionally disturbed," she was told that this is why he was being placed, but that responsibility for his disturbance lay in the social situation and that she had taken on more than she could handle by working and caring for a child. She was firmly advised that she must find a job within two weeks. She did so, and further responded by discussing the embarrassment Bill caused her and the relief she would feel by his placement since she could not cope with him. When she projected her guilt and her shame over this attitude by saying her sister would find out and not permit the placement, she was requested to contribute a fairly large proportion of her budget for Bill's care to relieve her guilt over deserting him. She was told also that because she did not get what she had needed while growing up, she was unable to give this to Bill. She was like a person who had not received enough for an adequate bank deposit and yet was having to pay out so much in terms of energy in the care of herself and Bill that she would soon be overdrawn. As a result, placement was necessary as a "loan" from the agency so that she could replenish herself. STEPS OF ACTION

From the very first step of action, the guiding principle is to strive to obtain the active participation of the parent so far as the parent's circumstances and resistances will permit. Also, as much sharing by parent and worker of the process of dealing with the child as is commensurate with the latter's protection is recommended. In this way the fearfulness of what is going to happen to him is reduced. Simple, honest explanations of the unknown along the way, given with reassurances, serve to cut down the suspense and help him, with, of course, the support of the parent and worker, gradually to absorb some of the trauma. Telling the Child. With a dynamic relationship formed as illustrated above and new layers of feelings about placement settled, the first action can be that of having the parent help with the first meeting between the worker and the child. This may again bring up a flurry of emotional doubts and resistances in the parent, and these have to be handled as before.

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Preparing the child for meeting the worker should rest with the parent as far as possible, not only for support to the child, but also to place the responsibility for what is to happen where it belongs. Where placement is voluntary, the parent in many instances has for some time before told the child in none-too-helpful terms that he will be placed. Perhaps the child, hearing it many times, has become used to it as a disciplinary threat, and thus believes it will not actually happen. Therefore, it is necessary to prepare a child already informed in this fashion, as well as one who has never been told, to meet the terrible bogey in the person of the worker who is to effect the placement. The parent will need to be advised either how to tell the child initially or how to correct inaccurate information already given defensively. He may, however, in his own fear and guilt, block off the task of telling the child either of these things at home, and to counteract this possibility he needs to be supported all along the way. After the child meets the worker, the latter still has to ascertain whether the child has been told and also what was told him. This should begin early. It may be found that the child has, after all, not been told anything, or has been given a distorted explanation, so that it then becomes necessary for the worker to help the parent when all three are present to tell the child. If a parent is not available or is wholly unable to tell the child about the placement, the task devolves upon the worker. If the child is very small but can communicate, play techniques should be used to make the explanation more graphic than can words alone, as in the following example. Joan, aged three, talked quite readily, was hyperactive, and seemed fearful of her own aggression in play during her first meeting with the worker. Once she ran out to see if her mother were still in the adjoining room. The worker began to develop a relationship with Joan by giving her dependency gratification through reading from a picture book. Joan recognized a picture there of a pounding board, and was eager to play with one when told there was one in the office. After this she sought more attention from the worker by asking the latter to identify each object in the dollhouse. She was verbally reassured that she knew these, and when

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the questions were turned back to her, she named each correctly. She became easily frightened when the doll furniture fell, but was readily reassured. Although placement was not mentioned to her in the first interview, she was asked toward the end, in view of her positive reaction to the worker, if she would like to go for a ride with the worker, to which there was a very definite and emphatic "No!" In the next two interviews, placement was introduced and discussed through play material. The worker called one of the dolls Joan, telling a story about how this doll was going to live in a foster home where there were nice people who liked little girls. The physical surroundings of the foster home were described—the room where she would sleep with another little girl but in a bed for herself alone, the other children to play with there, and finally how the doll went there with the worker. Joan continually shook her head saying, "Oh, no, I'm not going with you. I'm staying with my Mommy and Daddy." She then became hostile to the mother doll, wanting to tear that doll's clothes off, but she did not want to leave at the end of the session, however, and then wished to take home the doll named Joan. In the following interview, Joan talked about the fact that this doll was going in the car with the worker but that she herself was not. When the mother was signaled to leave the room during this session, Joan clung to her and shut the door so as not to let her go. Then Joan wanted her doll and suggested to her mother that she, the mother, go home, leaving Joan at the office to get the doll. After that, Joan was in considerable conflict, protesting that she did not want to go anywhere with the worker, yet not wishing to leave the worker's office at the end of the interview. In the last interview at the office, Joan played well so long as the mother was in either the room or the waiting room. In relation to the dolls, it had become obviously clear to Joan that she was to be placed, as she began to talk about the doll named Joan who was "going by the people." In this example it is demonstrated that with the parent's participation, the impression can be left with the child that it is either

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the parent or the court which is responsible for the placement. With a mother present during the telling of it or even during the child's play depicting this, the mother can be helped to verbalize and confirm the worker during some discussions of it. This leaves the worker in a more neutral position from which the child can be encouraged to accept help proffered him in an arrangement so fraught with pain. Some of the mechanical means used to help achieve this goal are to be found in the arrangements made for meeting the child, especially the first time. These arrangements can be so worked out as to show the child graphically that it is not the worker who is bent upon taking him away from his helpless parents, but rather the parents who are sending him away. When this is done, the child is helped to see early who is responsible for making the placement. One means for doing this is to arrange as many contacts in the agency office as geographic conditions permit, with a family member bringing the child there, preferably the responsible parent, instead of the worker going to the home. A later home visit may help for diagnostic purposes, if that is needed, and it may also help the child bridge the gap between his old home and the one which awaits him. In a situation where the family lives in a rural area and is too far away from the agency office to bring the child there for a first meeting with the worker, arrangements might be made to meet at some public place, such as the nearest village railroad station, church vestry, town hall, or post office, which at the same time affords some privacy. In involuntary placements where the court permits the child to remain at home until placement, it is to be hoped that some positive relationship with the parent can be established to be used instead of or along with the court's authority to gain his cooperation for bringing the child to the worker. If this does not prove possible, the parent can be told that since placement planning is part of the court order, he has to bring the child to the agency office, still with the hope, however, that a positive relationship may yet be reached for his future cooperation. Should none of these devices work, beçause the parent is completely inaccessible to cooperation or not

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physically available, the child could be brought to the agency office the first time by a court official. This resource can also be utilized where a child has already been removed from his family and is being held in a court detention home, if it is known that the child would resist a worker's visit there to release him, sometimes a welcome contact for the child. Education of court officials for this brief function can be accomplished by appealing to them with a positive approach and a common-sense explanation of its meaning in terms of future helpfulness to the child. In any placement situation, either voluntary or involuntary, the placement worker's making his first contact with the child by coming to his home for the purpose of eventually removing him will most likely leave a strong impression with the child that the worker is an invading enemy. Thus is created a barrier which will impede the worker's further attempts to help the child both in the process of separation and in later adjustment. In this activity of preparing the child to meet the worker and in later contacts with the child, the worker should guard against the contamination of his neutral but sympathetic role in developing his relationship with the child. The worker's function can be used unfavorably with the children by their parents to defend their own action and by community agencies, albeit unwittingly, in executing their own functions when they prematurely tell a child the placement worker will place him. Another source of contamination exists within the worker's own feelings. It is not unusual for the worker's own personal guilt to get mixed up with that of the parents. The worker's identifications with both child and parent can stir up alternately in himself pain and guilt from personal experiences, even if he was not a placed child. Each of us inevitably has met with some deprivation and frustration in growing up. If the emotional residue in the worker from these experiences remains strong and through the identifications is recalled, this will complicate his attitudes. He may become so sorry for the child as to feel guilty for helping in the act of placing him. It is always necessary to focus on the reality that it is the parents who are causing the placement and that the worker has had nothing to do with creating this specific family situation. Further need on the part of the

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worker to deal with his own feelings is discussed later in this writing. If the first talk with the child reveals that he has been given adequate factual information about the plan of placement, the worker can then make interested inquiry of him in a neutral but not detached manner as to how the child is reacting to the contemplated removal from his home. If the child is not too highly defended, his conscious reactions are most accurately revealed before he begins to form attitudes toward and a relationship with the worker, for these will color his expressions. Identification with the child's wishes and attitudes as he expresses them is most important in order eventually to involve him in a relationship. If the child shows unwillingness to leave his home, even if he has obviously suffered there, sympathy with him is nevertheless indicated for having to leave, to comfort him and to allay his feelings that the worker wishes him to leave this home. Care should also be taken to leave room for the child's expression of ambivalent feelings, some of which he is as yet unaware. If, on the other hand, the child is saying that he is glad to leave this disturbed family, then acceptance of his feelings with an expression of understanding and an offer of help is indicated. Such understanding includes recognition of the need for the child to gain freedom and relief from unfortunate conditions, but it also implies regret that circumstances exist which make it necessary. One boy, for example, was told, "I can see where a boy needs to have a quiet place where he can get a good night's sleep so that he will be able to stay awake in school. But it's too bad it couldn't have been so with your own folks." Bitterness at parents is not a healthful ingredient for growth, even with a subsequent favorable foster home life. Early understanding shown by the worker to encourage the child's ventilation of feelings of tension for relief can set the stage for his later understanding of his family's failures, and will do much to help the child become more healthily reconciled to it. There are many surprises in the turns a child's reactions take, especially that of refusing to leave the most undesirable parents. He may reflect a parent's surly and irrational attitudes toward the

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court and the placement worker. Such a child knows what he has to deal with, and out of the poor experiences that have been his he can only believe that the unknown ahead of him will be much worse. He may also be clinging to an illusion of or just the wish for something he has never had, hoping to get it from his parents. What chance is there for a child with an attitude like this and with the parent's image so deeply imbedded within him to use placement constructively? Perhaps some emotional contact with the child from the first time the worker meets him may begin to open the way for introducing the attitudes of different parent-figures. Acknowledgment at the outset of the child's hostile attitude, in voluntary placements as well as in court commitments, brings the situation into the open. Secondly, his right to such an attitude is admitted though not accepted as the best one for his welfare. Thus is the worker's identification with the child shown. The guiding principle here is two-pronged: observation of the child's defensive reactions and meeting him at that point since these defensive feelings, although distorted, hold the only truth he knows. The worker's verbalization, with acceptance, of the possibility that there may be other feelings which are being covered over may evoke them sooner or later. Until then this gives the child a feeling of being understood while he needs to keep his defenses, which he is allowed to do. Through these approaches, the child will be less likely to project his hostility at his parents onto the worker, and hence the child will be freer to use the help from worker and foster family to bear the separation and work out an adjustment. Despite these early attempts at handling the child's feelings, his identification of the worker with removal from his family will still need to be handled further, especially if the child did not wish to leave them. Sometimes a child brings out his resentment at the worker in the accusation that if it were not for the worker's assistance, the parent would not be able to accomplish the placement. An explanation of the reality, tempered to the level of the ability of the child to receive it, is not defensive, and serves best here as in most difficult situations. The child can be told that the court or a parent can make a placement without the agency and its workers, that since placement is to be made, it is preferable that

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it be earned out in the way that is most helpful to the child; that most of the time an agency can do this better than others; and that if this worker were not here in the agency to undertake conduct of the placement, then some other worker would be assigned. If the child's pain is so great that he needs the hostility at the worker for survival, it is imperative to let him have it, accepting the anger without retaliation until it subsides to some degree. Κ instead of diminishing, however, it keeps mounting, a firm but warm limitation must be imposed on the expression of it to forestall a panic in the child. If the child's resentment toward the worker does not abate with handling after placement, it will interfere with helping him to settle in his new home and also in the treatment of his emotional problems. In cases where this has been so, it has sometimes been found that the worker who placed the child cannot engage in therapy with him. Then the work with the child after his placement should be transferred, whenever possible, to a different worker, who, by virtue of his position, can be sympathetic with the child about his having been placed. Attempts to maintain the neutral role, as well as the necessity for handling simultaneously the child's anger at the worker, are illustrated in the following case. Placement had been recommended for George, age ten, and his brother three years younger by several psychiatrists and agencies for five years preceding the mother's most recent application. Now additional pressure in the form of George's recent symptom picture of stealing and fecal soiling and the mother's inability to remain in a home for working mothers had finally pushed her into greater willingness to explore placement beyond the intake study. Because she was an extremely controlling person, still gripped in high ambivalence during the preplacement period, the worker gave her all the room she needed to clarify her feelings. This had to be done so that she would not sabotage the placement. The worker made no effort at this point to place his weight on either side of her ambivalence, and as a result the pressure of the ambivalence alone pushed the mother, as she explored it, into facing her involvement in her elder son's problems.

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Since George knew his placement was imminent, the worker, during the preplacement contacts with George, was careful to define his role in the mother's consideration about placing him. That George had been made aware of the worker's role was seen in a sketch he made after a few interviews with the worker. He drew a line down the center of a piece of paper and labeled each part "Separate Houses." On one side he drew a figure which he designated his mother and on the other side of the line another figure designated himself. He drew a third figure on the line itself, naming that one the worker who, George said, was "on the fence." George knew that his mother had not yet reached a definite decision about placing him and that she was to continue to see the worker for help in clarifying her plans. During the next period of work with the mother, she began to assume responsibility for her role in George's problems. Because of her permissiveness as a result of this change in attitude, his usual passive and conforming behavior sometimes gave way to open expressions of anger at his mother, in the form of telling her he would hate her the rest of his life if she placed him. With this venting of his feelings, his offensive symptoms cleared up, but new ones of a somatic nature then appeared. After placement, George continued to come for treatment of his problems to the same worker, maintaining a superficial friendly and guarded relationship. During the sessions he engaged in such activities as building aircraft models and playing chess, but was noncommunicative about his feelings. When he finally exposed them much later in a discussion of a current stealing episode, George admitted his anger at the world, his mother, and at his preferred younger brother. He added that he was angry at the worker too for not preventing his mother from placing him and for being a party to his placement. Once the child's knowledge of the coming placement has been ascertained and clarified, the next step in the development of the relationship with the child is to clear away the resentments the child holds against the worker either for being the bearer of such painful news or for being the force behind his receipt of it. The

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worker's telling the child, even in the parent's presence and with his confirmation, or his having persuaded and helped the parent to do so, becomes equated in the child's mind with the worker's being the one who is forcing the placement. This is because the child cannot bear to face the fact of the parent's desertion and must blame another for it in order not to believe it or to deny and excuse it in some other way. Therefore, the child harbors recurrent hostility toward the worker, who must constantly work at clearing it away even if it is hidden. Charles, age eight, had been told by his mother about the placement in preparation for meeting the worker. In his first interview with worker, Charles showed from the beginning of it his way of dealing with his anger, fears, and pain. This was to become master of the situation. His defenses, intellectual ones consisting of excellent vocabulary and pseudomature manner, were immediately apparent. The worker, however, felt that these defenses were not impregnable and that Charles was "wider open" than reported by previous diagnosticians. Charles had his rationale for the imminent placement well-rehearsed—that his divorced mother had a difficult life and that she worked hard to support him and herself, which had made her ill. He explained that she had been in the hospital, but that in order to be with him she came out too soon and therefore was not fully recovered. When an attempt was made to elicit his feelings about placement, Charles proved a master of evasion, turning questions back to the worker or initiating some game to distract. This was pointed out to him, but he was not responsive to mere interpretation. All the while he was denying possible anger at his mother for placing him, he played with such aggressive toys as darts. He talked with great hostility about his maternal grandmother for being mean to his mother and for threatening to kill his mother. Further he expressed disgust at his mother's boy friends, but was reluctant to leave the worker, a man, at the end of the interview. In the next interview, the worker blocked Charles's escape through the defenses by which Charles had controlled the previous interview. When the worker suggested that Charles might be angry

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about the planning which his mother had made through the worker for placement, Charles asked to play checkers. The worker told him that he knew Charles was going to say something like that as it is a good way not to discuss what was on his mind. Charles was then blocked both from talking about his mother and from distracting the worker. Later he tried saying that he did not mind going to a foster home as long as his mother would get well, but at that the worker told him he wished to talk about Charles this time and not his mother. This stopped him again and he decided to try the candy, stuffing his· mouth so that he could not talk. It was then pointed out to him that this was another device to avoid talking about things which hurt. Charles then turned to yet another method of resistance, that of control, by flattering the worker—about the worker's being a good loser at checkers and with how he enjoyed being in the worker's office. The worker's response was that there would be many times when Charles would not like what the worker said or did. At this Charles lost his control, angrily shouted, "You ought to be ashamed of yourself," adding quickly that he had no reason to be angry with the worker. The worker continued, saying, "When I find a foster home and place you," at which point Charles interrupted, not permitting the worker to complete the sentence and shouting, "No. When you say those things I want to take you across my knee and I can't say what I want to do." With worker's verbalized acceptance and support, Charles was able to say he wished to hit the worker. Charles's angry feelings related to the placement were again accepted verbally, and he was reassured that the worker still liked him. Although the interview was then almost over, the worker played one game with Charles to confirm his liking for him. Charles reverted to his former control, insisting that the worker pay him money for every point he won over the worker's score. The worker said he had no intention of giving Charles money at any point for what they did in the office. The worker continued that he felt he had much more to offer Charles than money, and also that he was ready to give Charles all he could of this. When Charles wondered what the worker meant, the latter explained that he would help

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Charles express his feelings so that Charles could feel better, that this was what the worker could give to Charles. In the next few weeks Charles dropped his protective attitude toward his mother and angrily told her that he did not see why she was always trying to get rid of him. (She had left him previously in her mother's care.) He berated his mother for pushing him around and told her that she treated him like his dog, of which she had previously disposed. During this trying period, the mother received much help from her therapist in a near-by clinic, as well as from the placement worker, and was able to tell Charles it was good for him to express anger at her. He replied that there was no sense in getting angry, for "whether I'm good or not, I still have to go." She then pointed out to him that that was as painful for her as it was for him, and told him that she thought it would make him feel better if he showed his anger. Finally, they both broke down and cried together, thereby clearing some of their feelings. The beginning of the description to the child of what placement entails should occur soon after he is told he is to be placed so that the child can gain intellectual mastery of it. Some factual information ought to be given whenever the child asks, as he may need to know immediately in his efforts to master his fear. Or if distortions by the parent, for whatever reason, are heard from either parent or child, the worker has to correct these gently but clearly, attempting also to help the parent in his own need with this explanation. A parent may try to assuage his guilt and the child's pain with unrealistically rosy descriptions of the foster home itself and of the parent's role there. Or, especially in the involuntary placement, the parent may, in his vindictiveness, vent his belligerence toward society through a baleful description to his child of foster home care. Ideally, the larger part of the description of what comprises foster home life should not be presented until after the child is helped to settle some of the feelings he is struggling with in regard to the proposed separation. This will serve the child best as at that point he can better hear and accept the description, which, if given earlier, may be too difficult for him to understand. If he hears what will really happen to him in the midst of chaotic feelings about the

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separation, he may not be able to absorb it. However, factual information can also be given piecemeal in conjunction with clearing away points of distortion, and this may help the child to feel somewhat reassured if he expects the worst. This description of the foster home experience should be re-explained later on after some of his upset has been calmed. Sometimes the child will drop hints of his misconceptions through the sort of questions he asks about foster care, but if he does not ask any, what he thinks foster home life is like should be actively elicited. This needs to be done to bring out whatever distortions, either glamorous or malevolent, he may have picked up from his parents or other sources, and to discover what he has made of the original information given to him by the worker. After the distortions are dispelled, then the correct information can be better integrated. To negate some of the despair and fear in the child who objects to separation, it is helpful for him to know that he will be able to visit with his parents and old friends, if the latter are not too far away. That there will be a similarity of activities in the new scene, like school, TV, movies, scouts, friends, play, and his familiar toys and other belongings, will also reassure him. Projecting into the future that he will still have much of the same things as other people and will be like them, can convey to him that his life will neither stop nor change completely. Soon will probably come the question that makes the parent falter most, the one from his child as to if and when he, the child, will return to the family. A tentative answer to this difficult question can be shaped with validity through an early psychosocial diagnosis of the parent's need to place and of the character structure of both parent and child. From this can be forecast either the parent's future capacity or the treatability of the child's emotional disturbance, or both. From this also, it can be speculated as to whether natural changes in the life situation may occur, such as a widower's remarriage. When the placement clearly is a temporary one, both that fact and the reasons supporting it can be shared with the child. If, on the other hand, the placement appears to be an indefinite one, so must be the reply, but without ever entirely closing

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the door to hope. To do this requires judicious handling, for fanning vague hope is just as erroneous as stifling all hope, since the former keeps the child in a state of suspenseful waiting and makes him unable to settle down to grow in a foster home. An example of the sort of statement a worker might make in this eventuality is, "I hope you can go home after a while, but I really don't know. It depends on what happens to your mother [or father]. It will be easier for you while waiting to see what is going to happen if you will settle down in this home and enjoy yourself." Another answer that might be given, when appropriate, is, "When you are less upset and have fewer worries, you will then enjoy living at home." However, whichever answer is given, it will require repeated reworking throughout the foster home care. When reality factors, such as death or expected long-time absence of both parents due to a deteriorated mental condition or terminal physical illness, are present, an entirely different situation prevails in terms of the nature of the answer to be given this question. These circumstances necessitate permanent placement, and this should be conveyed only gradually to the child, without, of course, any element of hope of return. Details of such explanations are presented in the chapter "Work with Children after Placement." Action in preplacement work is less terrifying to both child and parent after the foregoing preparation has been made for it. Explanations and discussions of the impending separation and of the foster home itself, can be borne when action is not imminent. Protracted discussions delaying the carrying out of the plan should be avoided, however, so as to make use of the readiness of parent and child to move. If the discussions should become too prolonged, as in the effort, a futile one, to settle all disturbed feelings, action should be instituted as soon as possible to break through the anxiety and tension which accumulate. Such action can be begun by entering directly into a description of the specific foster home selected for the child, as soon as one has been found among the available ones suitable for this child. Or if a different type of placement facility has been decided upon for this child, then the specifics of that resource can be described to him and his parent. Through focusing

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thus on the specific foster home or facility, both child and parent will be able to relate more vividly to the plan. Methods of and criteria for the selection of the type of placement facility, be it foster home or institution, with various intermediate plans of care, were described in the preceding chapter, "Types of Placement Facilities." The information given there has its uses during the intake study, as described in Chapter 1, but the final selection of the facility is usually best made during the preplacement work. The various stages through which the parent and child move in preplacement work deepen the tentative diagnosis made at intake so that selection of the appropriate placement facility can be made more soundly. Ideally, it is best to describe the selected foster home to the child and the parent separately. This has the advantage of permitting each to show his own feelings more freely, and above all keeps the parent from prejudicing his child from the start out of his own feelings of guilt and rivalry. The introduction of this foster home in separate interviews, moreover, not only gives the worker an opportunity to handle the reactions of each individually, but also helps each to gain a more positive attitude. Parent and child can come to the office together, or the worker can visit the home, but either way one is seen while the other waits until the first is finished. Usually it is the parent who is seen first, unless an adolescent is involved, and even then sometimes. The parent is asked not to talk to the child about the foster home until the worker has had a chance to do so. If the parent resists this request, then the worker should try to drain the parent's reactions before the child is told. The telling should be done by the worker in the parent's presence, as the worker may then counteract some of the remaining negative feelings the parent may spill over about the foster home to the child. Meeting the Foster Family. The first contact with the foster parents, especially with the foster mother, for the very young child of preschool years and up to approximately six years of age, should be in a place familiar to the child for added support in this frightening time. Usually this is the worker's office, to which, by this time, the child has ordinarily become attached, especially if play

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has been one of the techniques used for fun as well as for communication. If the first contact has to be in the foster home, it helps the very small child to have gained some grasp of its reality by having had a description of it presented through play in the office before the visit to the foster home. Whatever the age of the child, at the first contact with the foster mother there should usually be no one else present, especially not other children, except a familiar worker and perhaps the parent. It helps a child to gain a stronger impression of his one-to-one relationship with the foster mother, with a resultant sense of security, if he does not have to share her from the beginning with her own children or other foster children and strange adults. On the other hand, if a child has shown a chronic reluctance to a one-to-one relationship, or too high anxiety about participation in it, he may feel less threatened by the new foster mother if he meets her for the first time while she is surrounded by the others in the household. While making the new tie with a foster parent, the child's old contacts should never be taken away from him entirely, and much overlapping is desirable for the child's partial security during this operation. This, moreover, can also apply to some replacements as well as to first placements. Whenever possible, the natural parent or other parent-substitute should be present at some meeting between a small child and the foster mother before placement. Between the known parent at the old end of the child's life experience and a still strange foster family facing him at the new, there has to be a bridge enabling him to span this formidable emotional gap. This is provided by his meaningful relationship with the worker. The following case example illustrates how such a relationship between a child and a worker was developed and used in spanning the separation. It also shows how the specific foster home was introduced and how visits to the foster home by the beloved parent-figure prior to placement helped dilute the trauma of separation and made easier the child's integration with the new foster family. It further describes how immediate communication between the child and the parent-figure after placement also helped the child in the separation trauma.

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Dorothy was twenty-six months old when first placed. Her parents were divorced and her mother, age twenty-one, wished to join her own parents in another city in order to obtain their affection, of which she had never previously had enough. Since their life had no room in it for a small child, Dorothy's mother was willing to forego her child so as to become acceptable to her parents. For a few weeks before the placement was made, Dorothy was brought to the worker's office at close intervals and played there in her mother's presence. She ignored her mother's telling her, both at home and in the worker's presence, about the imminent placement, but went on playing as if she had not heard, was careful not to get her clothing dirty, and used very few toys, talking but little while she played. When her mother left her at the office on the day she was moved, Dorothy cried only a little. She clung to the worker in the car, and when he carried her into the new home, her entire body trembled but she did not cry at all. She went into a depression, quietly sucking her thumb for hours at a time while she was cuddled in the laps of both houseparents. Dorothy remained in this temporary home for fifteen months before she was replaced in a permanent foster home at age three and a half. The delay in the replacement was caused by blocks to the clarification of the parents' plans about relinquishing her for adoption, which appeared a possibility in that neither parent was including a place emotionally or realistically for Dorothy in the separate futures they were carving out for themselves. When after so many months their decision regarding adoption was not forthcoming, Dorothy's placement in a permanent foster home of a childless couple was planned in order to get her out of the temporary arrangement and introduce stability into her placement. By this time, however, she had become extremely attached to the couple who were houseparents in the temporary unit and they, in turn, to her. When the houseparents took their days off and a relief housemother came in, Dorothy would want to be reassured that she herself would not be moved. She expected and feared this as she had noted the other children being moved out of this temporary residential unit.

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Thus, it was planned that before moving Dorothy again, she should be involved in a close relationship with a worker while she still had the security of her tie to the houseparents. The worker's goal was to help the child lose some of her compulsive defenses gradually through play so that she could feel freer to express her feelings in the trauma which awaited her, and thus be more accessible to comfort and healing. At first Dorothy was fearful about coming to the office for play sessions and would not leave the housemother in the waiting room. For the next three months at weekly sessions the worker was able to help Dorothy play with her with much discussion of her feelings of loss and of anger at her own parents, which Dorothy brought out little by little. All of the play attendant to this discussion revolved around the dollhouse and the doll family, and these toys were later put to use in preparing her for the move to the foster home. Dorothy gradually became more active in play, talked more and with animation, and related in a happier mood. During the four weeks just prior to moving Dorothy, the subject of the foster home was introduced and discussed as follows. When Dorothy was in the midst of enjoying her play, securely wrapping and then hugging a doll, the worker brought up Dorothy's request to the housemother not to be taken to the office this day. The worker opened the anxiety by giving a monologue about children leaving the home where Dorothy was living, and about how this makes other children wonder about themselves and when they will be going, and how they are worried about it. She continued, saying that Dorothy would be going to a nice home too, one especially for her, just the way each of the other children was going to a home especially for him. Dorothy could still come to see the worker every week as before for them to play together. Then Dorothy handed the doll she had been hugging to the worker who talked tenderly to it about being a little girl who would get frightened at having to change homes and who would not want to go, but who could still have the worker. With the worker's permission, Dorothy drank from the nursing bottle she had prepared for the doll. The next interview was uneventful as Dorothy was again re-

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pressed. In the interview following that one, however, Dorothy's disturbed moods were expressed indirectly when she used a large quantity of finger paint, concentrating on purple and black. When she asked to play with the dolls, the worker introduced a story about houseparents living in a house with many children who moved away. The worker played out a car coming for the children who were to move, then a house with a new mamma and daddy. There was an especially nice house where the little doll who had not yet moved away was going to live. Dorothy asked the worker directly whom she was talking about, and the worker referred to the former houseparents, the new foster parents, Dorothy, and herself. Then Dorothy joined in the play, placing the man doll on the car and driving it away. She was here abreacting her first traumatic experience, her removal from her mother by her former worker, a man, in his car. Dorothy then turned to the worker with anxiety, and the latter talked sympathetically of how the baby doll was scared about going away, of how this was the way anybody would feel, but that the houseparents still loved her and wanted her to be happy in a place where she could be really settled. The worker continued that the doll was so frightened that she climbed into bed at night with the houseparents. Dorothy said, "I do that." Comforting her and then wondering aloud why the doll had to leave this home, the worker followed with an explanation that the doll was going to a real home which would be all hers. Dorothy added, "She will go to the beach," since Dorothy had enjoyed the beach near the temporary unit. After this session she showed that she was beginning to be ready for another transfer of feelings when she told the houseparents that she no longer missed her former worker, the man, since she now had this worker. A t the next interview, Dorothy held the worker's hand tightly instead of ignoring it as before on the way into the office from the waiting room. Dorothy played with clay, then painted, after which the worker drew a house closely resembling the apartment house where the new foster home was located and designating it as such. She drew and described the two flights of stairs leading to it, indicating the bedroom in the layout of the apartment which the little girl would have as her own, the doll and small folding chair and

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low table there, all expressly for this little girl. Dorothy listened despite herself, digressing at times to her painting. She also drew a house, then turned to playing with the dolls. The worker again described the new home and the love of the new mamma and daddy for the new little girl, occasionally substituting the word Dorothy for doll or girl. Dorothy stopped playing and listened, thumb in mouth. The worker played "bedtime" in the new house, and Dorothy pulled her bed and the foster parents' bed together. Sympathizing with Dorothy's wish to get into bed with the new parents in order to feel safer when she was scared, the worker gently restored the beds to their proper places. Then the visit by Dorothy to the new foster home was discussed with the promise that the housemother would accompany them. Dorothy played comfortably at home after this interview. When Dorothy, her worker, and her housemother made the visit to the new foster home, the worker pointed out to Dorothy the stairways and the bedroom for Dorothy, who went promptly to the folding chair and table which she herself recognized from the office play. She investigated the rest of the foster home and wished to see where the foster parents slept. On leaving, she told the new foster mother that she would see her next week in the office, as planned. That contact went off smoothly with Dorothy showing how she played. In the next office interview after the visit to the foster home, the worker reviewed with Dorothy the visit there and then ran the toy truck explaining that it was like the one the new foster father used in his business. A few days later Dorothy made another visit to the new foster home to meet the foster father. She again was accompanied by both the worker and the housemother since she would not go without the latter. With the foregoing frank sharing, support from old ties, and her own participation when she was ready, Dorothy could face her real feelings directly. When moving her the next day, Dorothy had no tears at first, being very busy carrying some of her belongings to the car. En route she was depressed, then sullen and angry, asking, "Why do I have to go?" On arrival, she recognized the new home

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and seemed excited while placing her things in her room. She immediately wished to telephone the housemother, however, which the foster mother helped her to do. When the worker began to take leave a half hour later, Dorothy burst into sobs, and first the worker then the foster mother, cradled her in their arms in turn, rocking and consoling her. There followed Dorothy's telephone call that night to the housefather she had left, with the foster mother initiating this call for Dorothy. These telephone calls to both old houseparents continued daily for two weeks, then dwindled of themselves. Dorothy also visited with the former houseparents that first week in the office. These contacts were continued but later spaced farther apart. Her subsequent development in her new foster home prospered and she showed great security and excellent integration there. Later on, it became possible for this family legally to adopt her. Even though proper attention is given to a child's first meeting with his foster family, his own parent's first meeting with the foster family is too often left to his own initiative, with or without the agency's approval, and after the placement has been effected. Small wonder that the parent has frequently gotten off to a bad start with the foster family. Many parents need the worker's support and formal introduction to the foster family to lend status to their role as parent in the face of another's caring for their child. In some instances where a careful evaluation of the prospect of such a visit indicates it would not disrupt the plan, the natural parent can meet the foster mother for the first time in the agency's office before placement. The parent could also visit the foster home, with or without meeting the foster mother at the agency first, before the placement is made, if appraisal of this move shows no contraindication. The child may or may not be included in this visit, but either way the parent will be accompanied by the worker. Actually, the parent's visit to the foster home before placement can increase his support of the child in his moving there, so. if possible, such a valuable visit should be arranged.

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One instance in which it would definitely be disadvantageous is with the kind of parent who would be thoroughly dissatisfied with any foster home on account of her own guilt feelings. After the choice of the foster home has been made and accepted by the child and his parent, where their decision is applicable, the preparation of the foster family, especially of the foster mother, for receiving the specific child, and ofttimes the parents as well, also occurs in the period of preplacement work with the family. The discussion of this preparation is presented in the chapter "Work with Foster Families." The Actual Moving to the Foster Family's Home. The actual moving of the child with his belongings should have the parent's maximum participation whenever conditions permit. In line with the attempt to keep the role of agency and worker as neutral as possible from the point of view of the child, as well as for support to the child while moving, the parent should bring him and his suitcases to the agency office. If the family lives at too great a distance from the agency office, as in rural areas or from the facility to which the child is going, the worker can plan to meet the child with his parent and his belongings at some intermediate point. The nearest bus station or store in a town midway, and in court cases the court house or the offices of another social agency near by, would provide a neutral meeting place. Thus the worker would not be left in the position of taking the child away from passive parents in their home. From any of these places, the worker and the child can proceed to the foster home, with or without the parent, as previously determined. Under some conditions, like those which prevail in the planning of the parent's visit to the foster home prior to placement, the parent can be permitted to bring the child and his belongings directly to the foster home, stopping at the agency office or at another designated place for the worker to join them. It is advisable to buoy up the parent to feel sure that he will not become overly upset at the leave-taking in the foster home. Another precaution is to obviate the parent's tendency to consume the worker's entire attention, which makes the child feel isolated. Daily telephone calls after the move between parent and child, initiated by

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either, and an early visit by the parent to the child, will ease the trauma of separation. In most situations, daily visits during the first week by the parent to the small child in the foster home can be helpful, as can later ones spaced at longer intervals. Correspondence, too, can help. 4 These measures are applicable in some degree to older children also. In all cases, however, such visiting plans should not be instituted unless the natural parent is involved by this time in a strong enough relationship with the worker for him to be able to guide the parent effectively in this or else the parent may overrun the foster home. When the child to be placed lives at a distance from the agency office, as in rural areas, it is difficult, if not impossible, to arrange for sufficient contacts in person for preplacement work. Dynamic child placement work can nevertheless be carried out in adjusted measure even in rural areas by the establishment of a network of county departments of public welfare having child welfare workers attached to the staff. Their development and guidance through strong leadership from a state department of public welfare with effective powers can provide for the processes necessary to constructive placement work. When a local agency has been involved initially in arranging for the child's placement, whether that agency be the local welfare official or the court, and that agency is at a distance from the placement agency headquarters, some preparation of the child for placement can begin in the local agency. However, when the worker who will actually place the child is at a distance geographically, he can begin to create some tie with the child through preliminary correspondence. This should be undertaken only with the consent of those in authority over the child, whether the own family, the county welfare worker, the superintendent of an institution, or the official in charge of the juvenile detention home. Such correspondence with the child by the placement worker should attempt to put into effect the usual measures followed in preplacement work so far as correspondence and other indirect methods will permit. The worker should first explain his mission and describe his role in it as is done in the in-person contacts.

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Then the worker should proceed to invite the child to write a description of his physical appearance; grade placement; close possessions in the way of toys, equipment, and pets; interests and favorite pastimes; and, especially, his feelings and questions about the move. This show of interest from the worker in the child as a person, even through the mail, begins to rub ofï some of the feeling of strangeness which the child has about his future and toward the worker. When the worker meets him at a designated place to bring him to the foster home, the child has already gained some familiarity with the worker through this interchange to help bridge the move. While corresponding, the worker's stated acceptance and encouragement of the child's expressions, especially about the kind of foster home he would like, will help him reveal his latent fears and fantasies about foster homes, and will also make the fact of placement more vivid to the child by inviting his open consideration of it. This sharing, together with the worker's stated identification with what the child has offered of himself, deepens the feeling between them even through correspondence. The child may find it easier to write rather than talk about his answers to the question asked him about why he thinks he is leaving his home. Careful examination of this output and of other information he has given about himself, can lead to a fairly accurate understanding of the child's needs and of his family background for planning of the placement. In the course of the correspondence the worker should also describe himself as a real person, referring to general appearance, interest in children, the type of work he does to help children, his sympathy for this child's plight accompanied by a note of hope. The development of the rest of the relationship will follow in the worker's responses to the child's revealed interests, such as baseball, stamp collections, pets, and dolls. Finally, the worker's direct written description of a particular foster home and what life there will probably be like, with reassurance of the worker's continued interest after placement, both through personal visits and more correspondence, will help prepare the child for the move. Since letter writing may bring out the worker's more formal professional manner, perhaps a reminder is in order here that the

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worker's writing style in this correspondence should be simple, informal, clear, and conversational, similar to his mode of conversing with a child in an interview situation. PREPARATION FOR

REPLACEMENT

Much of the preplacement work already described in both inperson and correspondence contacts can also apply to the preparation for replacement. Separation of the child from close or familiar ties other than those with his family (such as his ties with a foster family or an institution) will include some of the same travail for him as he would experience on being removed from his own family. Replacement from Foster Homes. Of the reasons for replacements from foster homes, one is the development of an unexpected reality situation in the foster family, as, for example, a decision to move out of the state or the need for the foster mother to nurse a married daughter who has suddenly fallen ill. Another cause for replacement lies in the mistaken evaluation of the foster family who are now found to be unable to give as is needed to the child. Still another reason for replacement is that the child's own disturbed behavior is found to be worse than the average foster family can tolerate. Whatever the reason for replacement, however, it should be explained to the child by degrees, in general terms at first, later, when the hurt is diminished, in more detail. Even when the reason for the replacement sounds as though the foster parents are rejecting of the child, it should not be masked by other less painful reasons, but should be softened for the child. He may be told that neither the worker nor the foster family are rejecting him but, rather, that his behavior makes it impossible for him to continue to live with this family. An offer of help, if this is available, to bring about a change in his behavior should accompany the explanation of the reality that such behavior is unacceptable. If the child is shielded from the knowledge of this reality, or is helped to deny or rationalize awareness of the truth, he is more harmed than helped since then the reason for motivation to change is lost to him. Moreover, the child is really aware of the real reason of his removal from the foster home anyway,

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and he will feel rejected even if he is shielded from this knowledge. As one adolescent girl who had had eight replacements in eleven years admonished, "Why wasn't I told about my bad habits which made me get moved around? How could I try to change them otherwise?" 5 More than likely this girl had been told about them by her various foster mothers, but told when the foster mothers were in a state of anger at the girl who construed the communication as attacks against which she defended herself by not hearing or not remembering. The converse of this can occur when the unacceptable habits are discussed by the worker in a supportive relationship with the child. If he points out that what he is saying is said becausc he wishes to help and does not mean to criticize, then, through the worker's identification with the child in the latter's dilemma, the child may gain enough strength from the relationship to modify his behavior consciously to some extent. Replacement from Institutions. If a child has spent long years in an institutional setting for dependency care, rather than for treatment purposes, this facility will feel to him like the only home he has ever had. In such instances as this, preparing the child for moving away serves the same purposes as are served when the move is from the own family's home. There are, however, some modifications and additions necessary to the usual preplacement work in preparation for replacement from such an institution to a foster home. It is generally acknowledged that a child who has spent most of his life, especially the first few years, or even less, in an institutional setting, whatever its size, has meager capacity for meaningful relationships.6 An infant requires during the first six to eight months of life warm intimate, and almost continuous attention during their brief waking hours from a mother-figure who plays, talks, and sings while she feeds, cuddles, and comforts through bodily contact, the infant's chief mechanism of understanding in his early months. This is the way a child establishes a tie with reality if he finds that his reality is pleasant or at least not too threatening. When this personalized mothering is absent as occurs in large nurseries, which sire usually understaffed so that the

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infant is picked up only occasionally and thus lacks adequate contact, what results is the autistic child. There are such serious gaps in his capacity to relate to reality (seen, for example, in his apathy, his lack of response to the point of almost complete withdrawal or unrelatedness, and his extreme bizarre behavior after he gains motility) that his is a form of psychosis which is largely irreversible.7 Sometimes an infant in an institution catches the special attention of one caretaking person, and getting extra handling from her, he relates better to his surroundings because of the personal warmth gained. When such special attention is inadequate, or inconsistent, or lost entirely through a change of staff, the child becomes depressed and withdraws, is unresponsive, and becomes puny; he is alternately inert and fearful to the point of psychosis. An infant who had experienced warmth from a mother-figure during the first few months of life prior to his admission to the institution, only to sense its loss with no adequate substitute in the last half of his first year, will become depressed to a similar degree. 8 Rarely is the psychotic child, whether stemming from an institutional background or from his own family, placeable in a foster home because of his unrestrained, untractable, and destructive behavior. There is a possibility of such placement when the child is a very young one who has some special appeal and who can be physically restrained because he is still so little. Ordinarily, the older, and thus the bigger, psychotic child is too uncontrollable for a foster home environment. Should such placement be considered for any psychotic child, thorough preparation is absolutely vital as he has only the slightest shred of a tie to reality in his accustomed environment. Actually, the link is so thin that if disturbed the child may regress into a more hopeless state. Since his recuperative powers are almost nonexistent so far as is known to date, much more work has to be done with him after placement. Because of this the best results with such a child are achieved in special treatment facilities as discussed in the chapter "Types of Placement Facilities." Should foster home care for the psychotic child be unavoidable, preparation for his placement should consist of the frequent

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repetition over a long period of time—even a few months—of reassurance in simple terms that he will be loved and protected, and kept from being hurt or from hurting others. Frequent contact with the foster mother to whom he is going in the familiar setting of either his own home or the agency playroom is another requisite. The gist of the reassurance from both the worker and the foster mother, an emotional communication to him, is that the world is really not such a terrifying place, where only hurtful and frightening things happen, and that he will not be left at the mercy of the force of his primitive rages. These rages are precipitated either by a slight change in the familiar, or by a trivial frustration, or, sometimes, in reaction to some inner current not apparent to others. Compounded with terror, they represent his reenactment of what the world felt like to him when, as an infant, he was deserted by a mother-figure not capable of meeting his basic needs for survival, either physical or emotional. Having been unable without emotional sustenance to develop beyond the stage of infancy, even though chronologically older, or, in other words, having no more ego development than an infant or slightly older child, the psychotic child does not have the capacity to integrate occasional reassurances. Repetitious reassurance given at close intervals, like continuous drops of water falling on a hard surface, leaves its mark eventually. If it is not supplied, this child when placed will be a frozen, unreachable vegetative mass or a wildly terrified streak of strange sounds and bizarre motions, which wreaks senseless destruction. Just as the child under two intensively needs mothering, so the child who comes to an institution after his second year of life for dependency care still requires much of the same close mothering to nourish and guide the development of his personality. If his first two years of life before admission have included sufficient mothering for him to have established a tie to reality, then he will not be psychotic. However, lacking adequate mothering after the second year, his development will be arrested at the level where a child is normally wholly self-centered, pleasure-loving, and impulseridden. In him these characteristics are exaggerated. He will, for example, approach strangers indiscriminately to requisition affec-

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tion through ingratiation in an attempt to establish security for himself. 9 These traits are residuals from the aee at which he was O left without adequate personal love and guidance, ingredients necessary to help him grow. For the rest of his life, this individual, known as a narcissistic character, will remain hard-shelled and unheeding of others' needs, with only sham feelings, unless therapy succeeds in breaking through this shell to the early

anxieties

where the real feelings are lodged. Such a narcissistic, self-centered, superficial small child in an institution usually will be highly enthusiastic about a proposed replacement in a desirable foster home. Relationships to personnel in the institution have necessarily been so thin and so lacking in personal emotional investment on the part of both overburdened caretakers and neglected child that he has no regret at leaving. Since the excessively impulse-driven child constantly looks for new fields to capture and explore for the treasures of pleasure, the prospect of foster home care seems far more appealing. Attempts to present a realistic picture of foster home life will make very little, if any, impression, and visits to the foster home prior to placement are almost always too brief for testing the reality. In fact, being a guest at such times actually creates the sort of atmosphere which encourages the child's glamorization of the foster home. What must be done is to make a diagnostic search for the vulnerable spot at which this child can be reached to establish a meaningful relationship. This is the task of the preplacement work, even though such involvement may weaken the chief defense of narcissism and release strong phobias. Otherwise, the child will weave a spell of charm over the foster family during the first few days to weeks of placement, only to disappoint them greatly later with a lack of response and hard-willed attitudes and behavior.

The

preparation of the child's accessible area and the foster parents' readiness to relate to the child at such points as certain phobias gets them all off to a better start for making the placement succeed. The child who comes to an institution at a later age, previously having had some warm family interrelationships, may nevertheless bear certain marks of institutional experience if the setting is large and impersonal and if he remains there over a long period

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of time. If the institution which offers dependency care is a small one with a closely knit personnel, there is much less danger of personality damage to the child. Even so, most growing children cannot seem to gain sufficient gratification when they have to share parent-figures as extensively as they do in a group setting.10 As a matter of fact, the capacity of a child in such a group to draw close to a parent-figure may be indicative of his readiness to use a foster family placement. The child who does not show this capacity, or who does not show enough of it, is maintaining a shell about himself, especially over his deeper feelings, even when he appears to be outgoing. The extent of this self-protective device depends on what happened to the child before he came to the institution and on the amount of impersonality in the setting. If the device is strong, such a child cannot be expected to respond readily to overtures of affection and devotion, or to relate deeply, if at all. This has come about because the child, upon entering such an institution, found himself lost in its impersonal atmosphere. He then had to find a way in his fear and loneliness to manage emotionally by himself, and did so by learning not to miss having people in close relationships with himself. In the process of learning he formed a protective shell to make this possible. Some of these children upon leaving the institution when they are older wish for nothing more than an impersonal boarding arrangement in a home or club rather than foster home care. They want to be left alone and do not even want to be approached about foster home care because they do not wish to be bothered with relationships with the foster family. This type of child may after leaving the institution concentrate his emotional energies on achieving at school or in a job, not risking emotional investment in people. Other children, whose shell is not too firmly crystallized and who have had some enriching relationship prior to institutional care, can thaw out after a while in a foster home, because they have long been thirsting for the experience of close relationships with others. Some of these, usually in mid-adolescence, are aware of the effect of the institutional life on their attitudes and habits and are fearful before going to a foster family that they will not be able to relate there. They also worry that

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they will not be able to participate in normal family life after marriage. This anxiety is a sign of health as it indicates that the wish for close interpersonal relationships is still present and that the child is accessible to help. Such a child requires much reassurance that he can learn other habits and attitudes. Further preparation beyond the reassurance consists of giving him intellectual information about the mores, patterns, and expectations present in family life to guide him at the beginning of his foster home experience. This is filled in later with the emotional education needed for living with the foster family. The child who is known to act out surreptitiously or openly within this type of institutional setting has to be told that life with a foster family also includes rules and restrictions. This warning, if impressed on the child as being warm interest in his welfare, may help to avert an orgy of acting out arising from the false belief usually held by such a child that outside the institution there are no restraints. The foster family in a case like this must on their side rigidly maintain a strict regime at the beginning. It is desirable that visits to the foster home prior to the child's moving there be short ones at first, lengthening later into overnight and weekend visits. Thus can the child, especially the fearful one, become gradually acclimated to a new mode of living. When the time comes for this child to move to the foster home, it is more meaningful for him, as well as for small children, for the foster family to come for them at the institution, as this helps them feel more vividly that they are really wanted by that family. During the preparation of a child for moving him from an institution to a foster home, the attitudes of the child's parents toward such a move, if they are in contact with him, require consideration. The work done with the parents in this connection has to be integrated with that done with the child, because the parents' attitudes influence the child. Parents' rivalry and misconceptions with reference to foster family care and other problems in the parent-child relationship stirred up by this plan require careful evaluation and handling to help insure the success of this replacement.

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EASING THE SEPARATION TRAUMA FOR IN OTHER

WORK

CHILDREN

SITUATIONS

Children awaiting placement or replacement in still other situations also, of course, require preparation to ease the separation trauma. The child who has spent some time in a residential treatment center first receives help there in preparing for the move to some other living arrangement, whether it be to another treatment facility or to a foster home. He may more readily than children in other institutions come to understand during the preplacement process what is going to happen to him because he has received extensive treatment with individualized attention in a close therapeutic and caretaking relationship. After he has attained such understanding, his preparation is then carried on further by the treatment institution in collaboration with the placement worker, according to the specific dynamics of the child. 11 Preparation of the infant and the baby who is still nonverbal for placement from their mothers, if present, to a foster mother, or from the temporary foster mother to an adoptive couple, is also needed. Since, however, specifics pertinent to this particular process are well described in detail by Dukette and Gerard, 12 they shall not be discussed here. EMERGENCY

PLACEMENTS

In working with children, the intent is to keep at a minimum the number of emergency placements. Nevertheless, in the face of family crises, such action is sometimes unavoidable. An emergency placement is frequently precipitated by a sudden disruption of the family unit, ordinarily caused by a tragedy which in itself makes the child suffer intensely. Encountered frequently from the long list of family tragedies well known to those in social work are death, imprisonment, suicide and homocide, incapacitating physical and mental illness, divorce, desertion and court removal of the child on findings of gross neglect, and abuse or parental immorality. When these or other like situations allow no time to prepare the child for placement, the usual procedures of preplacement work, so far as they are applicable here, have to be initiated simultane-

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ously with the placement itself and continued for a time thereafter. O n e preplacement measure is most essential at this time and must be taken immediately—that of explaining the cause of the placement to the child. In most emergency placements, circumstances are such that the child must be removed precipitously from his home not only without benefit of adequate preparation, but also without the security of a familiar, let alone a close, relationship with a worker. The child's initial shock at losing one or both parents is compounded by the frightening experience of being moved to strange people and surroundings. He suffers even further because the usual helplessness of childhood is intensified by the swift occurrences over which he has no control and for which he has had little, if any, discussion and preparation. If such tragedies as these occur at night, attempts should be made to avoid moving the child during his sleep, or even if he is roused by the commotion. If a child awakens in the morning to new and strange surroundings without the security of his parents' presence, he is left with a dread sense of unreality about the happenings of the night. His new situation seems unconnected with his past, and this makes it more difficult for him to master and integrate eventually the experience of loss. Some agencies

13

have a

roster of homemakers available to act as sitters and caretakers, to report to a home at any hour of day or night to take care of the children in their familiar setting for as long as twenty-four hours. With such a setup as this, the placement worker then has a few hours to make practical arrangements and some preparation, including explanation to the children, for their moving. During this disruptive, unplanned period the child needs especially strong support and reassurance of a dynamic quality in order to be reached. Skillful help is also required to counteract his tendency to repress the disturbance which he is trying to overcome. Workers are familiar with the sight of children at these times playing gaily and being enthusiastic about the trip away from the home. While such reactions appear incongruous, it should be remembered that these are only attempts to manage by repressing the fears. If repression is allowed to take place, the child's original

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reaction to the family tragedy and to the disruption will have been buried since he has not been helped to understand his reaction and to bear the pain. When this happens, there result reaction-formations in the child's personality, revealed in emotional disturbances and behavior disorders. After the placement in these cases, an overlay of feelings, together with their supporting defenses, makes it difficult, if not impossible, to reach therapeutically the original trauma. For healing to occur, therefore, it is of the utmost importance that the child not be permitted to remain emotionally alone in his sorrow, grappling with the mystery of the events which caused it. Although emergency placement leaves no time for the worker to develop a relationship with the child prior to his being moved, a relationship will develop in the course of this activity, but not necessarily one favorable for therapeutic use. It is therefore necessary knowingly to guide the development of the relationship during the removal from the home and in the placing action so that it may be of help to the child not only then but later as well. As in the usual preplacement work, the worker's identification with the child's feelings should be expressed at both the time and the level when the child would be aware of them. This may help the child to consider the worker as one who understands him and, in connection with the placement, as an innocent bystander, which he is. The worker should make efforts to negate the child's tendency in his projection of pain to identify him as the person who dealt him these blows. The worker can show his sympathy for what the child would like to have happen, that things would be different at home so that he could remain there. If the child cannot be helped to say it himself, then the worker should gently say it for him. He should tell the child further that he wishes it were possible for the child to attain these desires and that he would like to help him achieve them, if possible, instead of taking him to a new home. The hope can be held out to the child, in the face of his loss, that his entire world will not be changed, that he will be able to continue many of the activities which he enjoyed in his old environment, and that he will be cared for. Since living is most understandable to a child

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in terms of activities rather than intangible feelings, activities in which his feelings are carried should be stressed. It sometimes happens that the child will dwell solely on the fact of his sudden placement in order to conceal from himself his great loss. In the struggle to hold together his world now falling apart around him, he will cling desperately to the present and to what is apparent in order to survive emotionally. Not having enough strength to absorb both the shock of loss and the shock of placement, he clings to the latter possessively, closing out feelings of the past. But by these attempts to forget the pain of his past, he also shuts out memories which might hold strength for him. To help the child not to repress all of his past, especially at this time when he needs strengths he had used previously to meet the new living situation, discussion of former activities which are less highly charged with current pain should be initiated. It would be well if the worker and foster mother encouraged the child to talk about commonplaces of his family and old home surroundings. The child's chatter about old and familiar situations can cushion the shock of being surrounded suddenly by a strange environment and can help to bridge the gap between the old and new homes. Favorite toys and belongings, as well as pets, if possible, should be brought along when the child is moved. These known objects from his past serve not only as comfort for him but also as food for conversation to draw him out in not too painful areas. In all of this one should be cautious to employ sensitive discretion so as to make the remembering at any one time bearable for the child. A child's weeping as he remembers what he has lost does not necessarily imply that the situation created by the worker or the foster mother is unbearable for him or that it is unnecessary for him to bear it. Weeping is an essential ingredient in mourning, especially in children, and eventually permits healing. It makes the child accessible to comfort from other parent-figures, and as he shares his grief, he makes new ties to those who are helping him with his burdens. 14 There is a need for still further activity in an emergency placement, not always applicable in a planned placement. In the emer-

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gency placement, the worker should arrange for some remaining relative or family friend or neighbor who was meaningful to the child to visit him soon in his new home. This visit helps to make the child feel he has not lost all ties with the past. The child, having left much of himself when removed from his old ties, can now retrieve some part of his past identity in order to feel himself more complete and whole again. In planning for this visit it is important to stress the point to the visitor that too intense emotional scenes or expressions of hostility toward the absent parent should be avoided in the child's presence. Preparation of the foster family for the visit is also necessary; they must be led to understand and accept the meaning of this visit to the child. The worker's contact with the child's relatives and family friends, his former neighbors, school, and family physician can bring out much information helpful to understanding both the child's background and his current needs. The diagnostic evaluations thus made after the placement are especially needed for guiding further planning and for correcting possible errors committed unavoidably during the emergency placement. Of greatest importance for helping the child to cope with the overwhelming situation is informing him about its causes. An explanation about realities can be more reassuring than the fantasies and uncertainties which develop out of the unknown. Although it takes much time for adults, let alone children, to really grasp the full import of personal tragedy and to deal with it so as to become reconciled to it, intellectual awareness alone in the beginning will contribute to some mastery of it. As a matter of usual procedure, factual information explaining a family tragedy which has caused a need for placement is best given after a meaningful relationship is established with the child. Such a relationship encourages the child to share his past feelings and troubles relative to the final blow and supports him in his dealing with the pain these harsh facts have inflicted. However, in emergency placements, where there is no time to form a close positive relationship before an explanation must be given to clear away bewilderment, the discussion about causes should be reopened and dealt with later. In the subsequent relationship, the child can

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entrust to the worker bis feelings about the initial shock and also about the explanation he received earlier. The distortions he had to make of these explanations, in his strivings to endure the shocks, should then be discovered and dispelled. The child's past experience before placement with the illness or pathological behavior of his parent, together with his reactions, may then also gradually be uncovered. After the child has mostly emerged from this morass, the correct explanation of the tragedy and the placement should be stated again; it can then be better integrated by him. Subsequent comfort and reassurance given within the context of a meaningful relationship can be healing. At either time of telling the facts, at actual placement or later, counseling of the remaining parent and of the foster parents with regard to this matter should precede or be given simultaneously so as to help them in their explanations of the tragedy to the child. Children do go from one source to another seeking explanations of these volatile and inscrutable matters. It is highly important that others do not confuse the child with different information; the information they give should confirm what has been told him by the worker. The child whose placement occurred some time after the critical happening in the family can also benefit from explanations treated in this way. But this will be discussed more fully, with specific content of the factual explanations, in the chapter "Work with Children after Placement." CONCLUSION

To sum up, the more thorough and skilled the work of preplacement—whether the child is planfully placed from his home or an institution or replaced from a previous foster home, or is abruptly placed in an emergency—the more stable and constructive will be the placement. This preparation will provide the most secure base possible on which to proceed with subsequent work to make the placement meet the child's and family's needs.

J

WORK

WITH

FOSTER

FAMILIES

IN P L A N N I N G the work for the care of children separated from their family and placed with a foster family, the approach should be based on knowledge of each part of the triangle—the child, his family, and the foster family. The goal is to blend these parts in such a way as to make as near a whole emotional environment for the child as is possible when broken pieces have to be patched together. Emphasis has already been placed in the preceding chapters on the necessity for learning the special nature of each child and his parents and their respective needs. It is just as important to know these same features of the foster family, and to have as well concrete information about their circumstances, their home, and family members. THE SCIENTIFIC

APPROACH

TO F O S T E R

FAMILY

CARE

Acceptance of foster families for such a high responsibility rests on more than a search for adequate physical surroundings and a superficial appraisal of competence, leaving the remainder of the task of finding and creating the right environment for the particular child to chance or guesswork. While all elements in such situations, especially as it involves work with human beings, cannot be known —for what they mean or even for their very existence—what man has already learned about human behavior and interaction should be used as guiding principles in acquiring knowledge of foster families and how to work with them. Checking the fruits of this method

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against common sense and intuition helps to further the discovery of cause and effect relationships, thereby increasing our scientific knowledge of this area. So placing a child that he may achieve integration with a foster family, to whatever degree is indicated by the differentiated goal of placement, resembles the grafting of a branch of one tree to the trunk of another tree. The more scientific knowledge used in this procedure, aided, of course, to the utmost by the "green thumb" or knack and intuition, the more successful will be the outcome. In social work, this scientific approach constitutes the criterion by which the professional worker is differentiated from the well-intentioned, gifted lay person. It has happened on rare occasions that without much being specifically known about a particular foster mother's dynamics, she has done a more than creditable job in rearing a disturbed foster child. The worker placed the child there on the grounds that he "felt right" about this foster mother and her family. Fortunately, the worker's response to the foster mother's personality was proved sound, and it was good luck that he came across this particular applicant for a foster child. Such a personality, not often found, is one in which there is inner ease to an unusual degree, one which feels "straight" and unmuddled, and hence naturally acts and thinks "straight." This foster mother's investment is not so heavily weighted with her own neurotic needs that she is not free to give warmth without strings tied to it and to act flexibly. Ideally, a foster mother, although investing in a foster child, should not feel as close to him as to her own child, for realistically it is too much to expect that a woman will feel as close to another's child as to her own when all the while she is expecting to give the child back to his own parents eventually. Just as the diagnostic understanding of a child's and his family's needs and of placement resources, as described in the chapter "Types of Placement Facilities," should guide the selection of the appropriate facility, so too should diagnostic information guide the choice of and subsequent work with each foster family. Tools and methods for this work in general come from knowledge of the parent-child relationships within the foster family and, of course, of their current life situation. Knowledge of the dynamics operating

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in a specific foster family, as well as full information about their present life situation and the portents in this for the placed child, is as important as knowing the child and his own family. Such extensive understanding of a foster family may not be altogether gained before any child is placed with them, but the continuing use of a certain foster home for the same child or for succeeding children should add to the fund of useful knowledge about the foster family, if each of these experiences is evaluated for its meaning. Observation of a current placement and hindsight from seeing how a former placement served can provide insight as to how the foster family operates, both generally and in terms of a particular kind of child, for future use. Mentioned lastly here, but of foremost importance in this repertoire of tools, is the knowledge and capacity on the part of the worker for developing and fashioning a relationship with the foster family and its key members guided by knowledge of their character structure. Added to this are the awareness and skills necessary for handling this relationship so that it will be in harmony with the identifications and relationships of the worker with the child and the separate individuals of his natural family. There may be two natural parents, each of whom is remarried to another mate, and several children in placement, each with different foster families. Most of these family members will probably be seeking contact with the child in the foster home and the worker has to meet with each. Having the same worker deal with these multiple relationships all at one time, because they interact, may prove to be an impossible task, and may require the separation of case responsibility so that it can be carried by two or more workers. KNOWLEDGE OF THE CHILD AND HIS FAMILY SKETCHED IN

Retracing the above-enumerated areas of knowledge essential to the worker's readiness to select a foster family and help make the placement constructive, the first two, on the child and his family, will be sketched in at this point but briefly, mentioning only the details directly pertinent to the planning of placement with a given foster family. They are discussed more fully in all of the previous

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chapters and in the chapter "Work with Families after Placement," while the remainder of this chapter is devoted to the third area, that on the foster family. Knowledge of the Child. A general fund of information needed for the work of grafting the child onto the foster family is that concerning the general basic needs of children at each level in their personality development and how such needs are ordinarily met. Thus, one should be aware, for example, that infants need much cuddling, laughing, talking, and cooing from the mother-person for a sense of security and an incentive to communicate in order to establish ties with the world outside themselves. Then it would follow that the foster mother of an infant ought to have qualities which will make it possible for her to handle a baby in this fashion, and for a baby who has been deprived in large measure of these necessary ingredients for his development, a foster mother is needed who has the capacities and needs to overgive in this area to make up to the infant what he has lacked before. Or, it is known that a nine-year-old boy, unless seriously retarded emotionally, generally needs a man who, while meeting the boy's dependency needs, also teaches him skills and judgment for achievement, for increasing mastery of the world, and for self-satisfaction as well, thereby creating self-confidence and initiative for competitive situations. On the basis of this, a foster family should be sought where the foster father can lend himself to this role. If a boy is in fact delinquent or shows tendencies in that direction, then the foster father must be a strong figure in his family, whether in a quiet but convincing manner or in a warm but aggressive fashion, so that this boy will respect the foster father's strength and learn from it methods of self-control while he is helped to gain satisfactions from ways other than delinquency. Knowledge is necessary of the various reactions children have when their basic needs are not adequately met so that the gaps as sources of deviant behavior can be discovered and dealt with. Familiarity with general mental hygiene concepts of constructive handling, to be modified according to each child's needs, provides valuable background on which to draw in counseling foster parents on how to deal with a child's deviant behavior resulting from

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original unmet needs. Understanding that the food fads of a fussy eater are very likely a reaction to original forced feeding (out of a mother's anxiety or impatience) gives clues to the child's present needs in this area. The child learned to express his resentment over the forced feeding and attempted to defend himself from it by controlling what he would eat. Therefore, nothing offered suits him. He needs a foster mother who will not be anxious about feeding him so that her manner of handling his eating will be a corrective experience for him. Counseling of the foster mother in the handling of this behavior is based on the general mental hygiene concept of meeting the child's original need while offsetting his reaction of anger to his earlier frustration. Following this principle, a child with such food fads is offered a choice among a given small number of foods, and not a choice at random. The child does not know how to limit his aggressions when given an open field. Whatever is offered him will bring a ready "No," an expression of his hostility, and this can go on endlessly. In such a situation he has the upper hand and uses it extensively, but he does not really feel the better for it, especially when the foster mother loses patience and ultimately leaves him alone to brood over food she chooses. Therefore, if he is told at the beginning, before an issue can be made of it, that he may choose one or two of four stipulated food items, he is made to feel that he is not being forced and that he has control over the choice, even though it is within limits. Both aspects of this please him since, respectively, they eliminate the lack of limits to his old resentment which made him anxious and the lack of choice which made him resentful. This is only one example of how the worker's knowledge of dynamics can help him to explain in detail the how and why of handling a child's difficult behavior, so that the foster mother can grasp the sense of it out of her practical experience with children instead of merely following advice as a dictum or disregarding it as extraneous. Knowledge of the specific child both realistically and dynamically includes his exact age, the name of his school, his school grade, physical appearance, health, where he is currently living and why he is leaving there, and a full descriptive picture of his behavior and

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adjustment in his home, in his school, and with his peers. How the child's behavior has been handled will shed light on the causal factors in this behavior, as will how he responds to the adults in his intimate sphere. Further, the child's emotional and mental makeup has to be learned. This is gained from his history, which should include a picture of his chief traumata, the conflicts created thereby, and how he managed to operate in the face of these, that is, the nature of his defenses. The child's present emotional needs can be gauged by knowing what happened to him in the past and what are his current defenses. The following case situation contains the aforementioned information which should be known in regard to a child about to be placed. Mary, age six, in the first grade of the Summit School, was referred by a day and night nursery where her parents had precipitously placed her and a younger sister of three a year before. Mary was now overage for that facility and consequently the family had to consider a foster home placement for her. Mary was an extremely attractive girl, neat and quiet, whose hands would flutter involuntarily at arm's length. A spastic motion clearly noticeable to all about her, the fluttering appeared to be a severe tic. It was ascertained that this symptom had no organic basis, and that, in fact, her entire health condition was good. Mary's parents had separated after many quarrels in the presence of their four children. The immature, self-centered mother concentrated on keeping herself well groomed and attractively dressed for her going out. She felt progressively more burdened by the care of her family which increased rapidly and which interfered with her own pursuits. With this burden upon her, she doubly resented her husband's freedom from responsibility, as he shirked his duties by spending the day at his mother's home. There, he would sleep and eat instead of going to work or coming home for meals. The parental quarrels were not over the effect each parent's irresponsibility had on the children, but rather over each parent's jealousy of the other's undue freedom from the burden of the care and support of the children. Since the two older children, ages twelve

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and ten, had less need for physical care, the mother complained most about the care of the two younger ones, Mary, then age five, and Joan, age two. These latter two she precipitously left in the hallway of the apartment building where their paternal grandmother lived. Small wonder then that Mary felt that she was the cause of her parents' separation—that which had brought about her placement —when she and her sister had been the subject of the parents' quarrels, the culmination of which was her ejection from their home. This served to confirm her innate feelings of guilt over her idea that she was bad, which stemmed from the disapproval shown by adults in the face of her childish misdeeds. In this she exhibited a reaction common to many children. To preserve the possibility of returning to her parents, she became an extremely good girl to the point of worrying over others. In her need to be good, she became very conforming, neat, and competent, with the hope that this behavior would eliminate her parents' quarrels so that their reconciliation would result and bring her back to them. But what happens to the fear and anger of the child who witnesses parental quarrels where the father strikes the mother and then the child is abandoned in a hallway, Mary's chief traumata as revealed by her history? She was disorganized for some time, but later, consistent care helped her repress the terrible fears. The conflict remained, however, between her natural dependency needs and her feeling that she was bad for needing parental care since this was what had caused her parents' quarrels. Her defense was to become the good girl, neat and competent, so as to require less help in her physical care and hence not be a burden to her mother. Yet it was not strong enough to hold down the underlying fears and anger. To express these feelings openly would conflict with her need to be a good girl. There resulted the silent equivalent of the temper outburst, namely, a siege of stubbornness which assailed her when some necessary limitation, frustrating her, would stir up much of the underlying anger. This stubbornness held her as if in a vise, and she was helpless within it. The so-called handwaving tic came to be understood later as an aborted effort to strike out in anger as she had seen her parents

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do to one another. Since this method of expressing her anger was at odds with her need to be good, her strict conscience would inhibit the gesture if she started to act on the impulse to strike. 1 This understanding of how symptoms like Mary's were generated cannot be complete from the outset of placement, but if it is achieved then in broad outline, it provides the basis for a constructive placement. First, it supplies a guide as to the kind of foster home suitable for the child and one as to which will accept him, and then it is helpful for the subsequent counseling of the foster family on how to deal with the symptoms and the difficult behavior. Knowledge of the Natural Family. Knowledge of the natural family's modes of operation and how these came about, of their individual histories, revealing their early relationships with each of their own parents, of their motivation for placing their child, and of their current life situation makes possible more adequate planning for foster home care. This information will also help to anticipate how they will relate to the foster family and what the latter will find in the parents to which to react. The parent who is openly dependent, seeking to lean on anybody who allows it, will wear out his welcome in a foster home by talking at length and repeatedly about personal problems and grievances against his erstwhile mate or current relatives, while trying to get mothering for himself from the foster mother. Some foster families can tolerate this, but with those that cannot, the natural parent will become jealous of the dependency gratification his child is getting there which he is denied. Or the parent whose hostility is a defense for feelings of inadequacy may either subtly or openly criticize the foster family's care of the child during his visits to their home. Foster parents who are guilty and defensive from other sources become quickly sensitized to this and react with much anger. The alcoholic parent may appear in an intoxicated condition, creating unpleasant scenes. A foster mother who suffered from alcoholism in her own family, during childhood, will react very adversely to such parents, as will foster parents who have extremely strict morals. The masochistically good, conforming, overworked parent will be extremely cooperative and grateful toward the foster family, only to fail unex-

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pectedly to observe some important request regarding his contact with the child. This stems from the parent's unconscious acting out of his repressed anger, a feature usual to the masochistic character. The parents' motivation for placement will hint which approaches the worker should take to avoid, if possible, and handle, if not, disturbances created in the foster family by the parents. It is helpful to know, for instance, that the parents' motivation is to be free of the child's care at all costs and that therefore the guilt surrounding this is either well rationalized or deeply repressed, or so thin as to be easily dissolved by other activities. Such a parent can be better counted on to cooperate in not creating disturbances beyond an initial display when this one is firmly handled in terms of the agency's possible refusal to carry further the care of the child. On the other hand, parents who are using the placement of the child as a pawn in marital friction are concentrating so heavily on this immediate end that they care little whether the child or the foster family is disturbed by their scenes when they visit. Awareness of the parents' current life situation can also be used as a guide for selecting the kind of foster family which will be able to accept the situation's effects on the child, for arranging the contacts after placement, for predicting what may occur during the parents' visits and the effect of the visits on the placement, and for calculating how often the visits should take place. Some foster families, for example, could not accept the visits of a prostitute mother who brings her pickup boy friends along. If parents who are separated are attempting reconciliation, this might well spur the child's thoughts to returning home soon and tend to keep him from relating to the foster family. Or if each parent after being divorced is contemplating remarriage to another person and these facts are not withheld from the child, he will be left bewildered and depressed in the foster home. If a parent brings his new mate to visit the child and meets the former mate there, a scene may result, as may confusion for the child as to what the parents' relationships are as a result of these changes. These examples point up why important trends and events in the current life situation of the parents need to be known both for the selection of the foster family and for the work with them after placement is made. The usual trends

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and events to be followed include such components as the living arrangements of the parents if the parents' whereabouts are known, their work and marital situations, and their disappearance or sudden appearance after a long period of contact or no contact, as these, along with many others, greatly affect the child's adjustment in the foster home. Knowledge of Interrelationships in the Natural Family, An understanding of the nature of the tie in the parent-child relationship provides yet another guide to planning for and dealing with the child's care in a foster home. Some foster families may not be able to understand, even after explanation, how a child can have such a strong tie and great yearning, sometimes shown openly, for a parent who has been extremely neglectful and even abusive like those of the first group described in Chapter 2. Moreover, often, the more pathological the parent's treatment of the child, the stronger is the child's tie to the parent. If there have been but few values in his first close dependency relationships, this tie is all such a child knows, and he clings desperately to it. Having received so little else, it is the only kind of contact he has with the world, and he is unable to understand the foster family's efforts to give to him. Eventually, in such a situation, the foster family, unable to accept his continuous withholding from them, may begin to believe that he is like his parent and to give up hope of his becoming different. Some foster families, if well prepared, may be able to accept the tremendous seduction of a small or even an older child which an immature, depressed parent is able to perpetrate. Parents of the second group described in Chapter 2, who seek all gratification from the child, are these. Other foster families may be too rivalrous to tolerate such immersion of the child by the parent; or else they may be too repelled and shocked by the parent's handling of the child to feel very positive toward the child after witnessing this. The report from the foster mother of the father who kisses his fourteenyear-old daughter on the mouth, "not as a father," or the one of the mother who calls her eight-year-old son "lover boy" to get him "all steamed up" reveal the reactions of the foster family. Such reports warn of the possible contamination of the foster family's

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feelings toward the child from their response to the parent, since the way the parent acts with the child stirs up shame and revulsion in the foster family over their own taboo feelings which they have repressed. Another instance where the parent's attitudes toward the child should be noted for handling with the foster family is when the parent's chief concern for the child is expressed in terms of whether or not the child will be a credit or disgrace to the parent, or will add to the parent's burdens, rather than in terms of the child's welfare or happiness. Such responses are usually found in the third group of parents described in Chapter 2. Foster mothers may become infuriated by the calculated selfishness in these parents, and may quarrel with them to the distress of the child. Or, if the foster family disapproves strongly and silently, the child will sense this and may thus become alienated from them. The highly conflicted parent of the fourth group may deal with his child in a severely contradictory manner and be very inconsistent out of the great ambivalences and guilt with which he is trying to deal. This will try the patience of the foster family, especially when such handling runs counter to their consistent handling. If the child incorporates the anxieties and tensions of the parent in conflict, this may bring on new or heightened symptoms in the child either of a somatic or of a behavioral nature, like a gastrointestinal upset or stealing, which spell more stress for the foster family. Then the parent's visits are not welcomed, are even dreaded by the foster family, thereby adding to the child's own anxieties. Of course, explanation to a foster family of the nature of these various parent-child relationships may help them to contain their indignation, soften their disapproval, and reduce the sharpness of their reaction. But better yet, early knowledge of the reactions to be expected in given situations on the part of the parent, child, and foster family may help determine the choice of foster family. This presumes knowing not only how parents and children will behave, but also which foster families can least or best accept particular expressions of the parent-child relationship.

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STUDY OF THE FOSTER HOME

Working with foster families, the chief focus of this chapter, is based on knowledge of their reality situations and what these mean, of their motivation for wanting a foster child, and of the dynamics in their personalities and family interrelationships. This is necessary not only for planning the right kind of placement for the child, but also for educating the foster family while they care for the child. An experience enabling growth may thus be provided for the child, and a fruitful experience thus awarded the foster family. Toward these ends, it is necessary to begin to give thought from the first contact with a family, at the time they make application to be a foster family, as to what the work with them will have to consist of. Preparation of the foster family for undergoing the study of their application, what will be contained in the study, and why is the first step. Preparation of the Foster Family for the Study. A foster family may feel resistant to being studied. This is usually true of the applicants who believe they are giving and not asking for service. In these cases it is important to bring out the feeling that the study is superfluous and personally accusing, tying this in with the fact that many people feel this way. Then a businesslike explanation should be given about the need for the study. It is needed for the foster family's own welfare as well as because of the agency's responsibility for the child. Reality examples should be presented. In this vein the applicant can be questioned rhetorically as to whether or not he would place his own child, if the need arose, with a strange family without learning what they were like, even if they were well recommended. The family can then be told that the sort of information asked for will help the agency to get to know them. To point this up a simile on investment might be used : the care of the child means the investment of the foster family itself, and, as would be true in a business venture, the agency which holds the precious plant of human life needs to know the assets and liabilities of the persons receiving the child. Moving closer to the specific case situation, it is best for a foster family to know in advance whether or not they would really

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like the responsibility of foster care before undertaking it. It can be pointed out that a study of their application for it can help the agency and the applicant to find out together. Further, they can be reminded that knowing them can help to determine what sort of child will best fit into their family, thus providing more certainty that this will be a happier experience for all concerned. The prospective foster parents will have reactions to any or all of the foregoing discussion, and thereby some diagnostic information about them will already be revealed. If the applicant shows interest in making the study, it is important to gain first a picture of the foster family's fantasies about what comprises the care of a foster child and what their expectations are in this venture. More specifically, the foster family's images of the child or children they prefer and the reasons for their preference should be elicited at the outset. Information should be sought also as to what they imagine it will be like to take care of a foster child; the role the child will have in their home (whether baby sitter, chore boy, boarder, companion to their child, or that of the daughter or son who was never born to them); what they expect of the child in his responses both now and as he is growing up; and how they consider the child in relation to his own family and to the agency. All this should be educed indirectly in order not to put the family on the defensive. They can be helped to express themselves with leading questions about, for example, the age or appearance of the child they would like to have or with a description of a hypothetical child, his experiences in the past, and his current behavior. Another way, by displacement, would be to describe for them some selected example of what other foster families generally experience in this undertaking. The more such information secured before giving the applicant realistic information about the children needing placement and about the agency's work, the more valid will be the picture gained of the prospective foster family. If such factual information is given without first bringing out the family's fantasies about foster children and their care, it will be very difficult, if not impossible, to ascertain the foster family's real motivations and expectations. The force of their wishes and fantasies will remain, and even though

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the wishes and fantasies are perhaps buried or pushed away, they will, nevertheless, continue to operate. What is told them by the worker will not be as real to them as it would have been, had their own ideas, stemming out of their needs, been brought out and their feelings about them aired. This would have permitted unrealistic attitudes to be altered. Without the uninfluenced airing, the diagnostic evaluation of the foster family will be blurred, and, in addition, their actions will continue to be influenced by their earlier views and expectations. Disappointment therefore will result. Since their expectations have been pushed down, their disappointment becomes less accessible to amelioration and continues to muddy the waters in the work attempted after placement is made. Once the various members of the applying foster family, at each one's interview, have been helped to express their wishes and expectations, why and how those which are incorrect have to be explained. Then the correct factual information can be supplied. Explanation beyond that stated during the preparation for the study is now given regarding the specific nature of foster child care. More is spelled out concerning the requirement that the foster family give up the child whenever that becomes necessary, about the difficulties the child will have in adjusting and the disturbances he will bring with him from his background, the actual presence and possible interference of the natural family, and the agency's continuing relationship with all three parts of the triangle and its supervision of the child. Following this discussion, less charged subjects are considered together with the applicant in order to allow the previous material to ferment until reactions set in. Such subjects should include the provisions the agency will make for handling the practical aspects of the child's care. For example, the possible board and room rate, the child's clothing needs, plans for his medical and dental care, and the school situation can be discussed. During this time, clues to the aforementioned reactions from deeper material should be watched for so that they can be followed in order to permit further clarification. These clues are to be found in unreasonable attitudes on the part of the prospective foster parent regarding trivial matters or in inconsistent reactions on other scores. Or, perhaps, some subject not significantly related to the business

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at hand will be seen to hold displaced feelings of great anger and distress stemming out of the disagreement between their ideas and the realities on the more vital issues of their relationship to and care of a foster child. Such phenomena should be explored but without interpreting the displacement, as a foster family at this point is not asking for such treatment. Only the matter which is believed to be the source of the disturbed reaction, such as the child's return to his own family or the agency's continuing contact, should be introduced again. Further exploration of the foster family's feelings about it should be undertaken, and then more explanation of the specific issue can be given for further clarification. There are two points at least in this process of studying a family's application to care for a child prior to reaching the one just described when the evaluation of the family's appropriateness may be concluded and a decision taken as to whether or not the study should be continued. One of these occurs when the explanation of the need for making the study has been presented. Another is after the applicant shares his expectations about placement. The reactions displayed may be so blatantly inconsistent with a constructive motivation that at either time, as now when reactions shown to previous discussions are too unfavorable and fixed, the inadequacy of the family for the work of foster care is clear, even allowing for change through casework help. If the applicant reveals attitudes fairly compatible with those which are needed for the care of a placed child or attitudes which seem modifiable, it is justifiable to continue into an exhaustive study. If rejection of the application is indicated, it can be done constructively, or at least with a minimum of damage to the applicant's self-esteem and sense of adequacy, if conveyed in terms of his expressed needs. If the applicant says that his only child is lonely and hence emotionally disturbed and that therefore he is seeking a companion for the child in a foster child, he can be told that a foster child is often a lonely, disturbed child himself, though for other reasons. Consequently, a foster child could not help the applicant, but rather would even add to his burdens. The foster family's capacity to work with the agency can begin to be gauged by their acceptance of the need for the study. Even

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though the assessment of this can produce a favorable impression, continuous evaluation of this aspect, as of others, should be carried on throughout the study, since the realizations in the applicant regarding the task will deepen, as will the worker's understanding of the applicant. At the beginning of the study, enthusiasm to take a child will still be fresh, and the family thus bemused may not be able to realize clearly what lies ahead. Although the reality of the job of foster care is never realized adequately until sometime after the child is placed with them, nevertheless the family will have gained a goodly appreciation of the task which lies ahead by the time the study has been completed. The applying foster family should be asked to consider hypothetical problems arising from the typical disturbed behavior of a child separated from his family in order to discover how they are equipped for dealing with these. More often than not at this point the foster parents themselves may suggest that they would like to feel they could call on the agency for help in such situations, should the problems be too perplexing and should they be at a loss as to how to proceed. What is involved in the foster family's investment of themselves in this work is not only described to them during the study, but also is well demonstrated, in a small way, by the extent they contribute to the content itself of the study, in which they are asked to participate. The purpose of what has gone into the discussion with the foster family up to this point has been largely to prepare them for making the study in terms of its being needed. It has also provided soundings and clarification for the applicant and the worker so that they may know whether or not to go further with it. The remainder of the study should include both factual and psychological information about the life situation of the family, the personalities involved, and the nature of the relationships between them. The Life Situation of the Foster Family. It is necessary to know the composition of the foster family itself and of the household if there are others in the home, such as roomers, hired help, and relatives. The age and sex of all have to be learned. Evaluation of these facts for what they will mean to the child must be made in relation to other factors in the situation. Hence, if there is an aged

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relative who requires a great deal of care living in this home, the presence of a maid or a practical nurse and the location of that relative's room in relation to the rooms of other family members may offset the disadvantages the relative's presence would create for the child. It is also necessary to know the physical condition of the home. This includes its material standards and state of care; its setup in terms, for example, of the number of rooms, their furnishings, and their location; and where the foster child will sleep in relation to where the others sleep. Knowledge is needed of the type of neighborhood in which the family lives. Is it rural, suburban, or urban? What is its delinquency rate, its cultural, financial, and social levels? Again it needs to be stressed that in evaluating this area for a given child the stereotypes should be avoided. For example, a rural development is commonly considered to have fewer stimuli for the acting out of a predelinquent child, whereas actually such a child may become even more daring and rash in his search for excitement when these quiet surroundings make him restless. Other facets of the neighborhood which need to be known are the recreational facilities, the type of school, and the proximity to the child's relatives, which is sometimes a factor to be considered. It follows, of course, that the foster family's standing in the community has to be ascertained. This is obtained from such sources as references from community figures, their pastor, and school authorities. The nature of the occupation of the foster father, and in addition that of all those in the household, and the approximate amount of income of the foster family should be known to the agency. The state of physical health of each member of the foster family and of others living in their home should be learned. The health of the immediate foster family should be discussed further with their family doctor, with their consent. And their religious observances and views, in their broad social aspects, should be noted. All this factual information is needed to make suitable arrangements for the child's adequate physical care and comfort and also to indicate sources of possible emotional stress to the child from difficult reality situations. A common example of such sources is

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the aged, sickly parent of the foster mother who will be querulous and irritable with the child. On the other hand, an aged grandparent in the home may be found to have the patience and capacity for companionship a child finds so delightful. A foster father who works nights and sleeps during the day, in a small crowded home with inadequate play space indoors or outdoors, can activate a chain of reactions, which although seemingly trivial at first may ultimately result in the child's removal. It is obvious that the noise of a child at play cannot help but disturb the foster father's sleep, and after a long period of this, tensions will be set up in both the child and the foster family. These could probably outweigh the benefits he could otherwise gain there. Often the prior knowledge of such sources of strain will not necessarily eliminate the home for use in foster care, but it will alert the worker to the need for planning measures to avoid the undesirable consequences. Such a measure might be arranging play activities after school in a neighborhood recreation center. Prior knowledge might also permit choosing a child whose needs and routines would fit appropriately in a particular home. An adolescent boy, for example, who is at school all day and works after school, would not interfere with the daytime sleep of the foster father employed at night. The general emotional stability and tone of the home atmosphere should be ascertained. Is there a too-still quality, a tomblike quiet, or a restful peace? Is it gay and fun-loving or tense and oppressive, with strictness or melancholy? Is it disorganized and scattered, making for discomfort and loneliness, or is there a sense of unity and sharing? What are the prevailing moods? A visit to the home in the evening or during a weekend, if possible, when most of the household of the foster home is convened may give the worker an opportunity not only to see who is there, but also to sense and perceive the atmosphere of the home. It is especially important to view the interactions of the family around mealtime, or, with children, at bedtime, and to catch the ensuing feelings on these occasions. Throughout the country it is bemoaned today that the number of adequate foster homes available is dwindling. It is unfortunate that in this situation some good ones will be overlooked and some

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undesirable ones may be used. This is especially true if the standards used to measure both the physical and emotional atmosphere of these homes are too rigid and unrealistic. Such standards may be governed by the subjective feelings of the worker. Or the surface picture may belie the actual pathological situation there, which is not discovered during the study due to lacks in the worker's dynamic understanding, or which is obscured by the worker's subjective need to avoid being judgmental during the evaluation. Either error will be detrimental to the foster home care. Since social work deals with maladjustments and deviations for which correction and healing are sought, the search for foster homes may tend to take the direction of trying to find the opposite of the distorted situation from which a child has come. If a worker's wish to help takes this form, this motivation, coupled with textbook information alone about human behavior, will create in him the need to search for the perfect home. Intellectually, he must know that it is impossible to find such families, but emotionally the wish and the hope for it remains. This causes the worker too often to seek a rosy situation, and therefore he may lose a desirable home when some deviation rears its head. Or he will make only a superficial study in order to maintain the illusion of the perfect fitness of the family to care for a foster child. As a result, there follow the surprises and disillusionments which cause the numerous replacements of the child. Later on, if the study and the basic diagnostic evaluation of the foster family have been inadequate, the work with the foster family to try to avoid the breakdown of the placement cannot be dynamically grounded. For example, neither the needs of the foster family nor those of the child can be properly filled. If workers can really believe and accept that there are no ideal foster families but that those having as much, and even greater, neurotic need as average families who rear children relatively well can serve adequately, then they will not be afraid to look for negatives as well as assets in a prospective foster family. Further, negatives can sometimes even have positive value for a certain child's specific needs. It is essential to know what is present in the emotional make-up of the foster family in order to make it usable. This much needs to be said at this point about worker's

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attitudes in regard to the realities in the search for foster homes. Further important influences from workers' other subjective views in the study of foster families will be discussed later in this chapter in connection with the total work with foster families. The Emotional Content of the Foster Family. Turning to deeper and more specific emotional content within the foster family, it is highly important to learn the character structure of each member, how each feels predominantly, how each operates, the role of each in the family balance. In these areas will be discovered most of the negatives as well as the positives in foster families. In order to learn all this, it is necessary to take a life history of each, with special emphasis on the individual's early experiences within his own family, especially those with his parents or parents-surrogate and siblings. This will reveal, with skilled interpretation, the essential patterns of an individual, referred to as the "infantile neurosis." Formed in the earliest years of life, it is the basic character structure. It does not necessarily mean that the foster parent is emotionally or mentally sick, as a basic character structure is universal, but it shows the person's special needs, the framework of his actions, and often the basic motivation (different sometimes from the stated one) to rear a foster child. Such understanding of the foster parent may indicate what reactions could be stirred up given certain behavior in a particular child or given merely the presence of the foster child, as seen in the following case example. A foster mother who was reared by her grandmother after her own mother's early death had always strained to return to her father's home after his remarriage and to be part of his new family. This never came about, but she never became reconciled to the separation, always striving to convince her father to take her back. Her stepmother, however, objected. The foster mother as a child had suffered abuse from uncles older than herself who were jealous of their mother's attention to her as a grandchild whom she was rearing. Later, when she was grown, she married and had a son. After a boy was placed with her, she gave more attention and even preference to him than to her own son. She justified this to her own son by telling him that the foster child needed her attention much

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more than did he as the foster child was not able to be with his own family. The presence of the foster child had stirred up her old longings to be included in her father's family out of which she overidentified with the foster child. She tried to give to herself what she had missed before by giving to him. She acted differently to the foster child than had her stepmother, who had kept her out, to her. When her own son became quite disturbed and withdrawn as a result of such aggravated sibling rivalry, her guilts caused her to request the foster child's removal, after having fostered his attachment to her. The worker's understanding of the foster mother's early life experience guided her work in helping the foster mother to understand her behavior and to modify it accordingly, thus maintaining the placement. The social history of a foster parent, showing what happened to the parent between the period of his early life experiences and the present time, should reveal the nature of the compensations secured from later life experiences—that is, how he has learned to manage, what he can tolerate, and the nature of his growth. In addition to aiding in the selection of the particular child who will best fit into a certain family, this evaluation will—and this is most important—serve as an excellent guide in the work with the foster family after a child is placed there. An illustration of this may be seen in the following example. Mrs. W. was eager to have some foster children, preferably babies, as her only child was now fifteen and she felt the need for greater activity. She gave the impression, however, of being somewhat peculiar because of her loud talk and laughter, and was heard to be harsh with her adolescent daughter. In taking her history, it was learned that she was third from the youngest of a sibship of eight, with a strong warm mother. Her father, though weaker, was given a place of esteem. Not much about her early childhood was enlightening in terms of her current personality until it was learned that the two siblings who displaced her were both boys and that she remembered how the father used to get down on the floor to

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play with these boys. Without her knowing why, she became extremely tomboyish in her latency and early adolescence, loved to be with boys, play their games, and so forth. Even now, she preferred being with the menfolk in large social gatherings. She was dressed in pretty feminine clothes, however, and with the loudness of speech and laughter, which were not all-pervasive, had a soft manner. In a temporary placement of two boys, ages four and two, with her, she did a fine job, giving affection and understanding care. It was decided that the loud laughter and tone were remnants of her hoydenish days which she still carried in part in her current life. However, now they were not felt to be bizarre, which had been the initial impression. Her tomboyish behavior was a reaction to her esteemed father's pleasure in her two younger brothers whom she envied in sibling rivalry and therefore emulated by becoming tomboyish. This she did to try to regain her former place with her father before these were born. Her original reaction to her father was largely positive because of his importance in the family, and she therefore made a positive identification with him toward the brothers. Out of her tie to her father, she loved them as he did. Her capacity to give warmth and affectionate mothering came from her earliest identification which had been with her mother. Thus, she had been able to do well with the two temporary foster boys, and was then given an infant boy in permanent placement. The history of her intervening life between infancy and adulthood showed the methods she developed in order to manage later. It also explained her current needs and strengths and the meaning of her unusual manner, including the harshness to her daughter. Regarding the latter, since the foster mother did not accept herself so well as a growing girl as she did as a mother, out of strong identification with her own mother, she could not so well accept her adolescent daughter. The current emotional picture of each member of a foster family, especially that of the foster mother, along with the history of each, should tell how the individual is now functioning, both within himself and in his reality situation. It should also indicate how

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much the individual can change. A survey of the three most important areas of a person's present life should help further in gaining a fuller understanding of his current ego functioning. These three important areas are the close interpersonal relationships, the work life, and the social relationships. In the first, where are included the marital and parent-child relationships, the manner of libidinal expression is more direct and at its highest test. In the last, social relationships, interests, and activities afford methods of sublimation as does the work life. The detailed content of what is included in the exploration of each of these three areas is described in the first chapter, "Diagnosis at Intake." If the foster family includes children, the examination of their adjustment is also enlightening, as a child's behavior in the three areas noted above is largely symptomatic of his parents' personality. The child's personality is especially revealing of the parents' underlying needs, because the child in his great natural dependency on his parents, is quick to sense and act upon those needs in order to please his parents. This aspect is illustrated in the following case. The oldest son, age twelve, of three sons, of a warm, relaxed foster mother, was a conforming and conscientious boy to the point of rigidity. This son was closer to his father than to his mother. When he was three, his father went into the army during the Second World War, and the boy was seen to grieve a great deal during his father's absence. The mother's history revealed that she was the youngest of four children, with a gap of ten years between herself and her next sibling. Her mother had been strict but at the same time extremely protective of her as a growing child, never helping her to learn enough about how to be responsible for herself, but instead assuming the responsibility for the foster mother. With her husband's absence, the foster mother turned to her small son in the sense of needing her dependency feelings met. She talked to this child about her woes. Because of his helplessness, she found him more available than her own mother for this. In his own needs for her, he sought to please her by taking on the role in which she unwittingly cast him. He tried to serve her strong underlying dependency needs

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which came through more vividly when her chief bulwark for them was not present. He became the strict mother she had formerly depended upon, and he also made himself rigidly conscientious in his assumption of responsibility in order to be able to carry this out when he was too young to undertake this. The entire evaluation of the foster mother's suitability should not rest solely on one area of difficulty by itself. Other factors present may either compensate for or dilute the neurotic drives, leaving her valuable despite her problems. In the above case situation, it was learned that the foster mother had never fully felt herself a homemaker and parent in her own right until her own mother's recent death. This was because her dominating mother, who had to take over for her as she had done all of the foster mother's life, had lived in the foster mother's home after the latter's marriage. The foster mother had three children whom she felt she never really had reared as her own because of her mother's presence. This the foster mother secretly resented. She told the worker that since her mother's death, she had felt free to take care of her home in her own way, and enjoyed it. She had applied for a foster child a year after her mother's death. Striving for growth in all directions once she felt free, she viewed the foster child as one she could rear by herself, since she had no plans to bear another child. As she was doing well in her growth since she had become unfettered, a foster child was placed in her home. Instead of the early dependency needs she had placed on her oldest son, she was now able to give constructively even though she had lost her mother's dominance on which she had leaned. When the worker gave her support, which was unlike her mother's dominance, she did not have to use a child as before to fill her underlying needs, but strove to prove herself able to function as a grown woman with the strengths she possessed but never had had the room to exercise. In securing such personal information, the worker who in the first place feels apologetic to the foster family for making the study, can be assured that securing the life history and a survey of the current adjustment need not be as prolonged and drawn out a process as would appear from this description of the amount of knowledge

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to be gained about the foster family. With practice, the salient points in a social history can be secured through alert listening and with a few skillful exploratory questions directed at the pertinent areas. No effort then need be made to obtain every detail, as all are not always fruitful or even necessary. Of course, the need for securing this information has to be first explained in nonthreatening terms to enlist the foster parent's cooperation. Other interviewing skills are needed for the worker's presentation of problem situations, as is done in projective testing, to elicit reactions to both general and specific situations common to foster home placement and to parent-child relationships. Even though foster parents' methods of handling given situations would not be correct in what they would say or do, as indicated by their response to these hypothetical situations, their general attitude and the tone of their feeling displayed with their response are more important. If these are positive and flexible in general, then it is very likely that the foster parents can be educated and the incorrect details of their words and actions changed. The nature of the foster parents' own questions and examples and their anecdotes given spontaneously are frequently diagnostic of attitudes and underlying feelings. A foster mother may be asked to discuss an experience of stress in her life and how she had managed it, especially one pertinent to her experience in child rearing. Her response, if not too studied, will reveal her strengths and weaknesses, as well as her methods of operation, such as the nature of the deftness brought into play, and what served her best. This may be the point at which exploration will lead into the foster family's attitude toward the natural family. Superficial prejudices in the foster family toward the failures of the child's own family are rather easily detected and either readily cleared away or covered over by the foster family. But in the foster family's recall of their own periods of great stress, they are helped to look at experiences analagous to those in the natural family. This will call forth their deeper feelings about the natural family's failures. If what the foster family expresses is harshness in judging the weaknesses of the natural family, then this attitude has to be studied further. This is done through a sympathetic presentation of the

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misfortunes of the natural parents and of the great deprivations in their early life which caused them to become as they are now. Then if these subsequent attempts to help the foster family to find some compassion for the natural family's defects bring no results, this aspect of the foster family should be tagged and later weighed against the total assets they present in the evaluation of their desirability as foster parents. Problems can certainly be expected to ensue from the foster family's lack of acceptance of the natural family and hence of the child. Interrelationships in the Foster Family. The interrelationships within the foster family—especially the special needs of one family member for another—the rivalries, and the scheme of family balance need to be known. Knowledge of how the relationships are constructed and what the needs of each member are in the marital, parent-child, and sibling relationships will provide signposts indicating what would upset the balance in them or aggravate existing strains there in terms of the placement of any child or of a particular kind of child. Even if placement of a child need not be avoided because of stress in the family interrelationships, or if the stress is discovered only after placement, this knowledge of the relationships is still needed in order to direct the work in the threatened areas. This will consist of bolstering, compensating, and the like to maintain the family balance. Draza Kline in a basic writing describes a case 2 where a foster mother who had done a good job in rearing her own children had also served well with foster children. She was the busy active partner, her husband the quiet, retiring one, and they had worked well together within these roles until a small boy, timid and withdrawn, was placed with them. He reached out to the foster father more easily, making a close tie with him and only a lesser one with the foster mother. Her position of importance in her own home was seriously challenged for the first time, and she saw herself failing where she had hitherto been most successful. Her need to have this child moved was soon expressed, and the reason was readily apparent. This child's needs had threatened the adequacy of the foster mother which had upset an important balance in the foster family's relationship. There are at times situations where a foster mother's own child

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is a disappointment to her, and she really prefers the foster child who holds a particular appeal which meets the foster parent's need. A small, pretty, vivacious foster mother had a daughter who was tall, slow-moving, deliberate, and orderly, but lacking in imagination and spontaneity and not popular with boys. True, she made a better adjustment than did the foster child in the family, as the latter did not achieve in school or conform socially to make girl friends as did the own daughter. Instead, the foster child, a girl slightly younger than the own daughter, was petite and pretty, with a sparkling personality. She wore clothes well and had many dates, beginning in early adolescence. It was most difficult for the foster mother to handle her guilt toward her own daughter for preferring and enjoying the foster daughter, which she did out of identification. Work to alleviate the foster mother's guilt and to help her relate better to her own daughter by pointing out the appreciation she had of her daughter's assets, even though these were different from those she liked in the foster child, helped to keep this placement intact until the foster daughter's early marriage. Motivations for Becoming Foster Parents. Much emphasis is placed, and correctly so, while making studies, on a family's motivation for wishing to take a foster child. With the exploration of the current reality situation and of the emotional make-up of the foster family, the motivation begins to become apparent. The agency's awareness of the underlying motivation as well as the stated or conscious one makes for a sounder placement. Sometimes the prospective foster parents may not be aware of their own unconscious motivation in this. When noted by the worker, it may or may not be wise to share it with the foster parent. Such sharing can be useful only if the work of educating and guiding the foster family in the care of the child after placement requires it. Both the stated and unconscious motivations may be valid and sound and compatible with the capacity to create a favorable experience for the foster child, especially if the respective motivations are not in serious conflict with each other. The foster family may have more than one motivation, all known to them. For in-

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stance, a young family with limited income may wish to have some extra money to help pay for their newly purchased home. If the foster mother does not wish to leave her own small children in a nursery or in the care of a housekeeper in order to earn for this purpose by employment outside the home, she may instead decide to keep a foster child for the board money. This motivation, while directed toward her own children's needs, may be indicative of the soundness of her capacity to be a mother. She may then apply this talent to her care of a foster child. As usual, however, using just one item is a dangerous way to arrive at a conclusion. A mother's choice of this method should bear further scrutiny as there are many other ways for a housewife to earn in the home. It may be that she is too passive and dependent to attempt other methods of earning. Evaluation of the parent-child relationships within the family should reveal whether such emotional needs are present in the foster mother, causing her to have to use the children's closeness to satisfy her own immature dependency and to circumvent her fears of contacts outside the home. Still further thought should be given to the motivation since there is the possibility that a passive mother may be extending herself, despite her passivity, to give enough to her own children so that they will be adequate products and thus a credit to her. This might arise out of a narcissistic need. Yet such a woman may not have sufficient capacity for mothering to make it stretch to other children, and, if so, she would not be able to make the effort to give to the foster child in whom she does not have a narcissistic investment. This might be tested by learning what interest she holds apart from her children, whether these require some giving of herself, and how she applies herself to them. On the other hand, a foster mother may realistically need the money, and at the same time she may have a great need to give mothering out of her own early emotional deprivation. These motivations are not contradictory, and may even stem from the same root, though they make their appearance on different levels. The mother's history may reveal this. Perhaps she was given to in abundance in the primary relationship with a mother-figure, from which she learned about giving to others. Then her source

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of dependency gratification was quite suddenly completely or to a large extent lost at too early an age. Instead of outgrowing her great need for dependency gratification, she continues to crave it because it was cut off so sharply and prematurely. While she manages by defenses to function adequately, at the same time she attempts to appease these longings by giving to herself through giving to others with whom she identifies at the level where she lost the source of her gratification, namely in childhood. She also wishes to give to herself through the things that money can buy. Unless there are too many demands made by this foster mother in return for her giving, her kind of mothering, although neurotically based, can serve a constructive end. It has been said repeatedly that the presence of financial motivation in and of itself does not detract from the usefulness of the foster family. Should this be found a motivation, it should be investigated to discover whether there are other motivations combined with this one or what intrinsic meaning the financial motivation may have beyond the practical need for money. The weighting of the financial motivation in conjunction with whatever others are found will uncover the further meaning the money may have for the foster parent. He may state an entirely different reason than money as the primary one for wanting a foster child, stressing this to cover his subjective need for the money, which he is too ashamed to face. On the other hand, he may really be altruistic about the money and desirous of other emotional compensations. Yet despite such a lack of primary motivation for money, the foster parent will expect to be paid. It is, however, acceptable in our culture to wish to be paid for creative and altruistic work, even if the work stems from unmet needs. Gaining an understanding of the meaning of money for the foster family, especially for the foster mother who does most of the work in foster home care, may help to clarify how useful the family can be in such work. If the foster mother merely wishes to gain some pin money, there would seem to be no contradiction in motivations if she chooses to earn it through her favorite work, child rearing, which becomes more of a hobby than a vocation after her own family is grown and gone from the home. Money

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as a motivation may also hold other subjective meanings. These include the sense of security it gives even in cases where the foster family is able to manage realistically without this income; the pleasure it provides when it permits an increase in the material standard of living; or the satisfaction it allows when it can be hoarded out of love of possession. These are but a sampling of the many meanings money may have for people. All are symptomatic of various needs, and should be considered in the total evaluation where money is a motivation. Turning to other motivations, it is often found that foster mothers who like to control and direct, in their need to give and to keep busy to meet their underlying stress, find that children in their natural helplessness lend themselves well to filling such needs. This behavior in the foster mother can meet the child's needs at the same time as long as she has warmth and flexibility. Some adolescents, however, who have a hard time maintaining their strivings toward independence do not fare well with such a foster mother, as she leaves no room for them to express themselves because of her need to control and direct. Other children who are younger but nevertheless very independent and elusive in order to avoid close relationships cannot be influenced by such a foster mother, who will become frustrated and, as a result, request their removal. This type of foster mother is particularly well suited to the acting-out adolescent should he be able to become involved in a relationship with her. He will feel better for the controls she imposes and these he will accept because of the relationship which has been established. Usually warmth accompanies these managing habits in this foster mother, so that the strong controls which stem from her can be somewhat integrated by the child. This type of foster mother is quite prevalent, and she and her family constellation are admirably depicted by Jean Charnley. 3 The "empty nest" often will be the source of the motivation for rearing foster children. When a couple still vigorous and in the prime of life find their children grown and gone from their home, they may have a need to sublimate. Their wish might be to use their capacity to be parents on account of the challenge and creativity that exists in rearing children, while at the same time

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they crave the companionship and response children give, the natural rewards of parenthood. The foster family with an only child may be seeking a foster child to provide a companion for their own child. This may or may not be a healthy situation for the foster child. If the only child has serious problems in himself, which the parents attribute to the fact that he has no brothers or sisters with whom to share their attention, then these foster parents are in effect expecting the foster child to help them rear their child. Their own child usually presents, along with personal disturbances, the social picture either of a withdrawn child, or of one who tries to dominate other children who, in turn, exclude him. Such social symptoms lend themselves well to his parents' belief that the problem is that he does not know how to share or to play with others on account of his being an only child. His parents then think that companionship with another child who lives in the home will cure their own child, when actually the problem lies in their own parentchild relationships. T o bring another child into this home would not only be unfair to the foster child, but would also increase the disturbance in their own child. What he had so little of from his parents in the first place, that which is causing his disturbance, would then have to be divided between him and another child, leaving the own child with even less than he had before. And the foster child who needs even more would get that much less too. A more favorable foster home situation with an only child is where the own child is relatively well adjusted, both in his relationships at home and with his peers outside. Here the parents do not seek a playmate for their only child, but another child to round out the family group. This makes for a healthy basis for wanting a foster child, because the presence of a foster child will stimulate desirable competition and will help the own child to learn to share the close tie he has to his parents. In this way the normal oedipal situation will be more readily resolved by the child. The child must learn in his growth process to renounce his parents as objects for the fulfillment of his dependency and sexual wishes. If some of this renunciation occurs early through learning

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to share the parents with another child, he will not have to struggle with this all at once later on. Foster parents will not ordinarily be aware of the advantages in these terms, but will state them in terms of their own understanding of the situation. They may believe that the presence of another child who is in a close tie with them will perhaps help their own child not to be babyish and to be less self-centered. Or maybe they will merely say that it will help their child grow up better, even though he is not a problem to them. The only child, in sharing with another child the happy family experiences which are more intimate than the experiences shared with playmates, will find in this a richness which offers some compensation for the loss of the parents' sole attention. Naturally, some rivalry and jealousy will be roused, but when handled adequately by the parents, they can become healthy ingredients in the development of both children. The foster family who wishes an older child to serve as a babysitter, or to help with the heavy housework in a large household or with the farm chores, should be asked to reach an understanding prior to placement with the child and the agency that some payment be made to the child. If the child is old enough to do such work, then he is old enough to be asked to decide whether or not he wishes to have such a work arrangement with the foster family. He should be allowed to keep his earnings for his own use to serve as an incentive to work, and they should not be considered part of his board payment. Society in Western culture has come a long way since the time when child indenture was condoned, and it is now considered the right of every child to be provided with the necessities of life, if not by his parents, then by society itself. It is to be expected that a growing boy or girl will need training in work responsibility to prepare for being selfmaintaining later on. This training should consist of letting the child assume responsibility for such chores as keeping his room neat and his personal belongings and clothing put away. These and other tasks involved in personal care are given in accordance with the child's growth. In addition, some participation in general household responsibilities which belong to the areas from which

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the child, together with the family, gains pleasure and other benefits is also indicated. In this way the child learns to share in family activities. Such responsibilities may include helping with the cooking and the dishes, caring for the lawn and the indoor plants, clearing away accumulated magazines and newspapers, carrying out the garbage, and other common household chores,

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mensurate with the child's age. Payment for these is, of course, not to be expected. Baby sitting or helping with the profit-bearing business or with the farm work of a foster family do not belong to the category of activities for mutual family benefit in which it is appropriate that a child share the responsibility. These are adult responsibilities, and if a foster child does participate in them, he should be given some payment, even as should own children for helping thus. Another motivation for taking a foster child can be seen in the foster mother who has borne two or three children, yet wishes for a child who will be hers alone. This she finds in the foster child. The example of the mother who applied for a foster child after the death of her own dominating mother is illustrative of this. Her mother had robbed her of the experience of rearing her own children, and though she wanted to bring up a child by herself, she felt she could not financially afford to have a fourth child of her own. A foster mother may also wish to have a child of "her own" to love, but without having begotten him through sexual relations. This need may stem from the repugnance she feels toward sexuality, which may contaminate her feelings toward her own child. Her attitude toward boys and men will not be a healthy one, and yet she may wish it to be different. It is possible that she could consciously handle this with help to avoid a markedly unfavorable influence on a foster child. Then there is the foster mother who, having suffered extensively during pregnancy and delivery with her own children, refuses to bear another because of the pain involved. Wishing for a larger family, she may seek an infant foster child to rear as one of the family. There might be sexual conflicts involved in the difficult pregnancies and deliveries, and though deeply buried and well defended, their influence could be

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ascertained by studying the adjustments of this mother's own children. Other motivations for giving care to a foster child can stem from the constructive sublimation of various neurotic needs in a foster parent. Such an instance is seen in the foster mother who, frustrated in her educational and professional ambitions, takes on this task as a vocation. Mrs. M., in her middle thirties, overwhelmed the worker from the first interview with rapid, compulsive talk and showed that she was a "doer." She pushed her own daughter, age ten, with afterschool activities like parochial school a few days a week, piano lessons, and clubs. This prospective foster mother showed partial insight into herself when she referred to her own aggression, adding that she did not wish her own daughter to be like herself, but yearned for her to become a "fine young lady." She volunteered that her inability to relax with her daughter made the latter shy and needful of encouragement. This she gave by, for example, cuddling her daughter before bedtime, hoping thus to offset the pushing. This applicant showed herself eager to broaden her understanding of her own daughter through her relationship with an agency worker. Throughout, she talked of her envy of the worker's job, commenting that it was "so fascinating." Feeling that her own club work was not sufficiently satisfying, she thought that having another child in her home would be "exciting and absorbing." She had read articles about difficulties in parent-child relationships, and intelligently discussed the reasons parents place children. She showed an intensive interest in the agency's policies, and verbalized that she was looking forward to using the supervision of the worker. This foster mother's ambition to become a trained worker was apparent. Not only did her comments point to this, but also her show of interest in areas not usually thought of by the average foster parent and her responses, which were predicated on professional attitudes, indicated it. Her experimentation with techniques on her own daughter showed good insight. The results were

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noted as favorable during a home visit when the daughter appeared to be quite independent, poised, and able to speak up to her mother, who accepted this. The foster mother's history indicated a capacity to learn, gained from a positive identification with the adults who taught her. Her father deserted when she was a small child, and she was reared by her grandmother in her mother's home while the latter worked to support them. Her mother saw to it that she received a good education, even though this was difficult because they lived in Europe, and the men teachers of the private school she attended liked her. She spoke of them warmly as father-substitutes to whom she brought her personal problems and confidences. One teacher especially played this role for her, and they maintained a fond relationship for one another throughout her life, even meeting in this country. Her education had been a happy as well as therapeutic experience for her, but she could not continue with it to the advanced degree she wished due to the family's financial struggle. Mrs. M.'s frustration from the interruption of these satisfying personal and educational experiences led her to seek indirect means of enlarging her knowledge and gaining therapeutic benefits for herself. This was why she wanted to be a foster parent. Especially the worker's contact with her in this would serve well these needs, and although the needs stemmed from frustrations, her history showed she could make positive use of them. She was therefore considered a useful prospective foster mother, as was her daughter considered a satisfactory prospective foster sibling. That she would assert herself in the inevitable sibling rivalry was a good risk, for she was observed as being poised and somewhat independent. Other motivations stemming from neurotic bases may also be useful, if the foster families holding them are selected on the basis of this knowledge to meet the needs of a given child and his parents. In other words, such foster families have only a special limited use, but they can be of value to a specific child with skillful casework help after the placement. This is illustrated in the following case situation.

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Mrs. G., a vivacious outgoing woman of twenty-nine, applied for a foster child between the ages of one and two, stating that she wished to replace her own child who had died at age two only six months before. Her child had been ill since she was six months old and had spent the last ten months of her life in a hospital. Mrs. G. described, with tremendous feeling, the care she had given her deceased baby, even during the ten months the baby was hospitalized, arriving at the hospital daily in time to feed the baby instead of letting the nurse do this. The exact cause of death was not known to the family, but it was thought to have been a congenital defect in the respiratory tract. The couple did have another child, age seven, but the mother felt that this daughter was already slipping away as she was growing up. The applicant spontaneously stated that she wished to become pregnant again but was afraid to do so as she would dread throughout the nine months the possibility of another congenital anomaly. Since her baby's death, the mother had tried throwing herself into many activities, especially those pertaining to children, but these had not satisfied her. She felt a great need to have a baby in her arms, and thought that if she liked having foster children, she might go on being a foster mother, never having another baby of her own. She also thought, on the other hand, that if she were to get a baby for temporary care, she might become ready to bear one by the time the foster child was released from her care. She preferred a boy foster child instead of a girl, because he would remind her less of her deceased child. Such rigid specifications from a foster parent for a child, by themselves, would mean that there was a highly subjective need for the child. The use of a foster child to replace a lost child can have ominous results, as the foster child is not then accepted for himself, and is forced to fit the pattern of the child he is replacing. There is also the danger that when the foster child is used in the parent's grieving for her deceased child, her depression will be communicated to the foster child. The foster mother in this case was straightforward about her own need and also about the guilt and anxieties from which her need for the foster child stemmed. This knowledge made it easier to plan the selection of a child and

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to help the foster mother with these feelings once the child was placed. Coupled with the negatives already mentioned in this applicant's motivation was her tremendous need for infants, revealed through her inability to sublimate through activities with growing children and her waning interest in her elder daughter. This child was seen to be well adjusted, except that she was too independent for her age, a result of her need to manage her later dependency feelings, which were not being sufficiently met by her mother. Mrs. G.'s wish to overwhelm an infant with mothering, in itself not too healthy, and her readiness with prepared solutions as to how she would relinquish the foster child were both considered excellent assets for a nine-month-old boy whose mother had been psychotic since the baby's birth. This baby had been given scant mothering at the most crucial period of his life. At the time of placement he was lethargic, he rarely smiled, and was hardly responsive. When he did respond, it was with a fearful expression. On the way to becoming an autistic child, he needed to be enveloped in love, to soak in it even more than most infants, in order to make up for his previous lack of it and to revive and increase the slight sparks of response he had learned. These requirements could be amply met through Mrs. G.'s great need to hold an infant in her arms. Since this infant's parents remained together and the mother was receiving psychiatric help for her post-partum breakdown, it appeared that the couple would reclaim their baby in the not-toodistant future. The father had already stated this definitely, and the mother was struggling with it in her therapy. Consequently, the temporary nature of the placement fitted in not only with the family's requirements, but also with those of Mrs. G. The treatment carried out by the worker to alleviate Mrs. G.'s anxieties, which would otherwise have been communicated to the infant, will be described in a later section of this chapter dealing with the work done with foster families after the placement of a child. It should be stressed that without skilled treatment such a placement would be too hazardous because of the precarious balance of positives and negatives.

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MATCHING CHILD AND FOSTER

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The foregoing is illustrative of skillful, close matching of the child, the foster family, and the natural family in terms of psychological factors. Sociologically, the child's overplacement or underplacement in terms of social, intellectual, and economic factors are to be avoided to avert conflict for all concerned. For the same reason, because religion is an important aspect of our culture, the child should be placed with a family whose faith or religious identification is the same as that of the natural family. Matching of the three parts of the triangle in other types of situations can be more general, especially if the diagnostic picture of each part is not yet clear enough at the beginning of placement to know definitively the needs of each part. A genuine acceptance of the fact that no ideal foster family exists can help the worker to do the best with what there is. This does not mean that attempts should not still be made to match the obvious needs, both real and subjective, of each so far as circumstances permit. It does mean that when the best selection cannot be made because this is not realistically available, the knowledge of what is needed is still necessary. Such knowledge consists of being aware of what each part needs from the other in the present, and also of what the past of each has been. This will afford a prognostic view as to how the foster family will react to education and counseling. When reality does not permit the most desirable matching of needs, then it is necessary to know the lacks and what these may mean, and to anticipate and prepare for the problems which will arise on account of them. The handling of these gaps should begin in the preparation of the foster family for receiving a child and be continued in the work with them after placement. If the worker knows in advance where to look for these lacks, this handling can be undertaken before too much trouble ensues from them. Finding means of balancing the trouble spots with some positive points and methods of compensating for lacks in the matching can help the worker to assess a foster home as acceptable and to make a constructive experience out of it for a child. This is shown in the following case example.

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Danny, age eighteen, would not relate to any adults because of his intense loyalty to his deceased parents, especially his father, who had been a strong but brutal man. The hostility Danny carried, without knowing it, toward his parents for abandoning him by dying and for the unhappiness they caused him prior to their death created a further barrier to his making ties with adults. To his peers and to younger children, he was abusive, as his father had been to him. Danny had to idealize his father since the latter's aggression, used possessively with his children, was all Danny had left to cling to in his bereft state. This idolatry of his father blocked any approach to helping him with his hostility toward his father, now displaced on the world at large. Danny's temper outbursts were uncontrollable, and he was abusive in the profane and depreciating terms he used. He had been in placement since the age of twelve, and was contained in the special residential unit of the agency as it was felt that no foster home would tolerate him. At eighteen, he was no longer able to remain even in the residential treatment unit because of his severe acting out there. Yet he was too immature, dependent, and unprepared to be placed in a self-sufficient living plan. He had been "nursed" through high school with the help of a tutor and through the permissiveness gained from the school officials by the worker's efforts. He had just been graduated, but was at a loss about the future, which frightened him and hence aggravated his difficult behavior. As he was too ashamed to admit to his dependency, it was thought that the loneliness and fear bred of living in the impersonal surroundings of a club or the "Y" would panic him into delinquency. A foster family wherein the father was the dominant figure in a positive sense wished to have an older boy as a boarder. This special request for a boarder, rather than for a foster child, produced the impression that they did not wish for intimate closeness with the child, and would permit a youth like Danny the emotional distance he needed because of his loyalty to his deceased parents. The foster mother, however, stipulated that she would brook no "hollering." She was told that Danny did have temper outbursts, but that nobody had ever liked him enough to try to stop him from

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having them as he had kept people at arm's length and worked at alienating them, even though he was lonely. It was learned that the foster father had known Danny's father as both had formerly lived in the same neighborhood. The foster father remembered Danny's father with liking because the latter had always acted "the good fellow" with the men on the corner where they assembled in the old neighborhood. This fact was considered "a find" to help balance out Danny's surliness and to meet his withholding attitude toward adults at a point of positive identification with his father. In addition, the fact that the foster father was forceful, though kind, helped Danny to transfer his ties with his own dominating father to the foster father. When this happened, he transferred some of his idealized feelings as well, but they were met more adequately by the foster father than they had been originally by the own father. With his dependency met in the only way acceptable to him, Danny's hostility was diluted, and he became more likable. His need to explode in temper outbursts lessened, and he was able to accept limitations to this from the foster parents. Always having been a good worker, originally to please his father whom he had helped in the latter's work, and now out of a strong urge to have money, he was guided by the agency worker, a man, and by the foster father to a job where he earned quite adequate wages. He derived dependency pleasure from having his foster father accompany him to purchase an overcoat. Thus this boy gained a pivot late in placement which kept him from a possibly delinquent life. After he was drafted into the army, this was the home to which he wrote and to which he returned to spend his furloughs. The placement was constructive, although it appeared at first glance that the child and the foster family were not suited to each other. It was the chance discovery about the foster father in the situation which changed the picture. On appraisal, it was found to hold assets for the boy. These could not have been used had not the boy's needs and the foster father's personality been known to work out the balance for the areas which did not match. Some general examples of matching can be listed as follows. Care should be taken, however, not to use them as stereotypes, but

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rather to qualify them for closer evaluation with specific information about the given children and foster families who fall into these types. A strict, orderly home and foster family is recommended either for the neat, conforming quiet child or for his opposite, the child needing limitations and control. This sort of foster home does not necessarily lack in warmth, but the warmth there is given within the outlines of the strict habits. The neat and conforming child will feel comfortable in an environment where there are habits like his own. The second sort of child who lacks internal controls needs more forceful external ones, at least at first, in order to feel more secure. The exhibitionistic foster family, which likes to boast and create a dramatic impression, is suitable for the child who has skills he likes to show off and who makes clever remarks to gain attention. He may be adept at reciting, singing, performing on a musical instrument, or in some other way demonstrating his talents. Such a child will use these means, the only ones he knows, to gain acceptance, and at the same time he will be a credit and do honor publicly to the foster family who need this sort of recognition. Such a combination will be constructive for the child, however, only if the mutual satisfaction on which the neurotic balance rests leaves room for more basic gratification for the child without his having to earn it largely by his performance. The ambitious foster family who is more quiet than the above one, yet is striving for social and intellectual achievement and for cultural advantages, would be good for the child of high intelligence who wins many awards in school and scouts, finds odd jobs through which he advances himself, and leans toward the arts rather than toward athletics. Such a foster family can accept the child's problems in other areas so long as he answers some of their particular needs. An example of this was seen in the case of an extremely obese boy who had a ravenous appetite which some of his former foster families had found repulsive. He was kept in the home of a subsequent foster family for years. There he was loved for his high achievement in school, for his interest in reading the classics, and especially for his love of good music which he introduced to this family and for which they were grateful to him. In return, the foster

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family were willing to accustom themselves to the chronic loss of goodies left around the house for the family's treats. The foster mother also had to devise a new food-shopping plan in order to keep the family supplied. Since this foster child would consume at one sitting a week's store of some foods, the foster mother started to shop daily for an amount of food calculated to last only for that day. This was the only way the family could be sure that their next meal would be available when the time came for it. A very relaxed, easygoing, warm family, without much drive and with not-too-high standards, would be suitable for the vegetative, bland child or for the slow, confused, and brooding child. One foster mother of this type was described as being "undeveloped intellectually, at ease in discussing such concrete matters as food and housing, and simple and direct in her manner. She cannot verbalize regarding causes of behavior, but she handles her own children intuitively well." She herself gave an example of this when she told how her daughter after grammar school

graduation

planned, at a girl friend's suggestion, to meet some boys at a drugstore corner to go out to celebrate. The foster mother persuaded her daughter to bring the boys home first for a minor celebration before going out for the major one, so that the foster mother could view the crowd and convey the impression to the boys that the girls had a responsible family interested in them. An extremely affectionate family is recommended both for the child who is openly loving and demonstrative and for the emotionally starved child who requires much tangible proof of love before he can reciprocate. The first child may offer affection, but if he does not receive a like response, may feel rejected. The other child, not being used to it, may not know how to express his feelings of love. In the foregoing examples are discussed a few among the many characteristics which have to be considered in matching the child with the foster family. This consideration will do much toward achieving a smoother integration, especially at the beginning. It might appear that such matching would only reinforce the neurotic patterns in the child, and this would, of course, be undesirable. One might argue that a neat, quiet child, for example, needs in-

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stead a relaxed, outgoing family instead who will encourage him to expand in order to become less inhibited and somewhat carefree. A compulsive, orderly foster family would hardly, on the face of things, provide such an opportunity for this kind of child. What is more important, however, is that the child be accepted from the beginning for himself as he is. This is more likely to happen naturally when the needs of the child and of the foster family are compatible, even though these needs have neurotic content. If along with this content, there is capacity for healthy giving and healthy growth, both child and foster parents will derive greater benefit from the placement. Such blending helps the child to fit in more readily, to begin to feel secure sooner, and thus to make new ties and to take root at the earliest time possible after placement. After this has begun to happen, then work should be undertaken both with the foster family, to modify their attitudes so that they will be able to handle the child differently to allow room for change in him, and with the child, to help him become freer of his neuroticism by direct treatment of him. If the foster family has the capacity, within their faulty structure, for giving the sort of care which will provide for a relatively healthy growth in the child, then he will fare rather well even if the foster family cannot change its habits. It must be recognized that basic character structure cannot ever be entirely changed. Some fundamental framework is needed as a basis for functioning. Only the excesses and other serious deviations which greatly hinder growth and create much suffering need be changed, including the source from which these negatives spring. And the change in this delimited area will never be a total one, but modifications and compensations can be made in order to allow for more freedom to grow, for compromise with reality, and for better functioning. The goal for the child then, if measured by this, need not be unrealistic, and planning for his care can be done accordingly. In selecting a foster home for a child of a given age, the ages and sex of the children already in the foster family, both own children, or other foster children, or both, should be considered. These factors influence the degree of sibling rivalry and the extent of sexual stimulation which will emanate from close living. It should

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be remembered that the incest taboo has not been integrated in children who have not grown up together in the same family unit, and housing them together after they pass their early years will present some of the same problems which camps and schools make provisions to avoid. It should also be remembered that some foster parents relate better to children of certain ages while other ages may bring problems if they stir up underlying feelings in the foster family. A foster mother who would be excellent in her care of babies because of her need for closeness would feel abandoned and angered by the adolescent who is striving to achieve independence. The child who is conforming and compliant during latency may shock and alienate the foster parents in the adolescent upheaval with an eruption of unacceptable behavior which had hitherto been dormant. An adolescent girl, in her exacerbated sexual seduction, may make an immature foster father very uncomfortable and upset the family balance. Therefore, in making a selection, the worker should anticipate what the age period which lies close ahead, as well as the current one, will mean to the child and the foster family. WORKERS' SUBJECTIVE ATTITUDES

Before leaving the subject of workers' expectations of foster homes, at least three areas which trouble workers in the field of child placement should be mentioned. These are the worker's own needs, his attitude toward the child, and his attitude toward the foster family. There may possibly be unconscious factors operating in the worker, which maintain their influence, despite his intelligent approach to home-finding, and which create blocks in his work. A worker may be searching for the perfect family for himself, owing to lacks in his own childhood. The foster families he looks for will hold the hopes his unsatisfied unconscious self is seeking. The needs of that unconscious self may include, for example, having excessive dependency gratification from parents, or being against mothering, or being the father's favorite. Without his knowing it himself, prospective foster families are measured against these needs as the worker studies these families. In view of the fact that everybody, even those who are well adjusted, has inevitably experienced some kind of

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deprivation and frustration in living, it is not necessarily alarming to have unconscious needs. Developing a capacity for self-awareness in regard to these unconscious feelings, especially as they relate to professional performance, is the first step in handling them. Then must come the ability to compromise with reality so as to give up the unrealistic search. Capacity to utilize other satisfactions will make the adjustment sounder. All these points are criteria of maturity. Achieved sufficiently well, they make for the mature self-disciplined worker. Another aspect of the worker's subjective needs may be found in his overidentification with the child. This is especially true of the female worker who, out of maternal needs, wishes to possess the child for herself. This makes it most difficult for her to share the child with the foster parents and interferes unconsciously with her capacity to find the appropriate foster family for the child. Either no family is found adequate on the one hand, or, on the other, little attention is paid to the adequacy of the foster family, as if they did not matter to the child. The worker who feels pleased that the foster family can give to the child what he needs is not apt to be overly critical of the foster family nor indifferent to them; he is in sound rapport with the child. It is not unusual, however, to find some of the highly subjective reactions to the child, as mentioned above, existing without the underlying feelings in a worker who has invested a tremendous amount of effort and feeling in helping a very disturbed child make remarkable progress. This is especially true in work with psychotic children where the use of the relationship between child and worker is the chief tool. The worker in this situation is more closely related to the child out of real giving to him than is true in the usual professional relationship. Being naturally more wary of what a foster family may now do to that child, the worker becomes overly selective in choosing the foster home for him. An understanding and sympathetic supervisor can help such a worker with this planning by sharing the responsibility for the child. Since the supervisor is close enough to the situation to sense the needs of the child, he may well feel sufficiently concerned for him individually to aid in making the best choice. To a worker who is otherwise not too

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deeply involved such help would be welcome, as it makes him feel confident that the child will get the right kind of home. Another involvement of the worker with the child who is to be placed may emanate from his feeling an unduly great weight of responsibility toward the child with reference to placing him. The worker realizes that his act of providing a substitute home for the child—which will be of lasting significance in the child's life—ranks in importance as a life and death matter, in the emotional sense. Because of all the child has already suffered, the worker is anxious to forestall more pain and disappointment for him, which would be his lot if he experienced an unhappy foster home. He wishes to avoid for the child the necessity for leaving new ties begun with a foster family. An unhappy placement, requiring that the child be moved from the foster home, would be a cruel repetition of what he endured in the loss of his own family. These realizations can make a worker hypercritical in the evaluation of foster families. Or, unable to bear the pain of these realizations after experiencing them overlong, the worker will repress them and work on a superficial level, where there is not sufficient evaluation of the foster family. The worker can even come to feel guilty toward the child on account of the possibility that he may cause the child additional pain through a poor placement. This reaction of guilt may, further, reflect back to the very need to place the child. To gain perspective, the worker must stop to realize that he did not cause the child's original pain in the loss of his family and that he is attempting to help the child gain something which will enable him to compensate as far as possible for that loss. Lastly, the questions the worker must try to answer are: Will a particular foster family give this child sufficient security and emotional nourishment despite their negatives? And will this situation be a better one than that of his own family? Directly toward the foster family itself, the worker may have yet another set of subjective attitudes to handle. Still influenced by the beginning teaching of social work not to be judgmental, without its meaning fully understood, the worker can feel guilty about judging the foster family as to its adequacy. Further guilt may be aroused

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by the act of deciding on the judgment that this family should not be given a foster child. Such guilt can blur the diagnostic understanding of the foster family and the subsequent evaluation which is based on that. It must be remembered that the judging is not done for the purpose of condemning a family in its entirety, but rather, so as to make an evaluation of their capacity in one single area. All of life's activities are based on value standards; without these, nobody would care what might happen. The passive approach may be the easiest for some workers as it eliminates the responsibility for making a decision based on an evaluation. For others, it may be more difficult to be passive when that is indicated, such as when the situation requires that the client make the decision. The discriminating use of activity as diagnostically indicated, involving the applicant in sharing the study which brings her to recognize the decision herself, is the correct course. In applying this to the need to refuse an applicant for foster children, it does much to guide the process of the study with its possible rejection so as not to cause an injustice or produce a sense of harshness in the worker with his possible subsequent guilt. Another area of subjectivity which burdens workers in this field is in their sense of obligation toward the foster family for tolerating the difficulties presented by a foster child. Workers may feel that they owe the foster family such a debt of gratitude for doing this, which they come to regard as a favor, that their critical faculties and their activity in guiding the foster family are inhibited. If the worker understands the motivation and needs of the foster family to rear a foster child, and if these coincide constructively with the needs of a particular child, then the worker can expend his efforts on helping each meet the other's need. This is what constitutes his true obligation to both the foster family and the child. When the worker acts thus, he can then feel assured that the foster parents will find gratification in return for their physical and emotional investment in giving care to the child. The improvement in the child's disturbance and the child's response to them personally are ample rewards to the foster family; they really seek nothing more. The fact that a foster family comes to the agency ostensibly to offer help to another, rather than to seek it for themselves, may

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create another subjective reaction in the worker, which will interfere with the work of guiding and educating the foster family. The worker may feel defensive about giving help to the foster family, especially when this entails the need for a change of attitudes within the foster family. Further, he may feel it is presumptuous of him to embark on such an approach when the foster family is not asking for it. It is well to remember here that such help is not accepted by anybody if it is not wanted. Therefore, it can probably be assumed that the foster family has asked for it indirectly by applying for a foster child. This may be barter; asking for a child may serve as a ticket of admission to the agency to enable the family to get its own needs met. If the foster family continues with their application after the preparation for the study is completed, then they are unconsciously seeking help with their own needs. This conclusion is valid because the family still wishes-to have a foster child after having discussed supervision by and work with the agency in their care of the child. If the foster parents are looking for emotional help for themselves from a foster child directly or from the agency behind him, without being willing to make the investment of self for the benefit of the child, then they are not healthy enough to be given a foster child. Most foster families, however, do not require much change in their attitudes since they have been chosen on the basis that their capacities for this endeavor are already quite fully developed. Those families who do require a great deal of change, even if they are willing to attempt this, are really not ready to function under the responsibility of caring for a placed child. These should not be chosen in the first place, but the need to help a foster family with their emotional setup to a greater extent than was originally planned sometimes arises. This is due to the fact that their need was not seen at the time the placement was made. By the time it becomes apparent, the child has usually already made a meaningful tie to the foster family, and this should be conserved. It then becomes necessary to undertake work with the foster parents similar to that done with parents in a child guidance clinic to bring the most favorable results possible from them for the foster child. Care should be taken to evaluate the potential gains from such effort,

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for these may make it feasible to keep the child with the foster family. This is indeed preferable to his replacement in most cases, as the foster family will probably have already become so important to him that replacement would be almost as traumatic as separation from the natural family. And as with a natural family, treatment should be attempted before the separation is planned in order to try to keep the child where he feels he belongs, if the situation in the foster family is not too damaging compared to the other trauma. The decision for replacement is often made too quickly. Appreciation of the child's ties to the foster family, despite disadvantages for him there, and the weighing of other possibly more serious disadvantages in moving him are lacking. The workers in the field of child placement must play an active role in the total life situation of the child, and this inevitably elicits subjective reactions in the workers themselves in varying degrees. Considering what they have to deal with in this complex triangular situation, the question arises as to how they can be expected to manage all of it. If they maintain a continuing awareness, as outlined, this will help to reduce the influence of their subjective feelings. Understanding support from their agency administration will help them to bear their anxieties so that their energies will not be deflected and their effectiveness not reduced. THE WORKER'S RELATIONSHIP WITH THE FOSTER FAMILY

The study of a foster family's application is usually made in a separate department of the placement agency, referred to as the home-finding department. By the time a worker has reached the point in the preplacement work with a child and his family of introducing them to the foster family, it is necessary for him to know the foster family too. His relationship with the foster family begins with the intention of placing a particular child there, and hence the development of the relationship is facilitated by the imminence of the reality toward which the foster family have been looking forward. All of what has already been said about workers' subjective attitudes also applies to the work which begins here. Some repetition of the study by this worker is unavoidable in order to familiarize himself with the foster family in relation to a

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particular child. The repetition will be more acceptable to the foster family if they are told that this is possibly in preparation for a particular child and that efforts are being made to determine whether each will be happy with the other. The work with foster families during the process of placing and after the child is placed, although not quite so direct in casework method as is the work with clients, is nevertheless based on the use of a relationship. The prime requisites for developing the relationship are the wish and capacity of the worker to give and an understanding of the dynamic needs of the individual to whom he relates. Especially is there the need for the worker to clear his own feelings, as far as he possibly can, in those subjective areas already mentioned and in the additional ones brought into play by new aspects of the work after the child's placement. There are general postulates relating to the worker's attitudes which govern the development of his relationship with a foster family. The worker's real conviction that he comes to help the foster family in the care of the child conveys a spirit which undoes the feeling in the foster family that he is "snooping." A worker will believe his efforts are both valid and necessary if he has a genuine appreciation of why a foster family's care of an unknown child disturbed by the loss of his own family requires skilled help to make it constructive. If the worker believes and feels comfortable in his role as provider of this skilled help, this should influence him to approach his task in a sincere and unpretentious manner. T o this a foster family will respond positively. It will help to open the way to mutual discussion of the child's care, to sharing the problems this entails, and to working for solutions together. As has been frequently said, the working relationship with a foster parent is not just like that with a client, nor is it exactly like that with a colleague. It does, however, bear a rather strong resemblance to the relationship between supervisor and student social worker, or later, experienced worker. The degree of the foster parent's experience, skills, and general development in performing this task can be likened to similar degrees of functioning in a staff worker. This is what determines the content of the supervisory responsibility for a staff worker. Just as both the supervisor and the

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worker are professional people striving toward the same goal—that of devising the best ways of helping people in need—so too, the worker and the foster parent, who is sometimes regarded as a professional parent, work together as a professional team toward a goal similar to that of the first team. Either the worker or the foster parent takes the lead in their work together at given times, though usually it is the worker who does so at first. As at all times within an agency structure the supervisor is administratively responsible for the student's or the worker's professional activities, so does the agency worker carry an over-all constant responsibility for the foster family's care of the child, since the worker as representative of the agency is liable for the foster child's welfare. Such authority in the worker is implicit and necessary to protect the children who are under care. The natural family or the court explicitly assigns this authority to the agency and its representatives when the agency is given the task of placing the child. Although the use of authority is not productive in teaching (including the teaching of foster parents), the understanding that it exists and is the premise on which the worker's presence is based endows the worker and the foster family with a framework for their mutual endeavors. Carrying the allegory further, just as a supervisor attempts to understand the manner of the worker's functioning in his professional activity, and is guided accordingly in the teaching role,* similarly, the worker's goal is to know the foster family's mode of operating, in order to plan his approach for helping them. This of course applies to the approach to the individual relationship with each member of the foster family, although, validly, there is greater concentration on the work with the foster mother, since she naturally carries the largest share of the care in most cases. The guiding principle generic to the development of any meaningful relationship is that a person's need has to be met at the point where he feels that need. To forestall the possibility that this be acted upon too literally, it should be stated that if the defensive need is socially unacceptable or destructive, it can almost never be gratified, even to win the person's confidence. Such giving is undertaken once in a great while in unusual situations, as in intensive treatment where there are controls of the hazards, to serve as a means to a

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better end. But it should be used only with caution as a last resort for reaching a client and its side effects weighed against gains expected. Before getting too far into a theoretical discussion at this point, suffice it to say that families with needs requiring an approach like the last one described above would be too disturbed to serve the role of foster family. But if a bossy, controlling foster mother needs to take the lead in the relationship with the worker and in planning for the foster child, the worker should recognize this need and give to her at this point by leaving room for her drive and initiative to operate. At the same time, to gain her respect so that she will listen to the worker's contribution when this is necessary, the worker must be firm with her when differences of opinion that matter arise. The firmness, however, must be accompanied by unfailing warmth. In working with a foster mother who, although a lay person, is ambitious for professional knowledge, the relationship with her will be facilitated if the worker shares with her the casework process, with fuller explanation of the dynamics of behavior, in a universalized fashion, than is given the average foster mother. The former foster mother will then gain the feeling that she is obtaining professional status and education. This gratifies her need at the same time she is learning more about how to deal with the foster child. Her self-esteem will be further increased if the worker, in discussing certain behavior of the foster child, quotes from clinical authorities in the professional literature. Another way of relating dynamically is shown in the illustration of the approach to the openly dependent foster mother who has not erected defenses to hide her own dependency needs. She can serve well for a foster child if she has ego strengths elsewhere which help her adequately to use the direct advice given her by the worker. Expressions from the worker of valid praise and of confidence in her abilities, which might be construed by those with other types of character structures as depreciating, are eagerly sought by this foster mother who tends to underrate herself. This will bolster her in areas in which she has been unable to erect defenses for the deprivations in her early childhood. Yet another example is where a foster family's own son can be helped to accept better the rivalry

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of a younger foster child by bolstering continuously his pride in growing up and the status and achievements this brings him. As in all relationships, more times than is ever acknowledged transference feelings creep into the supervisory relationship between an agency supervisor and the worker on both sides, and if they are not recognized and dealt with, they will hinder the working relationship. This also occurs as often in the relationship between the worker and the foster family member. Many aspects of these subjective feelings as they pertain to the worker's efforts, have already been described. Similarly, the foster parent's underlying feelings will be evoked by different aspects of the experience of the relationship. His attitude toward the worker can become beclouded by subjective feelings from the past which do not belong to the actual contact with the worker. These feelings in the foster parent will create stumbling blocks in the joint efforts for the child's welfare, even invading the foster parent's relationship with the child. Such phenomena should be watched for in the foster parent's handling of the child, in the trends in the discussions with the worker, and in the foster parent's manner of dealing with the agency about concrete matters. If the intrusion of such alien feelings is not noted through open display in tone and manner, it may be seen in their more subtle expressions. For example, disregarding policies which were once accepted, or making unreasonable demands, especially in financial matters, on the agency are clues that transference feelings are operating. Care should be taken to differentiate these phenomena from justifiable reactions to real issues which occur because of error on the part of the worker, lack of understanding by him, or his acting out at the foster parent of unconscious negative feelings. When transference feelings appear repeatedly in the supervisory relationship, the supervisor may deal with these directly by pointing out that these reactions occur where the reality situation does not warrant them. There usually follow mutual attempts to clarify whether these feelings are reality or irrationally based. With maturity on both sides, some agreement can be reached after clarification of misunderstandings is secured. Then attempts can be made to guide the future relationship. For the supervisor to deal with

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these transference feelings more extensively requires embarking on therapy. While such intensive involvement is usually deemed inappropriate to the supervisor-worker relationship, it is quite appropriate for dealing with transference phenomena in the relationship with foster parents, except when their subjective feelings are inaccessible to consciousness. To the resistance that the foster parent may express in his accusation that the worker is "trying to use psychology" on him, the worker's nondefensive and sincere reply that he is trying to understand the situation better in order to be able to deal better with it may allay the resistance, at least temporarily. It is not always necessary for the worker to help the foster parent learn the original source within his past experiences from which his subjective feelings spring. Simply pointing out the overdetermined and displaced reaction to a given situation in a nonaccusatory manner, but with an attitude of searching for understanding, will set the stage and focus of the ensuing discussion. The worker's statement of his positive intentions may give the foster parent support in admitting his misunderstandings or grievances, either those which have arisen out of reality or those from transference feelings. If they are seen to be displaced subjective feelings, it is still not nccessary to point this out. They can be alluded to as misunderstandings to which the worker may have contributed. The worker should point out his own different attitude, as this serves to clarify the transference situation. After the feelings have been aired, and when this is followed by an offer of help in terms of the foster parent's current need, the source from which the troublesome transference feelings stem, usually deprivation, will be mollified. It is important to keep the relationship with the foster parent thus cleared of transference feelings, without interpretation of them. PREPLACEMENT WORK WITH THE FOSTER

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Once the foster family is selected for a given child, then they must be prepared for him. This preparation is carried on simultaneously with the advanced part of the preplacement work being done with the child and his family.

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Talking in the abstract provides some intellectual awareness of the experience of caring for a foster child and also ferments emotional reactions about it, but such talk makes only the beginning of an impression on the foster family of the meaning of this experience. The reality of it starts to take shape when a particular child is suggested and described, and depicted gradually so that the foster parent does not find the information overwhelming. The child's physical appearance, symptom and behavior picture should be described, as well as his assets and modes of operation, his practical habits, and a projection of his possible problems. It is important to be frank regarding the difficulties the child can be expected to present based on either what is known to occur in his home and other environmental areas like school and camp or on his past experience in placement. The harvest reaped from lack of frankness about the child is not worth the temporary shelter gained for him, if his behavior is quite certain to cause his early replacement. Even if his removal is not requested, the lack of frankness on the part of the worker will generate justifiable anger and distrust in the foster family. This creates a barrier toward any possible efforts to help the foster family cope with the child's difficult behavior so as to help him with it and not just to tolerate it while it worsens. It is suggested that the worker wait for the foster parents' reaction to the description given of the child before qualifying it with explanations. It is important to glean the foster family's original responses toward the child as he appears to them, since these will be basic to their daily response to him. They are more discernible, and hence more available for modification, if dealt with before explanations are given which can be used for rationalizations to cover over the initial responses. Their doubts and uncertainties about the child, if noted, should be accepted and aired, and they should be encouraged to tell what prejudices and other sorts of reactions the description has evoked. In stimulating the foster parents to discuss similar disturbed behavior, which they either have known in their own family or have observed elsewhere, and measures for coping with it, they are given time and opportunity to bring out indirectly the deeper reactions to the description which

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lie beneath their first polite and conforming statements. Discussion of actual behavior known to them in others which resembles that which will confront them may help them to realize somewhat more vividly what is in store for them. The foster family should be advised again at this point that the responsibility they are shouldering requires much investment of themselves. If they are still interested in continuing with the undertaking, then the child's history should be imparted to them selectively, giving them only enough to help them understand his disturbed behavior and how he feels about his experiences. In this way they may gain at least some sympathy for, if not understanding of, his plight. When relating the child's history to the foster family, they can be helped to realize more definitely than when advised at other times that if their care of this child should fail, the fault is not theirs. They can be shown where his problems arose in the trials he experienced in the past and that he brings the damage from these with him. This damage will create snags to his current adjustment no matter how auspicious his present environment. In order not to dismay the foster family about their future efforts, however, they can be told that the worker will help them to deal with the damage of the past in their present handling so as to make it possible for the child to use the current environment. Although emphasizing the fact that the damage to the child occurred in the past will not always allay the foster family's sense of failure should the placement not succeed, it may help when done in advance to alleviate their initial fears that the respoiisibility to "cure" the child is entirely theirs. To prepare the foster family further, still by degrees, anticipation of specific problems the child may present in relation to this particular family's situation should be communicated to them. Apparent sibling rivalries, aggressions toward situations which are provocative to the child's character structure, and other such problems which will occur, especially when the matching of the child to the foster family could not be as complementary as desirable, are pointed out. Among the general problem situations to be anticipated is the breakdown of the initial "honeymoon" period, which will probably

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be accompanied by great disappointment on the part of the foster family. This good period takes place at the beginning of the placement when the child is attempting to please in order to win a place for himself with the new family. It is well to tell the foster family that the child's conforming behavior is not deliberate deception, but is, rather, his defense for his insecurity. The defense will wear thin because it is not a habitual one and covers a tremendous upheaval. When the defense breaks down, the family may not turn against him so strongly if they have been thus informed. And they may also be better prepared to cope with him as he reverts to his usual pattern of behavior. They should be warned that a testing-out period will probably follow the "honeymoon," since the child also will be disappointed and angry that the latter period did not last because part of him wished and believed it would. He wants to feel that the foster family will accept him as he really is even as they accepted him when he was putting his best foot forward. The foster family should be further advised that the child wants to know how much he can use this environment for revenge and the limits to which he can go. Lastly, it should be explained that he does not have the strength to contain his impulses since his early experiences were not conducive to building it. Ideally, it would be better if the testing-out period came first so that the foster family would be less disappointed by the behavior accompanying it than when it appears after the "honeymoon" period. Even if they have been warned that it is to be expected, the "honeymoon" is bound to disarm them and leave them less prepared to accept it. In anticipating other types of symptoms, such as the regression which is usual to the threat of change, it should be mentioned to the foster family that these may not appear for some unforeseen reason. Then the foster family will not wait expectantly for the bedwetting or the late hours or the stealing to occur. Elimination of such waiting is desirable because an atmosphere of expectation, if too pronounced, may goad the child into acting out what is expected of him or into finding some other means of being provocative. The foster family should be reminded of the meaningfulness to the child of his ties with his natural family, and given information about the particular meanings this child's ties have for him. The

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kind of behavior the natural family shows toward their child and whatever may be carefully speculated about the parents' behavior in contacts with the foster family should be imparted to the latter before the child is placed, even before the child is introduced to them. Some discussion is indicated as to how the foster family should specifically handle the natural family, how they can remain as neutral as possible with the particular kind of parents involved, and when they should refer the natural parents with their requests and complaints to the agency. Throughout this discussion, the worker should mention his promises of support and understanding, so that the task will not seem too overwhelming to the foster family. If that family should now wish to withdraw, it is well to discover this before the child is subjected to meeting them. Should the belated decision of the foster family that this task is more than they feel they can undertake be received after the child and the family have met, inferiority in the former and guilt in the latter will be the result. These reactions can be averted with knowledge of this decision prior to the meeting. Meetings between the foster family and the child before the placement is made, and possibly between the foster family and the natural family, as described in the chapter on preplacement work, can facilitate the discussion of anticipated problems. If, during this process, the foster family, and especially the foster mother, find themselves feeling prejudice or even distaste toward the child, which makes them decide not to take him, it is necessary to protect the child from this rejection. Full sharing by the worker of information about the child with the foster family as described above, prior to the first meeting, should have obviated this painful situation. If, however, the information was shared and the foster family gave no hint of inability to accept the child, then it would be valid to assume that the onus of the need to reject rests on the foster family, that it stems from their problems. The reality of this situation can be related to the child to soften his resultant feelings of inferiority. Though the latter are inevitable, he can be helped to share his unwarrented sense of failure when it is explained to him that the foster family failed in their mission and that the worker did so in his by not better understanding the shortcomings of the

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foster family. An example, spelled out verbally, is thus given the child that adults can make mistakes but that these do not mean final failure, because the worker will try again to help the child and will learn from this abortive attempt not to make the same mistakes again. WORK W I T H THE FOSTER FAMILY AFTER P L A C E M E N T

After the child is placed more intensive work with the foster family becomes necessary, especially at the beginning, in order to help make the start a good one. When child and foster family are strange to each other, early and frequent visiting by the worker, giving support and guidance to both, is vitally important to the success of the placement. This concentrated work is essential until a favorable adjustment begins to take shape, and it should be continued until the adjustment crystallizes. After there is some stability in the placement, the contacts can usually be tapered off to less frequent visits, supplemented by intermittent telephone discussions, if this is geographically feasible. Such a plan is determined where the needs of the situation indicate it. In some cases foster parents require continuous support, while in others the child's problems necessitate the worker's continuing intensive contact. Where neither of these situations exists, periods of crisis may nevertheless occur even after the adjustment appears to be stable. For example, reactions requiring expert handling may be evoked by reality situations involving the natural family or by a phase of development in the child, such as adolescence, when old conflicts are reactivated and added to the stress of new impulses. The work then has to be concentrated again to help both child and foster family resolve the difficulties. Between crises, a continuing contact will help the worker to anticipate or to recognize early signs of trouble, and it will also keep the worker close enough to the foster home situation so that he is not considered an outsider or an intruder when it becomes necessary to be more active again. Despite the orientation and preparation of the foster family during the steps preceding placement, they may still react initially with shock, disappointment, and bewilderment to the responses of a child to placement, especially if he is a disturbed child. The foster

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family can better accept with sympathy the child who withdraws in a depression or the one who internalizes his feelings so that physical illness results. These reactions appear to be in the minority, however, and the acting-out child is the one more frequently seen. He is less acceptable, and again, it is first necessary to help the foster parent ventilate his feelings about this behavior and for the worker to show acceptance of these. Counseling of the foster parent should take place only after the feelings are explored, as their content provides the guide to the course the counseling should follow. The content of the ongoing work designed to help foster families care for placed children, which usually includes deeply emotionally disturbed children, is of varying degrees of intensity and depth. This content depends on the need, the accessibility of the foster parents, and the skill of the worker, as well as on the function the agency sees itself performing. Advice and Guidance. Counseling is the treatment measure most generally accepted by agencies as their function and is the one most palatable to foster families. It generally consists of giving advice fashioned to the dynamics of a given situation, with an explanation of the advice. But the foster parent cannot "hear" advice correctly when there are strong emotions either seething or deeply buried within him. Therefore, it is necessary first to ventilate whatever of these emotions have been stirred up. Then, rather than offering ready-made advice, even if it is appropriate to the given situation, it is preferable always to have suggestions come from the foster parent himself after discussion. These will be integrated better if they are part of the foster parent's own experience. He can be helped to contribute in the planning of the measures to be used by bringing into the discussion the understanding he has gained from handling his own children, from his own childhood, and from his reading of the sound articles now made available to the lay public. This material can be shaped with his participation to meet the foster child's needs. Later, it may be necessary to give the foster parents some guidance in their use of the advice they have secured in this fashion by a follow-up of the results and by rediscussion for further understanding. It is commonly acknowledged that not enough work is done with

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foster fathers and that the chief focus is on foster mothers. This parallels the pattern of the family in our total culture, where the mother-figure is the manager of the home and of family interrelationships, while the father-figure spends most of his day working outside the home. When the parent-figures have a close relationship, the foster mother will convey to her husband much of the guidance and understanding she has gained from her discussions with the worker. Often the foster father adds his contribution through his discussions of this with his wife. She, in turn, will bring his attitudes back to the worker for further consideration and integration. At certain times, however, direct contact with the foster father by the worker is indicated, especially where the issue is vital or where the foster father is directly implicated. If the foster parent's own experience seems sterile in terms of contributing to the formation of measures, or if it is such that it creates measures which run counter to the child's needs, this is because the foster parent's early experiences were too traumatic. Respectively, either they will have become overly defended so that the foster parent cannot draw on them, or they will have created warped attitudes toward the care of children who present unique problems, as does the placed child. For these, advice and guidance no longer serve, and other methods of dealing with the foster family must be tried, if there are such values in this foster family for the child that it ought to be salvaged for his care. Dynamic Supportive Work. When a foster mother cannot participate in fashioning suitable measures for dealing with her foster child, she can sometimes subscribe to a new approach explained to her because she has at least a beginning acceptance of it. She either understands it only intellectually, which is a limited basis for carrying it out, or her feelings about it are clear only to a certain point. There conflict sets in to obscure her fuller acceptance of the manner of handling devised. For these foster mothers to continue to act on the advice given them requires much support from the worker, with repeated reworking of this area, to uphold her action. A common example of this sort of situation is seen in the one where the foster mother is unable to be firm and consistent with a çhild when this is particularly needed. She will heartily agree that

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these measures are needed and will begin to carry them out. Then her underlying guilt from other sources will interfere, making her feel punitive instead of constructive in her firmness and limiting of the child. She knows and believes she should be firm, but her good intentions are sabotaged by the pervasive guilt which weakens her resolve. Another example is the foster mother whose underlying anxieties drain her energies. She too often becomes irritable, or she becomes discouraged more readily than she is able to remain patient in the face of the child's trying behavior. The worker's draining of the foster mother's guilt and anxiety, followed by his support and guidance reconfirming previous plans, helps to keep the handicapping feelings at a reduced level. This permits the foster mother to use her assets and function better. The child's extremely difficult behavior, or disturbing interference from the natural family, or both, can prove to be too much of a drain for even a strong foster parent to endure. No matter whether the disturbance from either is chronic over a long period of time with no sign of improvement or appears as repeated crises at quite frequent intervals, it may cause even this type of a foster family to give up. Here too, dynamic support from the worker can help the foster family maintain its resources and keep trying with the child. Sometimes a foster family which does not think of giving up, but functions poorly in their task, while the child becomes worse, can be vitalized to make better attempts at helping the child. This requires dynamic support on a continuing basis. A reality tragedy or great disappointment in the life of the foster family, or in that of the foster child, can also upset a previously adjusted balance. Dynamic support here can help in meeting the excessive strains produced until they subside or give way to change. It would be well to stop at this point to examine what are the components of dynamic support, which serves in so many different situations. It is not merely encouragement with kindness and warmth alone, although at times these are valuable ingredients. At other times the withholding of expressions of kindness, and, instead, a quiet standing by, waiting for the person to use his own resources, can be of greater help. Even when warm giving is constructive, it does not, by itself, go far enough in helping. Giving

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warmth in the fashion decreed by the specific needs of a personality and at the points where it meets the specific needs makes the giving meaningful and endows it with depth influence. This is valid treatment when the working through of underlying conflicts is neither desirable nor feasible nor warranted, and it is helpful also as an aid to depth treatment. With foster parents this constructive giving is a valuable treatment measure by itself, providing their need is not excessively neurotic, as when a person requires such help simply to function marginally in the community. With foster parents, the validity of dynamic supportive treatment presupposes, on the whole, a strong, well-functioning ego, which requires additional strength only at its weak places that are involved in the care of the foster child. Or, some foster parents need this to meet the additional stress which a most difficult child may inflict. More, it can help the foster mother to make the great investment of self that is needed and to continue with it; it can also make her willing and can enable her to accept the education and guidance for the accomplishment of this task. In some instances, the response from the child and the satisfaction from their creative achievement are rewarding enough for a foster family to provide an incentive for them to continue with their efforts. Other foster parents require a more continuous response from some source if they do not get it from the child. These may have to derive something directly for themselves from the worker to induce them to maintain their efforts. It is reasonable to expect that the initial investment of the foster family, which they originally mean to sustain, will not have the same intrinsic stimuli for its continuance as are found in the guilt and sense of responsibility in natural parents who come to a child guidance clinic for help with their own children. While the foster parents do require support of one kind to continue their investment, it is not necessary to supply the supportive relationship in the same intensity at all times to foster parents to bear the pain of guilt, since their emotional involvement in the child is much less than that found in parents at child guidance clinics. Dynamic support that is far-reaching can be built into the gaps left over from the lacks in the early relationships of childhood of

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the foster parent without uncovering the original trauma and without working through the underlying conflicts. Using this method, change, although limited, since the original trauma is untouched, can be wrought. Uncovering the original trauma does not fall within the scope of the work with the foster families except in rare instances, which will be discussed later in this chapter under The Work of Uncovering in a Partialized Area. The case example which follows here illustrates several of the foregoing points, showing that supportive treatment for previous gaps, given in the fashion needed earlier, not only helped the foster mother in the care of the child, but also brought about change in herself. Mrs. D. was twenty-four when she applied for a foster child in 1942. Her rigid specification that she wished only an infant girl signified that she was trying to meet a deep need in this way. She and her husband, ten years her senior, were a childless couple who had lived with her parents and single adult sister since their marriage. In discussing her childlessness, Mrs. D. showed herself very anxious to have a child of her own, which her physician had told her might yet happen, as she might "fool us." When Mrs. D. made her initial application, she was accompanied by her sister who appeared poised, while aggressive, and intelligent. Mrs. D., on the other hand, gave the impression of being kindly but "not too bright," expressing her wishes and enthusiasm in a childish way. Her manner in the presence of her husband, however, was more self-confident and mature than when she was with her sister and her mother without him. In the home visit, the worker saw that Mrs. D.'s mother was a stately, attractive woman whose presence, it would seem, would be of great value to a foster child. The above, salient factors put together suggested an immature woman who had lacked sufficient gratification from her own mother. The latter was closer to the sister since the sister had identified with the mother, seen in her poise, in order to win her. Mrs. D. still hungered for the early dependency gratification that had not been adequately met by her mother, and she sought mothering from her husband who was appreciably older than she. When he met her needs by supporting her through his presence,

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she took on maturity. Her own deep need to be mothered was underlying her great anxiety to have a baby. She wanted to give to herself by giving to the baby with whom she closely identified. To have her own child would make her the possessor of the object of this fulfillment. She needed this object continuously since she had never been sufficiently sure of her mother and since she could not possess her husband enough to have him with her at all times as she could a helpless object like the baby. It was clear that she hoped the care of an infant would help her to be sufficiently released from anxiety to conceive a child of her own. But if that did not happen, she would still have the foster infant as an object for gratifying her need for love. Because of the scarcity of foster homes during the war years, some of the questions raised about the suitability of this foster family were waived since there were positive factors present. An infant girl, Marion, four months old, was placed there. This child came from a socially deteriorated family with many children, all of whom were eventually removed from the parents' care by the court. The parents then moved to a distant part of the country and made no direct contact with Marion, the agency, or the foster family for ten years. An error was made in not keeping Marion more vividly aware that she had once had other parents. Although she was told this early, she "forgot" it because she did not remember her parents. The foster parents out of their own need, since no child had been born to them, reared her as if she were their very own, even arranging her official use of their family name in school and in the neighborhood. When Marion was eleven, her parents suddenly appeared to claim her, and there followed dramatic court scenes where Marion was asked by the judge her choice of parents. Being at the onset of adolescence, Marion used this in the service of her natural adolescent rebellion, which was made stronger on account of the tie with a mother-person whose need made her overpossessive. All of this, together with the shock of meeting her own parents as strangers, made her act out to the point of becoming predelinquent. She began to receive poor grades in school for the first time in a

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history of high academic achievement. She truanted from school in the company of new friends, undesirable companions, who were older than she and who had a pattern of antisocial behavior. She refused to bring them home, she was insulting, defiant, and provocative to her foster mother, and she either ignored her foster father or fought with him when he tried to discipline her. It was clear that the foster mother's tenuous security was threatened by this blow to her most vulnerable area—the loss of the child in whom she saw herself being gratified. Some of this threat would have come to Mrs. D. even if the natural parents had not appeared, as Marion's natural rebellion in adolescence would have stirred Mrs. D.'s fears of losing her emotionally. The latter was aggravated, however, by the court's decision that the natural parents should continue to be in contact with Marion. This she used as a threat with her foster parents. Mrs. D. became frantic and tried to protect her investment and to keep the object of her needs at all costs. In her extreme anxiety, precipitated by the reality crises, she became less patient, more angry, and overly restrictive with Marion. T h e foster mother's efforts took the form of such extremes of activity as installing an extension telephone in order to listen to Marion's conversations and plans with friends. She would not deliver messages from these friends to Marion, opened her mail, even listened at the door of the office when Marion was talking to the worker. Despite all her well-intentioned efforts, Mrs. D. was making a bad situation much worse. It looked very serious when it was found that Mrs. D. was treating Marion in the manner of the mother who unconsciously drives her daughter into an illegitimate pregnancy in order to satisfy the mother's own need for a baby. 5 Mrs. D. kept calling Marion an "immoral girl," thus justifying her need to patrol the near-by park in her car to watch Marion with her friends in order to circumvent Marion's alleged sexual activity.® At this point, the foster mother was assigned another worker, while Marion remained with the first worker. The foster mother's worker, a warm, mature woman, saw the foster mother in a series of interviews over a period of six months. During this time, she opened up the foster mother's current anxieties, sympathized with

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her about the difficulty of the task of rearing an adolescent, and suggested that Mrs. D. inquire from her friends how they act with their adolescent daughters. Mrs. D. found some support from the information she learned from her friends. The worker helped Mrs. D. bring out her fears of disapproval from her own mother and sister whose high standards Mrs. D. had never been able to satisfy. From the worker's understanding and comfort in this area, and from her acceptance of and support in Mrs. D.'s need to be mothered, the latter received a corrective emotional experience.' Since this gratification was given to Mrs. D. at the points and in the manner in which she needed it, due to her early lacks, her anxieties decreased and she was able to approach Marion with a positive attitude. The foster mother became able to place reasonable limits on Marion without tearing her down. The worker also saw the foster father personally, since the fatherfigure counts for a great deal in the adolescent's struggle to resolve the oedipal conflict. He was counseled why and how he should establish a relationship with Marion by himself. An evening walk to the corner drugstore where he and Marion could chat alone over a soda would be a way of serving this purpose, he was told. The foster father participated thus, and the improved relationships with both her foster parents brought changes in Marion, who soon found other, more desirable companions of her own age, received better school grades, kept reasonable hours, and enjoyed a warm companionship with the foster family. After the foster mother had gained from the worker the mothering for herself she had formerly sought to fulfill through Marion, she gave up much of her infantilization and overpossessiveness of Marion. Then she became pregnant for the first time in fifteen years of marriage. Thus, she no longer had the need to press her foster daughter into having a baby for her, having become mature enough herself to undertake real motherhood. The dynamic support given her in the manner she needed it at the gap in the level of her development met her needs at the point of previous lacks. Built in thus, which is possible in an openly dependent person, it brought change to the personality and life situation of both the foster family and the foster child.

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Working within the Dynamics of Character Structure. Another approach for enabling the foster mother in the care of foster children is through skilled dealing with her defensive needs to help her gain satisfaction at this more superficial level. This will make her more flexible and accessible for giving to the child. Even though the specific underlying structure of these defenses is not known, the general underlying need can be understood from observation of the individual's current methods of operating and from her recent history. This is illustrated in the following case situation. Mrs. Y. would make a point of haggling even for the nickel or dime she spent on the foster boy beyond the generous board rate (which did include such extras), and she stressed immediate reimbursement for extras not budgeted. Realistically, however, her economic situation did not warrant such stringent grasping for money. It was felt that in doing this she was expressing a defensive need by which she was dealing with underlying anger and guilt. For when these demands were not immediately met, she became incensed out of proportion to the issue. Her great need for extra and immediate gratification seemed to stem from a feeling of insecurity accompanied by much anxiety which she was striving to keep abated through this behavior. This behavior, however, was obtruding into the training of the foster child. During his infrequent contacts with the worker alone, the child would try to inveigle the worker into giving him an extra dime for himself. He had heard the foster mother use him to demand extra small change from the agency, and he was following her in this. There was an intricate substructure to this pattern in the foster mother, including guilt over the death of her only son at age six. This foster son was replacing her own son, largely for the sake of the foster father. The foster parents now had three daughters whom the mother reared favorably, without the indulgence, on account of her guilt, which she extended to the foster boy. The source of some of this guilt toward boys was observed in her account of what she considered her negligence toward her son. When he was ill, she did not hurry with him to a certain hospital to get a lifesaving serum for the meningitis from which he died, although somebody

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else had done so. She excused her defection in this by saying that her pregnancy with her second child had interfered. Her warm, close relationship with her husband indicated that she felt some positives for males, and this warmth did reach the foster boy. The underlying conflicts which prompted her to use this activity around money as a defense for insecurity from guilt were inaccessible given the nature of this contact with her, and hence not clearly understood or available for modification. It was necessary, however, to meet some of the need underlying this defensive reaction to reduce its undesirable influence on the foster child. From her surface behavior, it was clear that she had suffered some early deprivation which made her cry in her clamoring for money like a hungry child in distress who demands more food than he needs and is unable to wait to be fed. Both of these demands, like hers for money, stem from the insecurity and anxiety produced by early deprivation of some kind. Guilt over anger at this and that aggravated by later tragedy made her indulgent with the foster boy. Thereafter, with this knowledge at the worker's command, whenever an occasion arose to discuss financial matters, the foster mother was offered in advance of her claim an amount of compensation which exceeded by a trifle whatever she was expected to ask. Moreover, efforts were made to send her the reimbursement the very same day it had been discussed, rather than let it wait until the end of the month, the usual practice. Thus her underlying deprivation was gratified at the point of her defensive need, instead of in a manner more closely related to the specific nature of her original need, which was not possible under the circumstances. The worker's anticipation of the foster mother's need, and the granting of it before she could upset herself by demanding it, was a satisfactory method of gratifying her and of obviating the anxiety which would arise if she had to wait for it. The foster mother learned from this to feel reassured that she would be adequately taken care of. Her demands lessened markedly, and she became a more reasonable, pleasant person to deal with in financial and other matters. At the end of the year after this approach was instituted, the foster son's interview with the worker alone was

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significant for his omission of attempts to manipulate bits of money out of the worker. When the foster mother cannot seem to understand or accept, at least temporarily, a particular kind of behavior in the foster child, although she is otherwise constructive with him, it is necessary to focus attempts on bringing some change into the area which blocks her. Otherwise, the tensions arising from the friction from this issue, if it is an important one, will spread and disturb the rest of the good relationship between foster child and mother. Since a foster mother has a more objective attitude toward a foster child than she would have toward her own child, she is less apt to feel accused when a single negative response is pointed out to her while mentioning the over-all value of the relationship. She can be helped, if the universality of prejudices is shown as acceptable, to view this problem area as a prejudice to which she is entitled. Being less involved and hence less defensive than a natural mother is toward her own child, she can then be drawn into some uncovering work more directly than would occur with a natural mother whose readiness to approach this would have to be awaited. This work, in fact, can be made into an interesting adventure, one, at first, of an intellectual nature or one where her curiosity about possible reasons for the prejudice is stimulated. The purpose of this endeavor is to unearth the basis of her strong unaccepting attitude, and then to help her gain some empathy for the child through reliving her own unhappy experience from which the prejudice came. It is obvious that this approach must be deferred until most of her angry feelings toward the child over the troublesome issue have been drained off and abated naturally. The focus of inquiry can then be directed toward the appropriate areas in the foster mother's early experiences which would lend themselves to recall of memories and their surrounding feelings similar to the material under question in the child. In working with these techniques, the course is not always as simple and easy as was depicted. Where the foster mother has many ego strengths and is comfortable about her own failings, it

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is more than likely that she will meet this approach with direct participation. In other situations some version of the following common defenses might be met. A foster mother may feel affronted by the attempted invasion of her private feelings, and hence be reticent in disclosing background experiences. This would be particularly true if the preparation for this entree had not been sufficient, or if the foster mother is overly sensitive about her past. On the other hand, the foster mother might be the sort of person who spills too readily and too much, thereby unraveling herself to the detriment of the intent of this work. Where the problem is reticence, a worker might have been able to anticipate the possibility of resistance to discussion of a partialized area of background experiences by observing how readily a foster mother has offered anecdotes of her past when discussing other situations before this. If a foster mother had not, even rarely, spontaneously shared at least uncharged memories, it might be assumed that she would not lend herself to sharing now in connection with a threatening area. With such a foster mother an indirect discussion of her possible experiences in the past and of the unhappiness they brought may be held by universalizing these occurrences and the sort of reactions they usually create in people. This should be followed by sympathetic expressions of understanding and comfort for people in such situations. A gossip device like this can be used sometime after an annoying issue has been mentioned, but with some not too soon after it. A variation of this device would be to displace such conversation onto a friend of the worker's, but definitely never onto another foster parent, real or imaginary. Enough seeds for thought can be planted in this indirect fashion so that the foster mother may be able to figure out the rest by herself. If this does not happen or if there are no signs of positive use of these tangential discussions, then it is safe to assume that the defenses are too impregnable for this sort of working relationship. Verbalization of acceptance of universal human weaknesses, with sympathetic humor, and other forms of reassurance on the part of the worker may soften the foster mother's barriers to tolerance. If they do not, however, the barriers should then be left alone.

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The worker should be cautious with the foster mother who talks too freely about her background experiences, revealing an unhappy past life. Care should be taken not to encourage extensive uncovering, as it may bring with it much anxiety and depression. It is also extremely important to close off this excessive spilling because it creates an increasing inappropriate dependency on the worker. This can be done by quietly insisting that the work be focused on one small area of feelings at a time. Limiting it to her current reality problem with the child, the rest of the flow will thereby be stopped. In order not to leave the foster mother feeling rejected by this, some comment should be made to the effect that the worker is interested in other things the foster mother wishes to say, but that just now he is especially interested in what the foster mother had mentioned about the particular pertinent aspect. The material is then dealt with by the method most suited to this foster mother's character structure, based on the fact that her undefended dependency will lend itself well to support and guidance. The foster mother who is at an impasse because she has not yet "taken over" with the child needs concrete permission and guidance from the worker to enable her to move into a parentlike relationship with the child. Her hesitancy may occur when feelings arise in her that she has no right to handle in this manner a strange child whose own parents are alive. Or, it may be due to the foster parent's too great dependence on the worker for support in a new experience, or to the fact that the foster mother is naturally a retiring person. It might also be that the child's deviant behavior is so foreign to her experience that she cannot rally her resources to cope with him. In many of these instances, the foster mother can learn by identifying with the worker when the latter instructs or explains to the child in the foster mother's presence. The example set by the worker lends support to the foster mother and at the same time imparts valuable information to her. With a foster mother who would find such a technique an affront and yet would be expecting the worker's help, the worker might ponder aloud about the situation, though not in the child's presence. Stressing its complexity, he could then bring out what he would try to do were he handling the situation. It is important to avoid making the

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foster mother feel depreciated, or deposed by, or rivalrous with the worker. To oßset this, even with the openly dependent foster parent, and especially in the presence of the child, the worker should follow up with the projection of the responsibility just illustrated, onto the authority of the foster parent. Direct Treatment of Underlying Problems in the Foster Family. The matter of direct treatment of conflicts within the foster family itself (such as marital and parent-child problems), of the intrapsychic conflicts of an individual foster parent, when they color the life of the foster child there, was in the past completely unheard of. Even now it is usually ruled out as not belonging within the scope of the function of the child placement agency. Foster parents may secure such treatment in some other setting and still serve well as a foster family, if their problems do not intrude into this task. The latter is hardly likely, however, unless they have a great deal of help from the placement worker, who must guide the foster family in keeping this tide from affecting their care of the foster child. There are certain rare instances where the placement worker may engage in some direct treatment of the underlying problems within the foster family, if the need of it comes up quite naturally in the discussion of the child's care, rather than through the worker's attempts to help the foster parents become aware of their need for treatment. In order to hold a foster home which has some particular value for the foster child, such as his having been there most of his life, uncovering treatment, if indicated for the foster mother, could be undertaken in a partialized area, if she is willing. Actually, she might feel that the agency owes her this if she believes that the foster child's presence created her need for such treatment. The foster mother's motivation to be treated by the placement worker would come from her attachment to the worker and also from her desire to avoid the expense of such treatment. She actually wants treatment for her own sake and not solely on account of the foster child's presence. If the worker has the time and the skills required, it is valid for him to undertake such treatment work in order to save a placement. To remove the child from his foster family when a disturbance appears within the family is like making a placement

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from his own family, and whenever treatment can obviate this, as with his own family originally, it is indicated. When such treatment is not feasible, the claim of the foster mother for treatment from the agency should be handled by helping her secure it elsewhere. Her claim is really not valid since her problems must have existed within her before she had the foster child. And even if the child's presence precipitated them into the open, it was her need to have the foster child which brought her to this point. As her treatment progresses wherever it takes place, she should be helped to recognize this for a healthier tie to the child. From another point of view, the foster mother may or may not be motivated to undergo such intensive treatment for the sake of a foster child. If it appears that she does, then this investment of self will probably be neurotically based. For example, she may need to make restitution for her early guilts and will do so through this present extensive effort on behalf of the foster child. More often, the foster mother who wishes to enter into such treatment, is interested in gains from it directly for her own benefit, and she uses the foster care situation as a ticket of admission, just as the disturbed natural mother brings her own child to the child guidance clinic for this purpose. Such motivation is understandably sounder than the indirect one of restitution, and can be fulfilled if other conditions warrant. There are also foster families whose defenses are strong enough to maintain a balance in the neurotic situation from which their motivation for a foster child is derived, and these can have value for certain foster children. But if this balance should be upset, requiring more intensive treatment than support, and there is no insight into the need for such treatment, then these families will have little if any usefulness for foster children. In summary, the general considerations which may govern the exceptions to the policy of not treating conflictual areas in foster parents by uncovering procedures are as follows. Because of his particular role with the agency, the foster parent, unlike the natural parent, has to have conscious motivation for this type of help, and also the capacity for such treatment. The skill of the worker to do this type of work and whether or not the agency's function will permit it are further points of determination. Lastly,

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the most important consideration in justifying this effort by the agency is whether or not such help will produce adequate foster family care, which is very meaningful to the child. The Work of Uncovering in a Partialized Area. The guiding principles for carrying out uncovering work cannot be learned from anything but actual practice under supervision, but a review of them will be attempted here for confirmation of what a worker may already have done and for his possibly clearer understanding of the work done. The approaches to this work mentioned here should be followed neither rigidly nor literally, but used with imagination. The partialized area diagnostically found pertinent to the problem is the focus of the work. Other material, no matter how interesting, should be excluded, for defenses are weakened when too much is uncovered at one time. Moreover, it is simply not the business of the placement worker to attempt more extensive treatment of the personality, even were he skilled enough to do so. Once the partialized area has been uncovered, by whatever approach, some of which were outlined in the preceding sections, it is usually necessary to drain off the old feelings about the memories recalled but briefly. (In any case, the draining should definitely not continue as long as in any of the usual depth therapies. ) There follows a sympathetic discussion of what happened then and how it affected the foster mother's later attitudes. Comfort and reassurance is given for healing and to build new strengths to help her in the next step. This is to relate the distorted reaction in the foster parent from her old experience to her reaction to the current disturbing situation with the foster child. By this time, with both the old feelings aired and understanding of them gained, the foster mother is better able to have an empathie feeling for the child. She is also freer, through her new understanding, to shape her own methods or to accept and use suggestions from the worker for improved handling of the child. These techniques follow the course, in a diluted form, of some of the work done with parents in child guidance clinics. The following case example illustrates how direct treatment of the underlying conflicts in a foster mother, in order to gain a home for a foster child, was carried out under the conditions stated.

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The treatment given in this case was concerned with the anxieties stemming from the underlying conflicts in the foster mother previously described in this chapter who sought an infant boy for care to help her work out her feelings about the death of her infant daughter from a congenital chest condition. She was afraid to become pregnant again as she dreaded the possibility of bearing another defective child. The worker's placement of the baby, David, when he had a slight cold even made her angry. Her deeper anger and its accompanying anxiety over the death of her child from a respiratory ailment had to be treated if the anxiety was not to interfere with her handling of the foster baby and so that this anxiety would not be communicated to the baby. Mrs. G., the foster mother, was told that the worker understood her annoyance about the baby's cold, but that the worker believed she could handle this adequately, which reassured Mrs. G. temporarily. Mrs. G.'s readiness for working on her underlying feelings was seen in her sharing of information about her background at the end of her first interview during the study of her application. She told then that she was "something like a foster child" herself, as she had been reared by an aunt and uncle after she was five. When she was three, her father had been committed to a mental hospital, leaving her mother with the care of two children, herself and an older brother. They lived in another city, where her mother worked and kept the children in a day nursery. Mrs. G. recalled spontaneously and with much feeling how upset she had been when taken daily to the nursery and left there from age three to age five. When a childless aunt and uncle visited from another part of the country, they reached an agreement with her mother to take her back home with them to rear. She lived with them from the age of five until her marriage, when she was past twenty. Extremely fond of them, she felt that they loved her dearly and that they had given her a great deal. She related her relatives' experience with her to that of herself and her husband in terms of both couples having a great deal to give to a child in need of familial ties. Her husband, when seen, was less enthusiastic than Mrs. G. about having a foster child, but was supporting her in this undertaking. In preparation for David's placement, Mrs. G. considered keep-

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ing his crib in her room, although there was sleeping space elsewhere; yet she could agree with the worker's suggestion that this was not desirable. Soon after placement, however, she did move his crib into her bedroom where he remained for a year and a half. The worker did not attempt to change this arrangement, as she saw that Mrs. G. needed to be this close to him because of her anxieties regarding his care. Moreover, David also needed the extra closeness, as previously described, and so the total advantages outweighed the possible disadvantages. After the foster mother's needs were met at the point of her defenses, and with reassurance from the worker for her anxieties, a meaningful relationship was developed. With this, Mrs. G. began, on her own initiative, to deal directly with the deeper content of her anxieties. As is seen in classical uncovering therapy, she uncovered her conflicts layer by layer, going from anxieties in the current situation regarding the foster baby, to feelings about her role with her deceased baby, and then to her own early childhood and old parent-child relationships there. At first, Mrs. G. was dismayed that she did not feel as close to this baby as she had to her own babies. This the worker believed was Mrs. G.'s expression of her chief anxiety, namely, that she was an inadequate mother. Therefore, the worker reassured her realistically in this anxiety by reminding her that David was not her own child and, further, that she had had him only briefly thus far. She was also told that it was natural for her to fear attachment to him, knowing she would suffer over losing him when he would later be returned to his parents. Further reassurance was then given her by pointing out to her that since the baby was now responding as a result of her care, she was not cheating or hurting him. In the visits following this, Mrs. G. talked of the possibility of having another child of her own, feeling then that some day she would be ready for this. She reported that she still missed her dead baby, but did not think of her as much as she had since David's arrival. She had thought in the beginning that she would be continuously comparing everything David did with what her own baby would be doing were she alive now. But Mrs. G. found that she was not doing this because she felt that David and the other baby were not alike.

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At the end of the first few months of the placement, Mrs. G. brought out that in winter she worried about her lost baby, wondering if she had put enough clothing on her for the cold weather when she had buried her. Mrs. G. stopped herself after saying this much, commenting that actually this was a very silly notion and that she tried hard not to dwell on it. In mourning for her as if she were alive, was seen Mrs. G.'s incomplete relinquishment of her dead baby. Before David's placement she had told people who asked that she had two children, one living and one deceased, and after David's arrival, she would say she had three children, two of whom were living. It is known that the neurotic elements in such extended, vivid grieving, which block the healing of grief, usually lie in guilt toward the deceased. 8 The discussions between the worker and Mrs. G. which followed Mrs. G.'s above comments brought forth from Mrs. G. how much she had done for her baby while the latter was alive. This pushed out Mrs. G.'s underlying guilt toward the deceased baby, which seemed to have no base in reality. She felt she had not done enough for her baby, but after facing this, she went on to look for other reasons for this guilt as she was able to see that actually she had done everything possible, which had been a great deal, for this baby and that the death was not her responsibility. In subsequent contacts, while discussing this guilt, Mrs. G. mentioned again that the nature of the baby's fatal illness was never definitely ascertained. There had been a difference of opinion about it among physicians at the hospital. At this point she brought out that when on the delivery table at the time of this baby's birth, she had been given the anesthesia too early by the nurse. This meant that when the baby was coming out, Mrs. G. had not been sufficiently awake to cooperate with the doctors and the nurses as she should have. From this she went on to say that the pressure needed to help the baby come out was not forthcoming from her, and that the baby was thereby temporarily asphyxiated. The congenital defect leading to death had been caused thus. Although repeatedly blaming the nurse for injecting the anesthesia too early, she persisted in feeling guilty herself for the baby's condition and for the subsequent death. After making these statements, Mrs. G. offered

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that she felt better now by having talked thus. It left her able to view the situation more realistically and to see that she could not have been responsible. She added that these thoughts occurred to her because she felt guilty and inferior about other things in the past. Then she revealed her increasing pleasure in David and along with it her wonderment over why people told her he was so cute when she felt that this was not really due to her care since he had not always been her responsibility. The worker gave her reassurance for the basic feelings of inferiority which Mrs. G. had just mentioned both directly and indirectly by pointing out that she had played a large part in David's development and that it was this that made him so appealing. It was noted subsequently that she became increasingly more secure in her role with David. Following Mrs. G.'s displacement of anger and blame on the nurse, to her a mother-figure, she spontaneously brought out her anger toward her own mother. She felt it was wrong of her mother to have sent her away to be reared by somebody else, no matter what the financial struggle had been. Mrs. G. believed it would have been better had she been kept by her mother all the while she was growing up, despite her happy experience with her aunt and uncle. She continued to express much hostility toward her mother for having sent her away while she kept her brother. After Mrs. G.'s first baby was born, she had visited her mother and brother for the first time since she had left them, but she had felt distant toward them during the visit. Some ambivalence came through toward her mother after this, when Mrs. G. reverted to saying that actually she had had a good home with her relatives, who gave her many things children need which she probably could not have had with her own mother, in view of her mother's circumstances. Somewhere along in here, Mrs. G. began to discuss marital problems, such as her husband's passivity, but the worker guided the treatment back to the partialized area. During the next six months, Mrs. G. discussed more actively her desire to become pregnant at this time instead of putting it off until some later time. While she still kept mentioning her fear and anxiety over pregnancy, she reported periodically that she was not yet pregnant, indicating that she was now trying to become so. David,

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now two years old, was making an excellent adjustment, developing beautifully as he played with animation, interest, and concentration, both with other babies and by himself. Mrs. G.'s relationship with him was deepening and the entire family was enjoying him. She continued to talk about her own mother's wrongdoing in placing her while keeping her brother, and then expressed anger at her brother for being preferred by their mother. Finally, she realized that her brother's life had not been a constructive one and that he had experienced many difficult years. Then she began to understand more and more that her aunt and uncle were her "real" parents, and she felt readier to leave her past behind her. Thus, with the emptying of this anger at her brother and her mother over which she felt guilty, the neurotic tie to her own family could be gradually relinquished. Her early separation trauma was now healing after all these years, and she was freer to turn to the present with a better integration of what her aunt and uncle had given her. Throughout the period of opening up this anger, especially that toward her brother, she did not allow it to run over into her feelings toward David. In view of the frequent occurrence of feelings toward younger siblings being displaced onto children, her lack of this showed capacity to differentiate the past from the present, or, in other words, showed her good reality testing. Following this, another layer of fears and guilt appeared. After the above material had been handled, Mrs. G. brought out that she had been fearful during pregnancy with both her children of hereditary mental illness in them because of her father's psychosis. This had figured in her earlier fear that she could not give birth to a normal baby, and although her last baby's defect was of a different nature, her guilt toward this baby had been compounded by her fear of transmitting her father's illness to the baby. Her brother also feared this hereditary influence in his children. Having emptied her resentment for her brother, she was able to open up this new material by associating to a difficult situation they shared in common. She knew she would continue to hold this fear during another pregnancy and that was really why she was anxious about becoming pregnant. The worker accepted these fears as being understandable, and then elicited Mrs. G.'s fantasies to find out her understanding

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of mental illness. Using some of the reality factors in her father's breakdown, along with the general dynamics of mental illness, the worker explained away some of the misleading ideas Mrs. G. had about it. Nevertheless, Mrs. G . still held more of this fear than was warranted by the facts, and this required more extensive exploration and treatment. That was not undertaken here because reality factors intervened. At this point David's parents were given by the court a specific period of time to get ready for his return. Mrs. G. then began to prepare herself for separation from David. Although she continued to give him devoted care, she began to invest less of herself in him. She reported that it gave her pleasure to watch his parents play with him during their visits to her home and that the three of them happy together was the way it should be, a family united. Thus she was able to assuage some of her old pain about her own broken family. She became pregnant a month after the court decision, even though some of her anxieties continued. The original worker left a few months later, and Mrs. G. did not feel the need at that time to relate to the new worker as she had to the former one. She handled her anxieties during the remainder of her pregnancy with her obstetrician. A healthy normal girl, whom she came to enjoy, was born to Mrs. G., and David returned to his parents a few months after the birth. He had continued to be a healthy, happy boy after the arrival of the baby, as Mrs. G. had handled his sibling rivalry well. This intensive treatment, with the uncovering of underlying conflicts, helped the foster mother serve most adequately in giving the sort of care very much needed by this foster child. The treatment was partialized to the guilt and anxiety around babies, which directly related to the care of the foster child. Therefore the benefits of the treatment were of limited value to the foster mother for her total neurosis, including marital problems, and since the treatment embraced only a limited period of time, she was not able to rework these same areas for greater amelioration of the disturbed feelings. Yet she had benefited enough from the treatment to be able to live her life in a richer, freer manner, while the agency had gained valuable foster care through it.

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OVER-ALL SUPERVISION OF THE CHILD IN THE FOSTER HOME

Over and above the various types of treatment approaches described as indicated in the work with foster families is the essential need to supervise the over-all placement situation. While this term smacks of an attitude of investigation, there is really nothing wrong with that if the social worker uses it in a constructive manner. This is how he is able to carry out adequately his responsibility to the parents or the community for the child's care. If the worker conveys to the foster family that his visits to observe and learn of the child's welfare and progress are made for the purpose of helping, the unfavorable aspect of investigation, the feeling it generates of being spied upon for negative purposes, will be eliminated. While it is important to settle first the external aspects of the child's care, in terms of such practical needs as his physical care and his general acceptance by the foster family, it is equally important that the worker not lose sight of the child himself during this time. While busying himself with arranging for the child's clothing, medical needs, appointments for visits with his own family, and other such matters, the worker must know the child's current and changing attitudes about these concrete matters in order to plan them wisely for him with the foster family. For this, it is necessary that the worker have a meaningful relationship with the child. If the worker first meets the child after preplacement work, he should develop the relationship as soon as possible and sustain it by continuous one-to-one contacts with the child. More about the need for such a relationship with the child for his welfare will be discussed in the chapter "Work with Children after Placement." Certain dangers can arise from this extremely important relationship of the worker with the child in regard to the foster family's attitudes and activities. These must be guarded against carefully. Too often the accusation is made, and at times with validity, that the worker identifies with the child to the extent of neglecting the needs of others connected with the child. It is understandable for the worker to identify primarily with the child's needs, not only because he is the most helpless one in the picture, but also because

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a child welfare agency is naturally child-centered. Obviously, however, it is short-sighted, if not fallacious, to identify so exclusively with the child that others necessary to him feel excluded. As a matter of fact, it is sometimes necessary to give emotionally to the foster mother before she can give to the child in the measure he requires. This sort of prior giving applies more frequently in the matter of attempting to help natural parents modify their behavior in regard to the child than it does with foster parents. The important principle remains, however, that even though the child's welfare is primary, the first step in achieving it is by stabilization of his reality situation, in this instance, his life with the foster family. If different identifications are called for from the worker at the same time, the choice should be made in favor of the foster parents. Later, the child can be helped to understand why this happened. In this matter of the relationship between the worker and the child versus those the worker develops with the other important people in the child's orbit, there can arise complications. Attention is first pointed to the rivalry of the foster mother with the worker for the child's affections. This rivalry appears in the area of authority over the child, over the child's chief attachments, and over which one is to achieve the results in handling the child's disturbed behavior. Actually, there need not be any clash between the roles of the worker and the foster family in these areas, but what is put into these areas by those involved may bring about the rivalry. In the first instance, it is not healthful for the child's personality development to have too many authority figures dealing with his training and discipline in duplicated areas. While the child meets such authority in his training and discipline with his teacher, scout master, and other such figures outside his home, these do not duplicate the parental authority in the home, just as parents do not intrude on the teacher's authority in the schoolroom. The child would be confused if the division of the jurisdiction between his parents and his teacher were not clearly defined, and it is therefore worked out cooperatively. Thus if the worker and the foster parent are sources of authority in the same areas, the child can become confused and his personality development can be hin-

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dered. Not only are splits and contradictions possible in the images of the parent-figure, there is also room for the child's natural tendencies to manipulate and exploit them. If a foster parent must await the authority of the worker for putting into effect the discipline and other decisions which arise in the daily care of the child, then the authority of the foster parent is greatly weakened. On account of this the child will not be able to make an adequate identification with the parent-surrogate for the purpose of learning self-control. He will be unable to incorporate the standards of the foster parent when the latter is hampered in maintaining them in connection with the foster child. There results a weakened or defective superego in a child who may have superego lacks already. In the one without these lacks, muçh anxiety will be produced as he still has a need for this sort of guidance from a parent-figure. The foster parent should have authority not only to apply discipline, but also to make decisions which will yield pleasure to the child. The person who disciplines and restricts should be the same one who gratifies and pleases. In this way are provided compensations for the inevitable deprivations, which make the latter become more acceptable for integration by the child. He can thus be helped to avoid the impression that the world, or people in it, is entirely all bad and mean or unrealistically all-giving and ever-good. The authority of parent-figures in the foster family and of the parent-figure in the worker should merge in the eyes of the foster child, with the role of each complementary to that of the other in order to bring about the best integration of authority by the child. The foster mother can be counseled that when she is at a loss as to what measures to use with the foster child on long-range questions which can wait, she should defer them for discussion with the worker. In situations where large expenditures or weighty decisions, for example, come up for consideration, she should explain to the child that grown-ups need advice too and that she wishes this from the worker in order to make the wisest plan for his welfare. This gives the child the sound impression that, first, adults are not omnipotent, and, second, the foster mother is seriously concerned with his best interests. Counseling at the onset of placement should consist of giving the

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foster mother permission to deal with day-by-day events to the best of her judgment and to use her full authority without resorting to threats of telling the worker about misdemeanors. This is necessary again to avoid splitting the authority of the parents-surrogate. Errors made by the foster mother can be corrected without destroying her authority. When a parent or parent-substitute can admit a mistake to a child but still retain authority to make the correction, then the distance between the child's world and that of the adult is narrowed. The child also gains a feeling of greater security from the knowledge that the adult's planning is not irrevocable. When the foster mother makes a serious mistake in her handling of the child, the worker should nevertheless identify with her at the start to present a united front to the child. From there he can begin to help the foster mother correct herself without destroying her authority, granting her the right to make unavoidable mistakes, but all the while keeping before the child the fact that the foster mother nevertheless has the better judgment, as well as his welfare at heart. To round out the caretaking activities of a devoted parent-figure, the foster parent should be the one who purchases clothing for the child, carries out the medical and dental appointments arranged by the worker, except perhaps for emergencies, and visits the school on parents' day and other like occasions, such as meetings of the parent-teachers association. Interested foster parents who make themselves known to the school on behalf of the child, are in a much better position to settle problems when they arise than if they are called as strangers to the school. The child's attendance at and excuses for absence from school are also the responsibility of the foster parent. A worker's visit to the school should not duplicate the foster parent's contacts there, as the worker will come to learn, in the over-all review of the child's adjustment, how he is progressing in terms of his personality make-up, which includes academic achievement. The worker will also interpret the child's dynamics to the school, discreetly selecting some of his history to enlighten the school and to gain its empathy. This will help the school to plan in the light of the child's needs to the extent that individualization of the child in the classroom is possible.

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A child quickly senses tensions among the adults around him, and he will do so in regard to such reactions toward his attachments by both the worker and the foster family. In order to avoid the undesirable influence this has on the child, it is the worker's responsibility to handle her subjective feelings as previously described and to help the foster parent, especially the foster mother, to handle hers. When the foster mother feels threatened by the privacy in the relationship between the child and the worker, fearing that the child is telling on her, it is necessary to allay this fear. The foster mother can be helped by understanding that a worker does not take a child's comments at face value and that workers have learned to evaluate that which a child tells in terms of its being part of his own problem. So as not to contradict this explanation later should the child report actual errors or shortcomings, the worker should reassure the foster mother on another such occasion that he is accepting of mistakes made by the foster family. The foster mother can be told that the worker himself makes mistakes occasionally and that he would welcome the foster mother's frank discussion of them if she notes them. It also can be pointed out that mistakes will be made as they are natural to everyone and that much can be learned from them. Thus by this universalization and identification with the foster parent, the latter will be less threatened when mistakes are discovered, which may eventually have to be shared with the foster parent for correction. In connection further with the rivalry from the foster mother for the child's exclusive affections, the worker can reassure her that her twenty-four hour daily contact with the child is far more important to the child's welfare than the brief hour he spends with the worker once a week or less. That it is possible and desirable for a person to have more than one meaningful relationship simultaneously without loss to any other one can also be pointed out. The foster mother who struggles with the handling and correction of a child's undesirable behavior naturally wishes to feel that she is responsible for his improvement, which often she is. When this type of care is supplemented with direct treatment of the child by the worker, the foster mother may feel that her efforts will not be adequately appreciated. The ambitious or controlling foster

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mother especially will vie with the worker as to who is really going to effect the "cure" of the child's disturbance. A foster parent in these circumstances should be helped to believe that the efforts of both are vitally important and that the work of each supplements that of the other as when a team works together. This sort of teamwork between a worker and a foster mother in a group home is illustrated in the case example of Paula in the chapter "Work with Children after Placement." The worker should explain to the foster mother that his attempts to help the child are directed toward overcoming the snags from the child's past. Elimination of these permits the child to become more accessible to the affection and discriminate training which the foster family give him. Greater accessibility, in turn, means he will be able to make better use of what is given him. Since the experience of living with the foster family is actually the most vital treatment measure for his improvement, the worker's efforts are directed toward helping the child to gain the most possible from it. The undoing of the snags which interfere requires a special kind of relationship with the child which the parent-figure's role cannot include. An example of this may be given by explaining that a psychiatrist, skilled as he is, would not treat his own child for emotional disturbances owing to the need for this special kind of relationship which is different from parenthood. To further appease the ambitious foster mother and to reduce the threat she feels on account of the close treatment relationship between the child and the worker, stress can be laid on the need for objectivity on the part of the worker toward the child in the work of treatment. The worker can achieve this end because he has less investment in the child and has had practice at keeping it thus. In the contacts between the foster family and the natural parents the role of the worker is usually to help keep the peace between them. The foster family is advised to avoid the possibility, when this is anticipated, of becoming involved in the parents' personal problems, such as marital friction. Sometimes an extremely dependent parent may become in a sense another foster child to their own child's foster family, if the latter permits or encourages it. If

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the foster family can keep this sort of relationship from becoming too burdensome, then the worker need not concern himself with it. In nearly all other types of situations, however, the foster family has to be helped with the contacts with the natural family. Sometimes this is needed largely only at the beginning until a pattern is worked out and becomes crystallized, while other situations may require continuous activity and support from the worker. It is important for the child's sake and for his relationship to the foster family that the latter respect his tie to his own family, no matter how unworthy his family may appear. Repeated efforts by the worker may be required to cultivate and keep alive the foster family's empathy for the child in his longing for his family in the face of the natural parent's undoing activities. In order to ameliorate the prejudices in the foster family toward the natural parents, the worker has to take the responsibility for guiding the contacts between them. He sets time limits for the family's visits to the foster home, prescribing the days and the hours of arrival and departure. If the parents are very disturbing to the child, the foster parents may be requested to remain present during the parents' visits to the child in the foster home instead of permitting the child to go out with them for an excursion. If such a procedure cannot be arranged, or is not beneficial, then the worker may deem it necessary to remove parental visiting from the foster home to the agency office. Sometimes the office is too far removed from the foster home for this to be feasible, as in rural areas, but it still may be possible for the worker to arrange the parental visits by having them occur on a weekday in some public facility like the local town hall or county building, with the worker present. As far as possible, however, the foster family should be helped to accept the parents in their home, since the child will then also feel more accepted by the foster family. Otherwise, either a conflict of loyalties is set up in the child, or he clings to the ghost of a relationship with his family while withholding himself from relating to the foster family. Counseling the foster family on how to handle the content of visits by difficult parents may help to make such visits more bearable for the foster family and quite smooth for

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the child. Advice should be given for dealing with the excessive gifts brought by some parents, or the food, pets, and unplanned clothing items they bring, which are expensive and not useful. If these matters get out of control for the foster parents, they should be advised to refer the natural parents to the agency about them. This applies also to requests made by the family to the foster parents, for example, for extra visits, which embarrass the foster family in their relations with the agency. At times the only thing to do is to support the foster family in disregarding the gifts which are affronts and nuisances. They can then be disposed of later in a discreet manner for the child's sake, or with a kind but firm explanation to the child that his parent did not understand about these matters. With reference to the location and content of the child's visits with his parents, in general, a brief visit in the foster home followed by a short trip of a few hours to the movies or the zoo, or to visit other points of interest, is the usual pattern, and is found satisfactory to all concerned. If the family prolongs the visit in the foster home and causes too much stress there, it is helpful to all concerned if the worker will advise the parent to concentrate on the trip outside the home. This could be done on the basis that it is better for the child and the parent to be alone together for a while. If this is what the parent really does not wish, then he should be encouraged to make such excursions brief, or to go to the movies where his attention does not need to be given directly to the child. If none of these measures meets the visiting situation adequately, or if the parents disturb the child too much even then, the visits should be planned to take place in the agency office or some other facility where the worker can be present throughout the visit. Whenever such protection is necessary to keep the child from unfavorable influences from the parent, it is found that the child is usually relieved rather than embittered by the worker's presence. The worker's role in such supervision is discussed in the chapter "Work with Families after Placement." In the child's conflict of loyalties, which the chapter "Work with Children after family's emotional investment in the child dealt with. The dilemma of their position

will be discussed later in Placement," the foster must be recognized and must be eased, yet it is

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highly important that they be helped not to wander from their position. They must constantly be reminded that all the while they are loving the child, they cannot allow themselves to feel exactly the same toward him as toward their own child. Moreover, even when the natural parents are not interested in the child, and have only infrequent or no contacts with him, the child's status in the foster family must not be allowed to become blurred. The natural parents' relinquishment of the child for adoption should be attempted if diagnostically indicated, but the foster family's hopes for this and that they may eventually adopt the child should be avoided until the plan of relinquishment is decided upon to avert tragedy for all concerned. Some signs of the foster family's negation of the child's status are when they register him in school under their own last name, or when they tell the neighbors upon moving to a new community that the child is adopted. They may even tell this to the child if they have reared him from infancy since he then will not be able to remember his own parents. Or, if the parent should come to visit only once or twice in many years, the foster family may tell the child anything they can think of to explain who the parent is except the truth, unless the parent has announced his status to the child. When the illusion is suddenly shattered by the unexpected appearance of the natural parent claiming his child, the latter's shock and disturbance from the abrupt realization will be severe. Reckoning with this is a serious matter. Such illusions in the foster family about the placed child tend to be built up when the agency ceases contact because a stable situation exists without current problems. It is sometimes thought that the payment of a board rate to a foster family will help keep the reality of the foster status before them. But quite frequently this has no validity; it must be accompanied by the worker's presence. Otherwise, either payment will become a mechanical matter, easily brushed aside, or it will be used by the foster family as a vehicle for their spite. By demanding more payment, they can express their anger at not having been given complete possession of the child. In such cases especially, it is imperative to institute the contact between worker and foster family at the beginning of placement and to keep it active, if reduced, throughout the years. Repeated explanation to the foster family as to why clarity of the child's status

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is desirable for their sake as well as for the child can then be given. References to the dramatic but heartbreaking newspaper accounts of painful separation from the child at a parent's unexpected request may help convince the foster family of the desirability of maintaining the foster child status. The worker's attitude of sympathy and helpfulness will serve to support the foster family in this position. A promise that this family will be considered first for adoption, if this ever becomes possible, should not be made lightly by the worker, as the agency administration or a succeeding worker may think differently. Before placing a child in a foster home when it appears that the placement will be a permanent one, it is important to take into account whether or not the foster parents under consideration would be desirable adoptive parents, should this become a possibility. Such a foster family should be sought in this instance, with a decision by the agency administration about adoption promises written into the record. The ties of the child and the foster family to each other must be guarded thus as invaluable. While foster families are always asked not to feel toward the child the same as they would toward an own child, they are at the same time asked to treat the child in caretaking activities just as they would an own child. This contradiction alone is indicative of the difficulty of the task the foster family undertakes. Yet this request to the foster family is not wholly unrealistic or impossible since the tie with the foster child can never be the same as that with an own child. The foster child's entry into the family was not from procreation out of an act of love, nor did the foster mother share the unique experience with him of childbirth, and only in few cases would the foster family have watched his development during infancy. His becoming part of the family is truly a grafting in whatever measure the case situation requires and permits. This nevertheless means that the foster family will have an emotional investment in the child, whatever their motivation, and an appeal to this investment will bring their continuous reinvestment in this undertaking. The child's response as well as the creativity and the meeting of needs in the foster family through this effort are sufficient rewards to make their endeavors worth while to them.

6

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IN THE PLACEMENT AGENCY work with children, even though not always direct work, really begins during the intake process, as discussion there with the parents and the referring agency is all related to the child, although focus may then be directed toward the parents. Direct contact with the child definitely should begin during the preplacement period, as described previously, though sometimes it cannot be avoided during the intake study. At intake, any direct work with the child is chiefly of a diagnostic nature, but it is more than this during preplacement work when the diagnosis is being confirmed. Overlapping then with the continuing diagnostic work is the handling of the child's feelings about the imminence of separation from his family, as well as the worker's efforts to develop a relationship to fulfill his function of providing an emotional bridge for the child at the time the separation takes place. DIRECT WORK WITH CHILDREN IN PLACEMENT

Direct work with the child after placement should constitute the major part of the placement worker's activity, not only because this phase consumes the longest period in the placement process, but also because only the beginnings will have been made prior to this toward effecting a sound placement. It is not enough to make the placement and leave it at that with only occasional surveillance or with only the work with the foster family. If placement is to be a treatment measure to provide the child with a far more constructive

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experience than that which he had in his own family, or to compensate for values he lost in his own family by being orphaned or otherwise deprived and hurt, a great deal of skilled work is needed, not only attendant to the act of placing the child, but also during placement itself. In broad outline first, part of the work after placement consists of supervision for guidance and protection of the child in his placement, including the planning of his physical and social needs, and in his environmental situations, such as contacts with relatives and possible conflicts with legal authorities, not only through the foster parents, but also by direct contact with the child. This is plainly the role of a parent-figure in which the worker in a placement agency serves the child realistically as well as in fantasy during his therapy. In addition, a large share of the direct work with the child after placement is needed to help him with both current and earlier conflicts and with the damage these have wrought and are still inflicting on his personality growth. T h e ill effects his personality has suffered from his life prior to placement, together with the painful loss he has experienced at the separation from his family, commonly referred to as the separation trauma, will prevent him from using the foster family for treatment, the purpose for which it was planned. T h e child's distrust of people; his clinging to old ties, to that which is familiar and to his hope that his parents will become different, in order to hold onto some security; as well as his disturbed behavior all create barriers to his constructive use of the foster family placement. Other areas of work with the child in placement include the feeling he has toward himself as a placed child, the conflicts of loyalties that arise when he begins to relate to the foster family, and especially the confusions in the child around the reasons for his placement. These require sensitive explanations of the tragedies which precipitated or eventually led to this move. Finally, the synthesis of the child's two sets of ties—the remnants of those with his natural family and the new ones with the foster family—has to be accomplished so that the child will feel whole and not pulled apart by them as by opposing forces. This obtains whether the child is to return to his natural family or not. If the child does return to his

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own family, and there has not been enough change in the parents to bring about an improved parent-child relationship, then it is helpful to the child to have gained an understanding of his parents as they truly are. By so doing he will have obtained some detachment from his old neurotic ties with his parents so as to protect himself from becoming a victim of their use of him in the service of their own illness. But whether or not he returns to his own family, the child needs help to learn to accept the defections in his parents so as to achieve some peace of mind. DEVELOPMENT OF THE CASEWORK RELATIONSHIP WITH THE CHILD IN PLACEMENT

Before going into the content of this work, it is necessary to discuss the basis of this endeavor, namely, the development and use of the casework relationship. This relationship with the child may begin during the intake study, usually in a negative manner. The agency and the worker are often presented to the child as instruments of punishment by the parent who is seeking his placement, or by the court which is ordering it. Such a disadvantageous beginning should be nullified as early and as fully as possible during intake or during preplacement work. Methods of developing the relationship at that time have already been discussed in the chapter on preplacement work. Some of these same methods apply in situations where a new worker picks up at the point a departing worker leaves off. In such circumstances, the child's feelings and behavioral reactions concerning the change of workers must be dealt with when the new relationship is begun.1 A professional relationship has to contain more than expressions of kindness in order to be meaningful. It should take into account the special needs of the child, as well as what is most important to him from his point of view. It means meeting him at his point of greatest involvement, if he is not too highly defended there, and at the point he has now reached in his emotional development. It also includes respect for his defenses. Knowledge of these aspects of the child is gained from the diagnostic study already developed, as described in previous chapters, and from observations of the child's reactions to the worker's presence and to the surroundings in which

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the meeting is held. These factors influence the particular defenses he will choose to use in this situation, while in other situations or with other people, he may react differently. Recognition and acceptance of the feelings the child displays to the worker, verbalized in terms reassuring to the child, followed by the worker's identification with the child in these feelings are first steps in the creation of a relationship. Most times, no interpretation of the child's feelings should be offered at this point unless it is of a reassuring nature. What is most helpful in the early stages of the relationship is an honest explanation, within the limits of the current reality, of the reason for the placement and what will happen there. Interpretation even of preconscious material will make the child become wary of the worker, who, he will think, can either read his mind or trap him into telling on himself. If the worker can anticipate the child's needs even in small things, and give these to the child before he asks for or even thinks of them himself, this will accelerate the development of the relationship. To be thus understood is to be loved, and when the understanding is demonstrated concretely, as children require, the feeling is conveyed to the child that the worker really is interested and cares. 2

The worker's expressed and demonstrated acceptance of the child's own family, no matter what they are like, will make the child feel that he himself is accepted by the worker, as was previously demonstrated. When the worker has to act in contradiction to the parents, a warm and sympathetic explanation to the child must follow. It cannot depreciate the parents, but rather, has to accept them at the same time it indicates that the parents have made a mistake, as is possible with all adults. Above all, the relationship must be shaped according to the child's needs, once he is involved. With a hostile, defensive child who holds himself aloof from the worker, or with the child influenced by a paranoid mother, who sets him against the worker, much distance should be allowed. Warm feelings should be shown toward this child only in the measure he indicates he can accept them at any given time, as he is not able to trust such feelings and is afraid to commit himself to them. 3 Still a different approach is needed for a child like the six-year-old psychotic boy who felt the world was

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just as ominous as the rage he felt toward it for having been deprived through neglect during infancy of his basic physical needs, even food, and for having been handled harshly because he cried over these lacks. He needed to be enveloped in love, not only through verbal and facial expressions from the worker, but also through physical demonstrations. A strong but warm, direct manner is indicated with the acting-out predelinquent. He will respect the worker who is not "soft," and will make contact, emerging through his hard shell when the approach is a quiet but forceful one. The warmth accompanying the firmness denies the attacking quality such an approach may carry, a quality which this sort of child expects from past experience with his own family, the school, and other authorities in his life. Remonstrations when necessary, and also advance restrictions, should be presented with the child's welfare as the focal point of their need. Sometimes they should even be delivered heatedly by the worker, each of these approaches conveying to the child that the worker cares about what happens to him. Humor and "kidding," with sensitivity toward the child's selfesteem, are especially necessary to help this child feel less embarrassed and frightened by the unaccustomed fondness he may come to feel for the worker. These are but a few of the many ways there are of developing and using the relationship between the child and the worker. Others can be devised by the worker if he uses his ingenuity in accordance with his knowledge of the child's dynamics and his own intuitive information. THE WORKER'S DUAL ROLE IN THE RELATIONSHIP

One of the most important aspects of the relationship between the child and the worker, it should be pointed out, is that the worker in the child placement agency plays a dual role in the relationship. In order to help the child use the treatment measure of placement so as to gain emotional health and development, the worker in his parental role makes dynamic use of the child's environmental resources. In his therapeutic role he directs his efforts toward helping the child resolve his inner conflicts created prior to the placement and toward effacing the symptoms stemming from this source and from the recent blow to the child of losing his family. This

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dual function complicates the worker's relationship with the child and produces a composite role for him, which is unlike that found in workers in other treatment agencies. In addition to helping in therapy, the worker bears the responsibility for actually arranging and supervising the child's real life situation on a continuing basis. This dual role carries some advantages, but it also creates involvements for the worker with the child in the relationship. These result particularly in evoking more readily than is usual in therapeutic relationships the irrational feelings from the child toward the worker which stem from his experiences with the parentfigures of his past. The worker's emotional closeness to the child on two fronts (from arranging the actual care and from the child's emotional need of him in therapy) invokes both real and fantasied responses from the child, which are difficult to tell apart at times. In an earlier publication 4 this writer has described these aspects of the dual role as follows. The relationship with the child, consisting of feelings built up from what actually happens between the worker and child as differentiated from transference, is likely to become a closer one than that usually found in other types of treatment situations. This grows out of the protective and supervisory role which the worker must take in loco parentis, despite the presence of the foster mother. F r o m this concern as a parent substitute, extending over the entire realm of the child's life rather than over the therapeutic sessions only, comes the overactivity of the worker as seen from the traditional view of the therapist's role. This is not considered to be overactivity in the caretaking role for a child in placement, but if it is carried over into the therapeutic role, it can create impediments to the therapeutic process. Among these is the pressure in the worker to get things done in the child's treatment as efficiently as in the child's life situation and to take care of his problems and anxieties for him. In other words, the worker becomes too actively a participant in helping him with the working-through and settling of the underlying problems. To keep the child functioning with his emotional handicap is the primary concern of the worker in her parental role, requiring her activity with the child in his reality situation as well as in treatment sessions designed to facilitate this adjustment. Such focus on maintaining even a minimal social functioning takes precedence in many instances over the concentration on direct therapeutic effort. This is in marked contrast with the therapist in other settings who can leave this kind of care, planning, and arrangement of the life situation to the

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natural family. The traumatized child is less free to bring out forbidden impulses during the treatment sessions with a worker who also manages his life-situation. The synthesis of these two roles by a worker is the requisite for any successful treatment of the child in the placement situation. Often this is not possible due to the extensive nature of the child's acting-out, which increases the need for the worker's activity. Here is where treatment goals must be limited, at least temporarily, with preference given out of necessity to dynamic and constructive management of the reality situation. Or, when the dynamics indicate too much contradiction in these roles, they should be carried by two workers. If she is to avoid the pitfalls that grow out of the contradictions between these roles, the worker who attempts to blend them must have exceptional knowledge of dynamics, constant alertness as to the form of their operation, and a full repertoire of therapeutic techniques, as well as extensive ingenuity. Elaborating on the foregoing statements, the worker may find himself in a situation where his roles conflict. He may need to hold the child to reality because of his extensive acting out—his staying out late at night, his neglect of his homework, his use of profanity to the foster mother—so as to avert his possible arrest in connection with delinquent companions, his lack of progress in school and his possible exclusion for poor performance, and his ejection from the foster home. At the same time there is a need to elicit the child's anxiety and despair underlying this behavior, which covers fears and guilt generated by rage and pain. The child will be much less likely to participate in the uncovering of these feelings to a worker who is responsible for disciplining him to avoid the end results of the acting out of these underlying feelings. In such a contradictory situation, it may be necessary to have one worker deal directly with the child in reality matters and also to counsel the foster parents on the use of disciplinary measures, while the child's feelings about these and other such matters are referred to another worker. The latter worker is then free of activities in connection with the child which would tend to inhibit his facing and sharing with him the forbidden feelings. Whether the work with the child is carried by one or two workers, the worker who is therapist may feel the need out of his own subjective anxiety to "cure" the child's emotional disorder at all costs. Thus, he will not weigh appropriately other factors. For example,

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he may disregard the child's reality situation, which worsens while he remains preoccupied with the therapeutic effort, only to result in the child's suffering worse consequences than he did initially. For this the child will turn against him. Another expression of the worker's subjective anxiety toward the child is his need to give to him in a manner which is not constructive because it is not in keeping with his dynamic needs. He may succumb to the child's seduction, or he may try to bribe him into a relationship or into cooperating by giving him ill-advised treats and other neurotic dependency gratification. Quoting further from this writer's previous article, 5 the following passage discusses other aspects of the relationship with the child. Another complication the dual role brings is an overidentification with the child with resulting negative feelings toward the parents who created such havoc in the child and, even worse, toward the parents who continue to do so after placement. The worker not only suffers for the child but is also working against the greatest odds to modify the effects of the trauma on the child. This is especially true when the parents can successfully interfere with and disturb the placement. For the worker to continue planning as well as treatment in the face of such undoing influences by the parents can readily set up in the worker negative feelings toward parents. Such feelings are bound to contaminate the worker's relationship with the child, especially when the latter strains toward the remnants of ties with the parents. Then the child feels that the worker is not in sympathy with his parents, is against them, and hence is against him. Further, the worker actually participates in making the placement, so that the child's negative or ambivalent feelings about the worker begin even before there has been an opportunity to develop a positive relationship to support and work through this negative transference and the separation trauma and earlier conflicts as well. Despite these problems, such a dual role has some advantages. It may make it possible for the worker to reach a child emotionally by doing for and giving to him concretely. By the time many children reach placement they have learned to distrust relationships. Only by this doing and giving, as mentioned, can such children be involved in a meaningful relationship to be used for therapeutic benefit. In some cases all that can be accomplished in treatment is this experience, which in itself would be only a limited gain in the presence of emotional illness. It would be more desirable, of course, if such a meaningful relationship could lend itself to the working-through of transference feelings and their conflicts, with their trauma and defense reactions.

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From management activities, the worker can also know the child more fully in his reality functioning and gain better understanding of the dynamics of his disturbance. All too often workers have not focussed on obtaining from the parents what they can give of the child's history. In addition, parents are often unable to give reliable information about the child's developmental experiences and early adjustments, and the worker sometimes has to depend upon the child's current adjustment and behavior patterns to give clues as to what may have happened to him in the past.

Planning and Supervision of the Child's Lije Situation. The worker's planning and supervision of the child's real life situation and his physical care, if it is to be dynamic in terms of fitting the child's needs, requires an ongoing contact with the child. Accompanying this there has to be a relationship between the child and the worker to support the child in his revelations of his changing current feelings and reactions. When the plans for his personal care are carried out by the closer parent-figure, the foster mother, his ties with the foster family are enriched. Nevertheless, the child still needs to know that the worker is in the background to insure the care of his needs, especially if he has had previous placements. He knows that though the foster family's ultimate responsibility is limited, the worker is the representative of the agency which remains to provide for his care even if workers leave or foster families discontinue care. The child in the foster home feels the worker's interest and concern for him through the latter's planning and advising for his material comfort and through such activities as school visits for his welfare and happiness. Negligence on the part of the worker in forgetting to provide for a child's essential material needs—as, for example, not sending the extra allowance for a winter coat or school supplies—will leave him feeling that the relationship with the worker is not worth much. This is true even if he had liked the worker well enough to entrust some of his sensitive feelings to him; for a child's conception of the world and its manifestations exists in terms of activity and concrete things, rather than words. Even when the child is making a satisfactory adjustment and intensive treatment is not being carried on, the worker's continuous contact, albeit less frequent than when first placed, is indicated to

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maintain a relationship for support in a life crisis or in a replacement, should either arise. The latter can be made suddenly necessary by tragedy in the foster family or by an unexpected change in their plans which excludes the foster child. Moving to another part of the country or the return to the foster home of a married daughter and her family so that there is no extra space available are examples of such changes. The worker's relationship alone can cushion the shock of the replacement for the child. Continuous supervision through the relationship with the child, as well as through visits to the foster home, is necessary to secure the adequacy of the placement. Subtle changes occurring in the foster family care may not be so apparent during visits to the foster home as they are in the moods and appearance of the child himself. The worker will catch these more quickly and readily if he is in rapport with the child. Lastly, the worker is the only link for many children to their natural family. Through a relationship with the child and with his family, the worker can be the agent which helps maintain the healthy aspects of this broken family unit by enabling them to have positive contacts with one another. Not only does the frequency of contact depend on the worker's permission, but his planning and work with the child and his parents on this matter, as well as their treatment in other areas, will help to make these brief reunions more enjoyable for both. Direct Treatment of the Child's Underlying Problem. The amelioration of the personality damage to the child prior to his placement is of utmost importance, first of all simply to permit him to remain in placement, as his old behavior disturbances may cause frequent replacements for him. Then he will have no chance to experience sustained ties. Even when the earlier suffering and its ill effects are repressed so as to allow conformity and hence acceptance by the foster family, the impoverishment of personality and other harmful results, such as serious withdrawal, somatic illnesses, and perhaps a later psychotic episode, may follow. The blow from the loss of the family, no matter what the circumstances, always leaves a wound, which will remain even if the child experiences a highly favorable placement with a foster family over a long

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period of years. Treatment of the separation trauma is always necessary, whether emotional disturbance as a result of this is apparent or not. The disturbance, when latent, usually rears its head both at times of great crises and, especially, in the close relationships the child will enter into as an adult with his spouse and his children. In treating the separation trauma, as well as other damage occurring before and after that, the undertaking is the same as in child guidance work, except that it is much more difficult because the pathology is usually greater. Even within this group, the extent of treatment needed for the effects of the separation trauma will vary according to the child's innate capacity to tolerate stress, what assets he has brought from his earliest years, and what benefits he has derived from placement. The question arises as to whether or not the child guidance work needed so extensively by children in placement should be carried on by the workers in placement agencies. The first consideration is the skill and training of these workers. If these abilities are not available in the staff of a child placement agency, they can be cultivated on an in-service training basis of staff development. The setting of this type of agency lends itself to a richer experience in clinical know-how than do traditional clinics, as the workers are closer to the child in their responsibility to him. Out of necessity to meet most trying and what appear to be insurmountable obstacles, new techniques are developed. The child guidance work should be done by the staff of the placement agency but not because of the small number of child guidance clinics in this country, each with long waiting lists, which makes it impractical for them to plan to undertake treatment of the many children in placement, or because their accessibility in rural areas is almost nil. Rather, the most valid reason for the placement agency to undertake the children's direct therapy for personality damage is that the placement worker has a closer understanding than anyone else of the foster child's unique living situation. This is best appreciated by the worker who handles it firsthand, even if the situation is not that of the particular child he is treating. Better integration of the knowledge of the child's unconscious material with that of his life situation during the course

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of the therapeutic process is attained through this understanding and appreciation, which thus also determine the progress of the task. It is difficult enough for an adult to talk about the painful experiences of his past, but it is much more so for a child since he has not yet had a chance to build up defenses and gain compensations to help him deal with his pain. The child in placement has greater resistance to bringing out this painful material than do most children who come to child guidance clinics while living with their own family because he has been given less gratification to build ego strength to bear it. The foster child further resists revealing his feelings about the past, in which his family figures prominently, because he is afraid he will thereby lose all chance to return to the family, a hope he clings to in fantasy or unconsciously. Even though he is assured that his confidences will not be revealed to his family, he is still controlled by their past omnipotence. Further, he senses, and correctly too, that if he shares in this way in the work of freeing himself from some part of his past, he will lose his tie to it, and he feels that he needs it badly in the absence of any new ties as strong as these. His clinging to the old serves as a defense until he is able to make new supporting ties. The fact of separation from his family also makes the foster child's treatment situation different from that of a child living in his own home, as the child in placement dangles between two sets of family ties. Too, not only is he afraid that treatment will threaten his clinging to the neurotic tie to his family by his facing the negatives about them, leaving him with little or no tie, but also his feeling of having been rejected is crystallized by the reality of placement which he views as abandonment. The child's reaction formations to this reality then become the more fixed to shield himself from this dreadful knowledge, creating further barriers to treatment. For all these reasons it is important not to attempt an exploration of the child's past or deep feelings, even those held on a conscious level, until he has formed meaningful relationships with the worker and the foster family (especially the latter) with whom he is currently living. There must be some framework of stability in the child's living arrangements with some content of positive feeling there to help him feel a little safe

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in letting go of old ties which do not currently nourish but are used as defenses. Even deeper and sounder relationships are necessary when the time comes to give the child the full and detailed explanation of the family situation which caused his placement. Brief factual information should be given the child at the onset about the reason for his placement for his intellectual mastery, as pointed out in the chapter on preplacement work. However, the more extensive work giving the most meaningful explanation of the separation should be done only after the relationship with the worker has grown strong. Moreover, it should be done when the child is in a state of positive transference to the worker, as the support he takes from the relationship, uncontaminated by negative transference, will cushion the shock from the explanation so that he can hear it more accurately. This relationship will lend the child confidence in the worker, and this will permit him to believe the worker's explanation. Lastly, the relationship will comfort and support the child so that he can bear the knowbdge he has acquired and can make his peace with it. With reference to the foster family, this explanation should be given only when the child's tie with a key person in that family is at the stage where it can be helpful on a continuous basis beyond the point at which the worker leaves off. This means at the stage where the foster parent can confirm the worker's explanation and give the child further comfort. In helping the child with his resistances, the usual techniques of child guidance work are utilized, plus others related to the special emotional situation of the placed child. Beginning discussions about himself at the point where he is in reality develops communication between the child and worker about activities and their accompanying feelings in neutral or less highly charged areas. Where he is can be discovered from clues found in the foster parent's report of the child's adjustment at school and at play and from the worker's observations of the child during his supervision of the foster home. This should be done in the spirit of amiable interest rather than in that of search. The child is helped to talk about his recent visit with his parents, for example, which is elicited in terms of his activity with them during the visit. A child can conceive of

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most situations in terms of activity, and current activity is not only fresh in the child's mind, but also helps make conscious his experiences of the past. If the worker asks questions, they should be posed from the point of view of interest and approval of the child's fun and pleasure with the parents, as the child naturally shields himself from thinking and talking about painful experiences. Sharing the memory of fun may then lead to the child's talking of other experiences, but all the while it also helps to build a relationship. There should be enough neutrality in the worker's attitude to allow room for the child to tell of his disappointments in the visit and previously. The worker's providing play for the child, and even sharing in it with the child when indicated, will help the child to express feelings and reveal attitudes toward his parents, whether or not they are in touch with him. Play is another way the child can share pleasure with the worker; thus, it helps the relationship to bear stress from material that is painful. Play also helps the child discharge feelings toward the significant people in his life, which he may be fearful to do in a direct fashion. This sort of expression through play serves the child in the same manner that dream material serves the adult in therapy. The child's discharge of tension through this play helps to make talk easier for him. Acceptance by the worker of what the child displays during play, permission to go on with it if the child hesitates out of fear, and support to do it when the child is too timid may help remove the child's fear and reassure him enough to enable him to bring out more directly the content of what he thinks are forbidden and frightening feelings. It is desirable that this procedure be carried out with the supervision of a mature and skilled therapist, preferably a child psychiatrist, to guide the worker in not undoing too much at one time. Otherwise the child may either become uncontrollable in his behavior outside the treatment sessions, or he may reveal so much to himself that he will withdraw, or regress, or become more resistive. Interpretation of the play material in the early stages of the relationship should be for reassurance rather than to help the child gain insight. For instance, when anger or sexuality appears, to which the child reacts with fear and guilt, the interpretation of their

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universal nature may reduce the guilt. An explanation that the thought does not equate the deed or act, and that he will be helped not to act out, that hate in itself does not hurt another, all may help the child feel reassured enough to face and deal with his hostile aggressions. Reassurance of another nature which dampens the child's feelings, such as reassuring him about the source of his anger or giving him other methods of closing off the expression of anger, is premature. It cannot be stressed too much that the child should be helped to empty in a gradual fashion his feelings of anxiety, hate, fear, guilt, and others which are destructive to his emotional health before either this type of reassurance or the interpretation is given. His fantasies containing these feelings should also be elicited first in order to clarify the distortions these feelings have made of reality for him. The interpretation for the child should include the connections between his destructive feelings, and also his fantasies, and the effect these have on the problem at hand in his current life situation. Building in with comfort, sympathy, hope, and love gives the child strength to alter his responses on the basis of his new understanding and to develop new patterns of behavior. Treatment of the child also includes a reintegrative process of guidance and reeducation by active instruction and direction.® With some children, the ego capacity for grasping verbal interpretation is small. Since it has little or no meaning for them, explanations must be demonstrated concretely as in the habit training of the preschool child. Such work is not like that in the reintegrative process; rather it is a process of ego construction for the ego which is seriously defective. For example, a psychotic child of eight whose rage was precipitated by some frustration in his reality situation showed no limits in the permissive atmosphere of the treatment session. First, he was restrained physically by the worker who explained that he was holding the child to show him that such rage and destruction are not permissible and, further, that they are controllable, to wit, as the worker was now showing him by his strength. The child was told that in this way he would learn eventually to control himself. Later, he was allowed to break something like balloons, or specific pieces of doll furniture, with the explanation that he could be

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angry and express it without destroying the world, which he believed his anger would do, so that his fear of it created disorganization in him. He was told that there are certain things he could do when angry, and other things he could not do, such as hurting himself or others, and that the worker would help him learn which he could and could not do. In this way, ego boundaries were established and his disorganization reduced. Along with or after the interpretation of the child's behavior and reactions may come the explanation of the parent's attitude and behavior which led to the child's placement. This is the most difficult part for the child to hear, and it should not be given if the child resists knowing it or is otherwise not ready to hear it even if he asks. In the latter instance, the child's question should not be rebuffed but answered directly with enough selective information to satisfy him for the present. Efforts by the worker should follow to prepare the child with universalization for reassurance, as described, for a more adequate understanding of his parents and the reasons emanating from them which caused his placement. If this subject was dealt with earlier with factual information for intellectual mastery, the child will already know, unless he is younger than nursery school age, the situation which caused his placement, such as death, divorce, neglect, desertion, or hospitalization. If he knows of them, he may not understand their nature and their cause. In many instances the placement does not occur until months or even a year or two after a family tragedy involving the loss or absence of a parent. Makeshift plans may be tried in the family until they break down and placement is requested. A housekeeper, or nursery school plan, or help from relatives or neighbors, even on a paid basis, can prove unsatisfactory. In the meantime, the child's reactions to the original family tragedy and disruption have been buried, since the child in most instances is not adequately helped at that time to understand them and to bear the pain. There result reaction-formations in the child's personality, revealed in emotional disturbances and behavior disorders. By the time this child is placed, these early reactive feelings are submerged, and their supporting defenses since erected make it difficult and sometimes impossible to reach therapeutically the original trauma.

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EXPLANATIONS OF REASONS FOR PLACEMENT

After placement, therapy should ultimately be directed toward the child's reactions to his parent's illness and pathological behavior previous to the event leading to the placement itself. When a good deal of this has been worked through as described, the explanation of the parent's defection in general and of the crisis or specific act precipitating placement is given. Reactions to the explanations themselves, such as shock, anxiety, or guilt, then have to be worked through also. Counseling of a remaining parent or significant relative, if feasible, and counseling especially of the foster parent should precede or be given simultaneously so as to help them in their explanations of the same matter to the child. It is highly important that these adults not confuse the child with information based on their view of the matter but if that is different from the worker's, should confirm what has been told the child by the worker. Children do go from one source to another seeking for explanations of these very volatile matters. Differences of views and opinions between the worker and the relative or foster parent cannot always be reconciled before the worker unexpectedly finds the situation ripe for the explanation. Early communication, then, with the other adult in the picture to share what has been told the child and to impress the need to confirm it is imperative. Further work must also be done with the true attitudes of the meaningful adults in the child's life to insure genuine cooperation from them in this matter. Factual explanations of life tragedies should be fashioned in terms which are both understandable and realistic while at the same time the least threatening to a child. The task of explaining such tragedies, especially death, is beyond the capacity of many adequate adults. Nevertheless, dynamic knowledge of human behavior, used sympathetically, can constitute the core of these explanations. Of all the tragedies, death is the most difficult to explain. Although among the wisest there may be agreement as to the concept of death, there are various ways of expressing it. If a child has been reared in a religious atmosphere which carries its own explanation of death, he can be told about it in terms of consolation familiar to him. This explanation will probably have already been given by

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a remaining parent or relatives. The child may have been informed that the deceased has gone to heaven. Picturing heaven as a place of happiness, he may find partial solace in the parent's happy state. If the worker does not hold the same beliefs, it is rather obvious that the difference should not be stressed with the child. But if the child should question the original explanation, either at the moment or much later, it can be supplemented with further information. Even then, however, the new information should not be contrary to or entirely destructive of the child's early source of strength. In this instance, the initial explanation is not dealt with as having been a distortion, since there is room for more than one explanation of the unknown after death and since the various explanations can be reconciled. The worker need not be the only one who has the right answer. When the child believes that the deceased parent is now in a state of happiness while the child is left behind, it is only natural that his question follow: "What of me?" The child's feeling of being deserted and deprived by the deceased parent creates resentment toward the parent for having died. These feelings, mixed with longing for the deceased parent, set up a conflict within the child. Guilt over his anger toward the lost parent rises to plague him. To forestall some of this, the child should be told that the parent did not wish to die, that death happened despite the will of the parent. If the child is one of religious background, he may believe it was God's will, as he has probably been told. There will still be a need later, however, to handle his feeling of anger over this loss. What of children reared without any meaningful religious concepts? One of the usual explanations given here by relatives is that death is something like going to sleep, but actually different in that one can awaken from ordinary, everyday sleep. In clarifying this with the child, differentiating death from sleep is necessary to avoid fearful fantasies from developing in the child to the effect that he will never awaken if he goes to sleep. Anxieties such as these develop in the child as retribution toward himself out of guilt over the anger at the parent for having died. Such a fantasy is quite probable when the explanation of death includes the information that the deceased parent cannot return. Again, to forestall feelings

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of rejection in the child, he should be told that the parent would like to return if he could. A sound explanation can be given in terms of creation and its natural manifestations. Just as the green grass and leaves lose color and fall away when life passes from them, so it is with the human being whose life also passes away. The human being cannot return in person any more than can the grass and the leaves. With each annual renewal of the green foliage, however, physical replicas of the grass and the leaves do reappear, whereas with the lost person what will always remain is the love which the child has had from him. When the child's understanding of the phenomena is still not clear and he shows signs of anxiety, he can be told that death is a natural occurrence, beyond human decision. People just do not control it. It must be natural, or it would not have happened. The child should be helped with his feelings that it does not make sense by telling him that even if one cannot understand, it could not have been avoided anyway. In the child's feelings of omnipotence and responsibility for the death, he should be reassured that he had nothing to say or do about it. In his fear of retribution and in his other anxieties, he should be reassured that usually death comes to old people and that he is a very long way from that age. Further detailed explanations of the cause of death may adhere closely to the facts surrounding it. Death by accident may be presented as something not intended which hurt the parent so much that he could not get better. Illness as the cause of death brings a similar explanation. But assurance must be given the child that he will be cared for in times of sickness as well as in times of health. Death of the mother as a result of childbirth requires still more explanation. It is necessary to prevent the fear of pregnancy and childbirth which can develop as a result of the child having learned about the circumstances surrounding his mother's death. As a result of these fears, the usual and inevitable anxieties around sexuality in the course of growing up are intensified and normal psychosexual development is hindered. Guilt feelings also can develop in boys and girls who learn later that the mother died as a result of their own birth. This guilt can cause sexuality in any form to appear

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to be a dangerous and forbidden act, even in marriage. Knowledge about the mother's death may also cause the child to consider himself a lethal being. A girl may grow up so fearing pregnancy and childbirth as to prevent her from bearing children, and a boy may reach adulthood resolved not to permit his wife to become pregnant for fear of risking her life. If a sibling's birth occasioned the mother's death, however, the guilt over sexuality and the fear of it is less strong—it was somebody else and not this child himself who killed her. But he may hold a lifelong bitterness toward the sibling whose birth accompanied the mother's death. T h e fact that childbirth is a normal, universal process must be stressed with the child. The condition which caused death should be explained as entirely accidental and not premeditated by anybody, including the newborn child. T o reach the child's deep-seated guilt over his assumed responsibility for the mother's death at his own birth requires that the light of reason be held up in the questions raised with him: "Doesn't every child need and wish to have his mother to take care of him?" "Then why should he want to do such a thing to prevent it?" Such questions can be used also with the child whose placement was caused by the mother's death at the birth of a sibling. It cannot be too strongly stressed that the child's fantasies concerning his responsibility for the mother's death must be routed as early in the child's life as he can be reached. Otherwise, these feelings will injure the individual's character and can become so fixed that they are almost impossible to modify. The child clings to them as substitute feelings for the loss of direct gratification from the mother; the feelings not only become an everlasting penance from which he cannot be moved, but also constitute a misdirected source of gratification replacing the mother's lost love. It can be said that this is the child's only form of contact with the deceased parent, and for this reason he clings to it. Such a neurotic completion stands in the way of the child's acceptance of healthful and nourishing gratification from mother-substitutes and later from his marital partner. This deviant method of finding satisfaction leads to secondary gains from the loss which are generated out of society's "pity for the orphan," and there results an unhealthy feeding of the unmet dependency needs of the child. Such reactions stemming out

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of the mother's death from childbirth are depicted in the following case example. Norma, now seventeen, was the youngest of three children whose mother died at Norma's birth. The father by himself reared the two eldest children, both boys, but had placed the infant Norma in a day and night nursery. Because she was receiving scant personal attention there, a paternal aunt, out of pity, took her at eighteen months. The aunt's entire household reflected this pity and gave her much love on this basis as well as out of their own need to give to a baby. Norma learned that she could rule them and have her own way by crying. When at age six she would see her aunt and uncle going out for the evening, she would weep until they gave up their plans and remained at home. Her grown cousins deferred their dates in order to play with her as she demanded until she went to sleep. Her father and brothers were like distant relatives to her, even after her aunt placed Norma at age nine. In the next five years Norma had to be placed four times. The reason for this was not at first apparent as she seemed quiet and conforming and did not show openly difficult behavior. The pattern was finally seen: Norma subtly controlled and manipulated the people in each setting. She exerted the control as a means of managing her dependency needs, as she learned to do with her aunt's family. In a strange family, she repressed her open demandingness and substituted subtle manipulation, setting people against each other, maintaining an innocent front while she appealed to their sense of pity. In one foster home she chose to ask the foster mother for food in the presence of the foster family's guests in a manner so plaintive that the foster mother was made to appear as if she starved "the poor, orphaned child." In the fifth placement, which was maintained for three years due to the firmness of the foster mother in averting her tactics to gain pity, Norma turned to the household help, using them for such an outlet, and secretly set them against the foster family. This identification with the servants, as well as that with the fringe group of peers at school, showed Norma's deep feelings of inferiority which stemmed from her sense of having been deserted

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by mother-figures and later from having been made an outcast by her father and her brothers. Though she reached out to her immediate family, they ignored her due to their resentment since it was her birth which had killed the mother. Their attitude intensified Norma's self-pity and the deep guilt she felt for her mother's death. Out of this guilt came her self-destructiveness. This was seen earlier in her need to destroy her foster home situations, including the last one which she much desired to keep. In adolescence she had a need to depreciate herself with dates, allowing the boys to cast her off and pick her up again at their will. She quarreled with and hurt her boy friends because she did not like necking with them (actually she feared it, and yet she was provocative in i t ) . She also destroyed her relationships with nice girls in the same way as she did with her foster parents. Finally she began to act out by throwing away her reputation—first by being sexually provocative toward nice boys, then by picking up strange men. She derived much gratification from all this acting out; the hurtful behavior gave her satisfaction as she conceived it, through self-suffering and through inflicting pain on others. She had learned to substitute the self-suffering for the gratification and security she had missed from her mother. Her hurtfulness toward others stemmed basically from her concept of interpersonal relationships as being hurtful, as well as from her later wish for revenge for the pain she had been dealt. At no time could she permit any of her foster mothers or her three successive workers to come emotionally close enough to her for her to relate meaningfully to them. T o do so meant to her that she would be rejected by them as she had been by her mother and that she would kill them as she felt she had killed her mother. She maintained herself by two chief defenses: with one she controlled by conforming and seeking warmth through provoking pity, while with the other, to her detriment, she kept her own counsel, planned her own life secretly, and manipulated accordingly. During the last worker's attempts to get at Norma's feelings about her mother, Norma revealed that she had done volunteer work at age sixteen as a nurse's aid in a near-by hospital largely to find out what causes death through childbirth. She was amazed

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to see women sitting up and chatting happily the day after delivery. It could be seen that Norma's wish to work in the hospital did not spring from a desire for self-healing but rather from morbid curiosity. She really did not wish to learn from what she saw there that unfortunate results are accidental and not intended and that the usual situation is the happy one she witnessed. Out of her morbid preoccupation, she continued to relate, she had gone on her own to the hospital where she was born and asked to see the room her mother had occupied at her birth sixteen years before. Whether this account represented her dramatic fantasy or a real activity, the worker tried to introduce some clarification to satisfy Norma's curiosity and to fill some of the void left by her mother, since little had been discussed with Norma during her lifetime about her mother. Since Norma had never sought factual information from relatives about her mother's death, her worker suggested that she do this now to clarify the situation. They could then discuss what really happened. Norma brought back information from an aunt that her mother had died in a coma. It was suggested to Norma that the coma had possibly been due to infection owing to accidents in the bodily composition and in the medical care, but Norma could not accept this. She responded with information she had not previously revealed—information she held as a trump card. Her mother had been ill throughout her pregnancy with Norma, requiring full bed care, and this illness had culminated in death. "She was sick with me before I was born," was the way she phrased it. Norma consistently rebuffed all further efforts to have her deal with reality; she had no wish by this time to feel differently about her mother's death as her unconscious needs would not permit this. She had become so steeped in this perverse means of gratification by which she had lived all these years that she had no way of giving it up. In cases where a parent has committed suicide it cannot be said that the resulting death was unintentional. Here the act itself lends confirmation to the child's fantasy and his consequent wrath over the parent's wish to abandon him. But it is fairly well established that at the time of a suicidal attempt, ánd some homicidal attempts

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also, there is at least a transitory break with reality—that is, there is an eruption of uncontrollable impulses leading to the act. Thus, explaining suicide or homicide to a child really means explaining mental illness in general. In the case of the very young child who was spared the sight and knowledge of the parent's act of suicide or homicide, or of his being murdered, he might have been told by others that the death in either instance was "an accident." At a later time, however, this child will usually show signs of having knowledge of the real cause of his parent's death, whether it was as suicide or as murder victim, or as killer executed for his homicidal act. Either it was dimly perceived in the past, or adult gossip which the child heard in the past has crystallized, as a result of his additional life experience, into a realization of what happened. If the truth was withheld during the child's early years, these later signs of awareness should be watched for so that his fantasies can be elicited as to what he believes happened. These should be corrected as indicated and followed by explanations to allay the horror and anxieties generated by the tragedy and especially the bitterness toward the offending parent who committed the suicide or homicide or that toward the world which harbored a person who murdered the parent. It is also important to include an explanation to the child as to why the exact information was not given earlier so that the child's trust in adults be not further decreased. The child can be told that it was the adults' intent to protect the child from pain when he was thought to be too young to cope with it. This should tend to inspire a positive rather than a distrustful attitude in the child. Mental illness can be explained as having been caused by immaturity in an adult: a part of his ego was arrested or never formed due to serious gaps in his early life, and the resulting inability to cope with life's responsibilities and problems led to turmoil and confusion. The final manifestation of this state of mind then might have been a break with reality. In the loss of control of his impulses or in the regression to safer ego states, he would completely lose contact at certain points of the current life situation which is reality. When an adult's discouragement and pain over his failure to

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cope with life becomes too intolerable, he may seek to escape by suicide. With another adult, however, the discouragement and pain may give way to extreme rage for having to suffer so, and he may, when the pain becomes too much to bear, seek to destroy in a homicidal attack that person believed by him to be the cause of the pain. The latter information can serve to explain both the death of a parent who was murdered or the act of a parent who committed a murder. The delusions of the psychotic parent heard by the child and the bizarre behavior emanating from them, both of which either frighten and puzzle the child or create in him a tendency to believe them true, can be explained to the child as the parent's way of trying to get along in his sickness. At the same time, to offset the influence of the parent's delusional ideas on the child, these must be held up to reality for him to compare with the thinking and behavior of other adults he knows—the worker, the foster parents, the teachers, and the parents of his playmates. Then it should be pointed out sympathetically that his own parent's strange talk is composed entirely of his own ideas, which are not like anybody else's, and that this is a way the parent has devised in his sickness to manage his worries. Being part of his sickness, they are not to be accepted as sound. Sometimes an acute situation or a seriously deteriorated condition in a chronic mental illness creates the need for institutionalization. With this may come the need for immediate or subsequent placement of the children, particularly when the disabled parent is the mother. The purpose of the parent's hospitalization should be made clear to the child. If he is told that the mental condition is an illness, as described, then he can better understand why rest and hospital care are necessary for the welfare of the parent. Obviously, dynamic expositions cannot be given to a child in the language of the adult; rather, they have to be given in terms of his own experience and from the point of view of a child. The language used to convey these various explanations is illustrated in the case example of Paula, given later in this chapter to illustrate the description of the treatment of vital areas typical in the lives of placed children.

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There might be controversy as to whether or not the pathological facts of life, as seen in suicide, homicide, illegitimacy, and sexual promiscuity, should be revealed in any terms to the very young child. He supposedly does not know of the existence of these circumstances of life, let alone their connection with his parent's life. It could be argued that it would be inadvisable to burden the fragile ego of the child by introducing such a parental picture. But it may be safe to assume that when a very young child's ego is mature enough to recognize the names of such phenomena in terms of what they signify, even without understanding how and why they occur, he has already come to appreciate some of the taboos and other attitudes of adults as to the unacceptability of such behavior. Sincc the natural reaction of children is to view life situations and new facts they are learning about in terms of themselves first, they screen what they learn about this phenomena against their own life experience to date. This is how events dimly perceived by the child in the past when he is too young to understand become meaningful with added life experience. Therefore, the child cannot be protected from this knowledge as he will know it eventually in any case. However, it does seem inadvisable to tell the child of such tender age, when he does not even know that such phenomena exist, more than his social experience is ready for. He should be told a little at a time, measured against his curiosity at any given time, just as any charged information is given to a child in the amount he is seeking to know at one time. If the attitude of meaningful adults about the nature of the parent's death or homicidal or other antisocial act is not forbidding, the child will feel free to ask what he wishes to know. He should then be told the facts to the extent he is asking them at one time. The child will sense such a permissive attitude toward these situations chiefly in the therapist or in an unusual foster parent, as the social taboos about them are usually too well ingrained in the attitudes of most adults for the latter to be permissive. If the child has already been made to feel that the subject should be repressed, the worker should watch for signs of awareness in the child, and when they appear, he should prepare the child to hear the true explanation, which has to be given eventually.

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There are yet other elements governing the timing of these explanations. Until much of the child's underlying anger toward the parent for abandoning him has been worked out and his ego thereby strengthened, the uncovering of the child's fantasies regarding the parent's sick behavior and the full explanation of it should ideally not be given to the child whatever his age. The other ideal requisites are that the child be in a positive relationship with the therapist and that his foster home situation be stabilized. These conditions for the task of explaining the pathology cannot always be met, as it may be the breakup of the foster home which precipitates out the distortions secretly held by the child about his parent. O r sometimes the anger at the parent will not be accessible to working through because it is being acted out at the environment instead. A fourteen-year-old girl was replaced several times because of her rages in which she seriously hurt other children, even throwing one down a flight of stairs. She knew that her father was serving a life sentence for killing her mother's boy friend, and she was bitter toward both her parents, as well as toward the world in general, except for her worker. The latter had steadfastly accepted her despite the outbursts of rage. Unable to work through this rage at first because of the girl's fear of it, the worker told the girl how it had come about that her father had killed the other man. The worker sympathetically explained the father's immaturity as his being childlike in his feelings even though he looked grown-up, and that that was why his actions did not match his appearance. Continuing, she said that just as this girl felt sorry after she had struck a child too hard in a fight, the father being bigger, struck somebody much harder and then was also sorry. He was now in prison to show that he was sorry. The girl's fears and guilt abated after this explanation as she could then identify with her father in a softened way, with less anger, because of the worker's nonjudgmental, though not condoning, attitude in the explanation of the father's act and the child's understanding of the father's human weakness. The daughter subsequently became better able to control her temper, spontaneously began a warm correspondence with

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her father, and with further help became closely tied to a foster family. She then was also able to emancipate herself from her alcoholic mother. With all such explanations, it is most important that the child be helped to differentiate himself from the parent so as to free himself from his compulsive feeling that he must share a similar fate. Because of the original identification usually made with a parent, the child's feeling that he must be like the parent in all ways includes the belief, which sometimes consciously worries him, that he must share his parent's fate in this tragedy also. This belief may root itself so deeply that it may influence him into meeting a similar end. Efforts to bolster the child's wish to save himself, to help him believe that he does not have to be like his unfortunate parent include encouragement of the child to discuss his parent and his parent's afflictions. In this way, the image of the parent which the child incorporates for identification will not be buried only to be unconsciously copied. This image should be brought out into the open and the deviations in it understood as the parent's problems. Thus can the child be helped to become reconciled to the meaning of his parent's problem and to the pain it brought to the child before the subject is laid aside. Then by concrete action, as well as through repeated discussion, the child should be assured that he will be given the care necessary for living—to have his basic dependency needs met so that he can grow up with more strength to be more mature than the parent. This, as well as guidance through warm discipline, will help him to learn how to handle himself, he can be told, in an adequate fashion, as do the worker and the foster parents. It can be pointed out that they, too, may get discouraged and angry, but that they can control themselves well enough to keep out of serious trouble. The child should be told that while he is helped to do this too, by being taken care of, he will learn from this help how to take care of himself. With such hope held before him and with his feelings of guilt for being better than his parent alleviated ( a feeling arising from ties of pity),

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the child will be in a stronger position to counteract the unfavorable influences of the parent's behavior. When a placement, in an emergency or not, is the result of a parent's incarceration, such information may be withheld from the child by the family but unwittingly communicated in a hurtful manner by an outsider. If a child is old enough to realize what has happened to the parent, he may pretend not to know because of his wish to avoid the supposedly contaminating disgrace. Even the very young child, however, will have some awareness of the truth and he puzzles over it. In both instances, it is more healthful for the child to share his burden, find himself still acceptable, and understand what caused his parent's behavior. The child's bewilderment and disappointment over the parent's defection and his anger over the parent's failure to take care of him both require handling. An explanation of imprisonment to the young child consists of a statement to the effect that the parent has done something so very wrong that the rule requires that he be punished in this way. Again, a differentiation must be made between the naughty acts of the child, which he describes as "bad," and that "bad act" which the parent has committed so as to allay the child's anxiety and guilt feelings over his own misdeeds. The child can be told that grownups are expected not to do certain wrong things, whereas children get into trouble either because they have not yet learned all of what is right or wrong, or else they have not yet learned how to control themselves. Jimmy was three and a half when his father was imprisoned for armed robbery. His mother placed their three children, of whom Jimmy was the eldest, after a year's unsuccessful trial of having a housekeeper to watch over them while she worked. The children missed their father as he had given them much attention. The mother had explained his father's absence to Jimmy by telling him that his father was in the navy when she took Jimmy at age three to visit his father in jail. Jimmy had two women workers during his first year in place-

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ment, but only with the third worker, a man, did Jimmy begin to mention his father quite often, though obliquely. Jimmy's manner of referring to his father gave some hint that he was somewhat uneasy about his father's situation. When Jimmy was five, he indirectly showed his fear of asking his mother to take him to visit his father again, thereby reflecting her forbidding attitude on this subject. By then Jimmy had made a deeper attachment to this worker, and asked the worker to persuade his mother to take him to see his father again. He repeated that she had promised to do so but that she had not kept her promise. In the foster home Jimmy was depressed at this time, and his talk centered chiefly on seeing his father. Thus, thoughts about his father seemed to weigh on his mind. By this time the worker, in his relationship with Jimmy's mother, was able to help her understand the need to tell Jimmy of his father's true whereabouts, and he advised her of the manner in which Jimmy should be told of his father's imprisonment. She had been too angry at the father for leaving her with the burden of caring for the children to let Jimmy talk about his father, and also, her pride made her wish to keep his imprisonment a secret as she considered it a disgrace. She was fearful that her small children would inadvertently disclose the situation to outsiders. After she explained the truth to Jimmy, he told the worker and his foster mother that his father was being punished by being kept in jail because he had done something very wrong. The worker confirmed and elaborated the mother's information. Jimmy said only three people were to know this secret, himself, the foster mother, and the worker. Subsequently Jimmy appeared somewhat lighthearted and outgoing in the foster home, as well as in the interviews with the worker. His play in the therapeutic sessions became freer and more imaginative. The worker established an atmosphere of permissivity with regard to Jimmy's destructiveness and other displays of aggression in the office, but limits set in advance were maintained whenever possible. In carrying out the restrictions the worker reassured Jimmy that thus would he learn to know what things he could or could not do to keep himself out of trouble now and later also as a grownup.

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In the child's natural reluctance to accept restrictions, even though at the same time he really likes and needs this form of help, he may assume that the leeway provided by this explanation of his present unreadiness to control himself is permission to act out impulses rather than information aimed at helping to control them. To counteract this, the child should be told that he will not be allowed to act out in his inexperience as his father did in order to keep the child out of trouble. The parent's defection, with its consequent suffering, can be explained as having stemmed from immaturity such as that described earlier in regard to mental illness. The child can be told that his parent had been unable to learn adequate control over anger and other impulses, owing to lacks in his own childhood for which he did not have help. Reassurance to reduce the child's anxiety over possible duplication of the parent's behavior in himself should be given along with encouragement that different behavior is possible for him. The child should be assured that adults, while helping him learn controls, will also help him enjoy himself. From the promise and fulfillment of his rightful needs for pleasure, the child gains incentive to accept necessary restrictions. It is vitally important for the parent-figure, whether it be the foster parent or the worker in either aspect of his dual role, to watch carefully his own temptation to give to the child in his neurotic claims instead of adhering to the necessary restrictions. His giving in to the child's demands can readily happen in the face of the child's maneuvering or his actual pain, which is old pain stirred by current unavoidable deprivation. The foster parent may be anxious to maintain a positive relationship with the child or to avoid precipitating difficult behavior. The worker may be pressed just to maintain the contact with the child, let alone to retain the positive relationship and avoid stirring up more resistance to treatment. Each of these parent-figures can thus find some rationalization for such giving when this would actually detract from the child's opportunities to learn to integrate for self-control. A lack of consistency will also lead to the child's confusion as to what is right or wrong, or will make him anxious. He can also misconstrue the inconsistency of the authoritative adult as a defection from which

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he may take permission to practice dishonesty. If he succeeds in his maneuvering, he will feel he can manage to have his way in life by such methods indefinitely, and here then is seen what is referred to as a lack of conscience, possible because he has no meaningful ties to counteract this. When restrictions are placed for the purpose of helping the child with his anxieties, he then will feel safer about his impulses, both in the present and with regard to the future. The integration of restrictions can take place if the process is consistently applied and gratification provided in other ways. As this integration is completed and sufficient self-control is achieved, the child is less apt to take example from his parent's antisocial behavior. Divorce ranks high among the causes of broken homes which lead either to precipitous or eventual placement of children. Since divorce per se is not the entire reason for placement, explanation of it should include the parents' immaturity as well as the tangible realities and difficult circumstances which prevent the care of the child at home. The child will wish to know why the parents were divorced. In the case of immature parents, the child can be told that his parents were not sufficiently grown up, even though they appeared completely grown up from the outside. The part of them which was not grown up won out and made them act unwisely over disagreements. In fact, they quarreled so much that they decided to separate, just as two friends do when they cannot get along together. Moreover, neither parent is grown up enough to be able to manage the care of the children without a partner to help in this responsibility. To carry this sorry tale still further, as in indicated in many cases, neither parent seeks anyone to marry with whom he will not fight so much as he is too disappointed to try again. Or if he does remarry, it may again be to one who is not grown up enough to help the parent take care of the children. Of course, this discouraging story should not be told in its entirety at one time, for the child will not be ready to hear it all at once. The clues as to when and how much to tell are taken from the child's questions, hints, and reactions, and it is safe to be guided by these as to what he already thinks, how much he wishes to know, and how much he should be told at any given time.

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A parent's outright desertion of his family is based on his inability to meet maturely the responsibilities and problems of family life or on his inability to cope with severe disappointment—a business failure, for instance. This immature behavior can be explained to a child in the same way that the imprisonment, divorce, and so forth are explained. In addition, the specifics to be offered in explaining desertion are that the parent had more worries than he could handle. He then became so discouraged that he has tried a way of forgetting them by disappearing into places where he would not be reminded of them. Among the unhappy situations causing separation of a child from his parents, especially in involuntary placements, is prostitution and subsequent arrest, which sometimes creates the need for an emergency placement. Even if the mother is not apprehended for prostitution, her promiscuity is one ground among others which can contribute to the involuntary placement of children. A child may have been left alone for long hours without adequate supervision or physical care while the mother was out soliciting. Neighbors may have complained that the parent brought people into the home for immoral purposes. The parent may have thought that the child of tender age would not be affected by witnessing the parent's sexual activities. Children of any age, however, are aware of any illicit sexual behavior on the part of the parent from having heard sly comments from outsiders or from having been present when telling invectives were hurled from one parent to the other. The disturbed behavior of these children may reflect anxiety and despair from disappointment in the parent in this or overstimulation and lack of sexual ethics from copying the parent. Some children removed by courts from these situations may themselves have been the victims of the parent's sexual delinquency, usually over a protracted period of time. These children have learned about sexuality in the most harmful way, and without some positives being present, the damage such experiences can do to their personality makes them the least accessible to healing (their attitudes may have become warped to an extent that sometimes defies correction). The parent's use of his child for sexual activity is a hostile attack even though physical violence in the

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usual sense has not occurred. It is not an expression of affection but rather one of exploitation, in which the child holds no value as a child for the parent. The child is left feeling that he is a worthless creature who was merely used. Therefore he will be full of anger at the parent, but this will be mixed with the pleasurable feelings of sexual excitement. In this way can be created a pattern in the child of using sexuality throughout his life in a sadistic manner for obtaining his highest satisfaction from it. Also, this sexual activity has increased the pleasurable feelings of sexual excitement at an age when the child is not ready to manage them in order to permit further development of his personality by sublimation. T o o much of the child's energies will be drained off thus to the neglect of learning otherwise to prepare for life, as through school work, social relationships, and so forth, which have become dull by comparison. If the child's ego structure was excessively weak before the sexual experience with his parent, this slight amount of ego integration may break down in the face of the force of the heightened sexual impulses to result in the child's mental illness. In addition there are guilt feelings and anxieties caused by the parent's admonitions, accompanied by threats, that the child keep secret the activity both from others in the family and from society. This in itself, supplemented by social taboos regarding sexuality learned in the family earlier or at school and other social institutions, places the child in the most severe conflict. He feels entirely unprotected—even by his family—which, in addition, jeopardizes him. When the parents give to the child somewhat adequately in other ways, the child then has some strengths with which to struggle in his conflict. Although still helpless to deal with it directly, he may express it through neurotic symptoms such as compulsive stealing or physical complaints. It is through these symptoms that he may be accessible to help for making an adequate adjustment later. Usually, however, the families who reach the courts on this charge are quite barren of most of the positives that are vital to the emotional needs of a child and that would create conflict in him. If this conflict were present, he might handle it through the indirect expression of symptoms as has been mentioned. If the

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child develops neither mental illness nor outward symptoms, in order to manage this intolerable conflict, he learns to bury it deeply enough to leave him free of guilt for short-lived pleasure. The parent's influence through warmth and teaching—the chief force for instilling and maintaining standards in the development of a child's conscience—is almost completely lacking in this situation. The child, thus betrayed, emerges with little if any conscience; he is bent on seeking easy pleasures without caring about method or consequences. There is at best a vacuous, rather than a careless quality to this disregard, and the guilt and anxieties are so deepseated and so lacking in compensatory values that he is inaccessible to help at this point. Perhaps when these outlets are blocked, if he is placed in a locked treatment institution, anxiety can be mobilized and therapy thrust upon him. Then he can be reached for change. Otherwise, if the child lives in the community, explanations of the parental behavior can have no new meaning for him: the facts are already known to him while his emotional reactions to the circumstances keep him inaccessible. What might make an impression, at least to the extent of "puzzling" the hard-shelled child, is the declaration, made sympathetically, that the parent may be mentally sick. This may provoke enough anxiety in the child about becoming mentally ill himself as to cause him to become accessible to help. Some children grow up in a family and a community wherein none of the values of social behavior of conventional society are present. Another code has prevailed in regard to sexuality, as to stealing, by which they have lived, as in the underworld, and with these there is no chance of penetrating their understanding with different values, unless they are removed from such an environment at an early age. Sometimes this amoral situation exists in a family not distinctly separated from society like the above group, but separated only by closely knit family bonds which close out other influences. More about the handling of these various children is included in the discussion of the acting-out child in the chapter "Types of Placement Facilities," and other writers, such as Fritz Redl,7 have discussed it with greater content. The child who has internalized his conflicts, unlike the acting-

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out child, is involved in deep emotional reactions to the sexually delinquent behavior of his parents, regardless of whether or not he has been the direct victim of this delinquency. In the instance where he has not, there are some workers in the field who advise that if the parent's activities are not known to the child, this information (as well as that of his illegitimate birth, if this be the case) should not be disclosed at all. Or at least he should not be told until he is grown, that is, of marriageable age, which in our culture is about eighteen years old. The reason given for withholding such information is that the example set by the parent's lack of self-control in not abiding by the conventional social regulation of sexuality gives implicit permission to the growing child to act out his own sexual impulses via delinquent behavior. 8 Or, if not this, they say the child may carry the burden of guilt for the parent's illicit behavior. Such guilt, as well as the fear of becoming like the parent, may tend to inhibit natural feelings or the expression of heterosexual interests and lead the child to a later life of painful frustration. There can also be a lack of incentive to grow and achieve due to the feelings of shame and inferiority, which waste an abundance of energy, and to the discouragement from the absence of a parent-ideal to emulate. There are other workers, however, who believe it advisable to help the unknowing child face this sort of knowledge about the parent since he is bound to know it somehow anyway even though efforts are made to protect him from it. The sharing of information about the subject of parental delinquency around sexuality needs to be handled in the same general fashion and for the same reasons as that about suicide, homicide, imprisonment, and so forth, as previously described in this chapter. Care should be taken not to bring out information about any of these subjects prematurely, and the working through of the child's feelings about it is as essential as the imparting of the facts. Whether the child's knowledge of the parent's promiscuity unfolds from repression in a therapeutic situation or comes as a shocking surprise with the child's accidental observance or hearing of the parent's behavior, the handling basically follows the same

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general pattern. First, the child's nagging awareness or his shock and pain and the extent of his knowledge must be brought out into the open, together with the defense reactions he has erected to cope with the shock and the feeling of shame. If the worker himself views the parent's sexual irregularities as symptoms of underlying illness for which the worker has empathy, then this attitude will be communicated to the child to help allay the shock. Such an attitude in the worker does not impart permission for the child's acting out like the parent. As in handling the child's knowledge of other deviant behavior of parents, the worker must help the child to differentiate himself from the parent. If the child reacts as if he were humiliated, the worker's acceptance of the child as a worthwhile person should be demonstrated concretely, whenever possible, on the basis of the child's being no different now than he was when this information was not known to him or about him. Finally, the child should be told that due to immaturity the parent sought pleasure to assuage loneliness or to ameliorate bitterness. This he did either in the manner of a small child before he is trained— namely, in the easiest way he could think of without thought of the consequences to himself or to others—or else out of spite to others. Such a weakness is not inherited but comes as a result of inadequate training in standards and self-control and from poor family experiences with which the parent himself was not helped. The child should be told that he can be different since he has been helped and since his development with respect to values has been different, which is illustrated by his suffering over it. With regard to illegitimacy, it should be pointed out to the child that it often occurs as the result of a meaningful relationship even though a neurotic one. This is found to be true more frequently with unmarried mothers who are not promiscuous than with prostitutes.8 The older child in particular who is illegitimate, as well as some younger ones, can be helped to find empathy out of their own emerging heterosexual interests and longings with the mother who had such a meaningful but unhappy relationship. Finally, the child should be counseled, as with all deviant behavior in parents which evokes social disapproval, that the information known about the

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parent be kept confidential. This advice is explained on the basis that other people might not really understand and therefore would feel hurt by it. As a result, they might not like the child. Even if the child's feelings of social inferiority over his illegitimate birth are allayed by his thinking of it from the point of view of the mother's meaningful relationship, it is still necessary to deal with his personal feelings of inferiority. These persist from the realization that the mother cast him aside for adoption or foster home placement. The history may indicate that the unmarried mother had been reluctant to give up her child, whether for adoption or permanent foster home placement, but that she finally decided to do so for social and other practical reasons and especially for the child's welfare. Without such history, however, information still has to be imparted to the child to help him feel personal value. He should be told that his mother wished very much to keep him since this is valid in all cases because mothers always do so wish basically in their instinctual drive for motherhood, whatever their superficial attitude. However, knowing that she could not make him happy, and wishing this for him above all else, she had arranged that he be provided with a family who could take care of him and make him happy, as she wished she could do for him. To the child's accusation that she should not have borne him if she could not take care of him, the answer that she did not realize it at the time might endow him with some tolerance for her defection and lessen his bitterness and sense of worthlessness. All explanations of the reason for the separation from parents are given to the child in order to help him cope with the pain of it. Therefore the explanations should include information which will help assuage the child's bitterness toward the parent for leaving him. The purpose is to free his energies from the pain and from his defensive feelings to permit room for growth in the placement situation, and bitterness is not conducive to growth. Placing the excuse for the parent's behavior in the explanation before him prematurely may make the child feel that the worker is taking sides with the parent against him and may block his expression of underlying feelings. Or the child may misconstrue the worker's explanation as criticism of his parent out of his own

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underlying hostility to the parent, but be unable to accept this "criticism" as he clings to the tie with the parent in the hope of being taken back home. Finally, the explanations can have but meager significance for the child unless the chief aspects of the disturbed parent-child relationship are treated also. Some techniques by which such work is done and used in the treatment of several vital issues in the life of a child after placement, as well as the contexts in which some explanations are given, are illustrated in the following case. This was carried by the author over a period of five and a half years while the child lived in an agency-owned group home housing six girls. CASE OF PAULA

Paula was six and the youngest of five children, four of whom were placed after their mother, in a chronic depression of psychotic proportions, made a suicide attempt. This was precipitated by the hospitalization of the third child for rheumatic fever, after two sons had been stricken with this disease before him. The mother loved her children with primitive intensity, and while they were small never showed hostility to them but only to her husband. She expressed warm feelings for the children in such an extremely affectionate manner that they were too closely interwoven with her. All the while she severely neglected their physical care because of her depression. She slept until noon, or just sat around physically close to her children to gain warmth and comfort from them for herself. In the meantime, meals were never at regular hours or adequately prepared, and were even too skimpy. The children ran around the cold house inadequately clothed and barefoot. While this mother's character structure and the parent-child relationship placed her in the second category of parents, the symbiosis between herself and the children was quantitatively not so close that it did not permit some individualization by the children who were therefore not psychotic. The father appeared to be an ineffectual man who spent long hours away from home, from dawn to late in the evening, on his fruit-peddling route. This he did in order to escape his wife's tirades belittling him in the presence of the children and to avoid

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the discouraging home situation in general. With his wife's acute breakdown and the serious illness of his sons, he sought the help of the child placement agency out of his inability to cope with the care of the family himself. The family agency had decided that a homemaker's services would not suffice, and his only recourse then was to the child placement agency. The latter referred both parents to the juvenile court on a dependency plea to ensure some stability of placement in view of the mother's immense need to feed on her children in her efforts to survive mentally at such tremendous cost to the children. The mother, however, had convinced the children in her later contacts with them after placement that she was fully able to take care of them at home. It was, she said, the wicked agency which had taken them away from her and which kept her and the children apart. Attempts were made by the workers to keep the children from visiting their mother since she disturbed them so much that they ran away from foster homes in order to return to her home. When placed in a foster home, Paula, a thin, gamin-like child, with large brown eyes, was completely untrained in table manners and ate with her hands. She could not tolerate restrictions of any kind. In four different foster homes in two and a half years of placement, she was then finally placed in a group foster home, where she remained for over five years. It was considered that this placement facility was indicated for her since her excessive loyalty to her mother, who was intensely possessive, was colored by deep-seated guilt about being separated from her. This appeared to be the central core in the failure of the foster home placements as she had fought there to keep from making ties with the foster families, while the group home would not place her in the position of having to fight thus. Paula would start out each placement blissfully, then soon would behave in an impulse-ridden manner, become demanding of attention and of material gratification, provocative toward adults, destructive, and at times violently threatening toward children as she tried to dominate them. She would make overt attempts to tantalize a foster family into asking for her removal, which, she felt, would mean her return to her mother. Despite four transfers in her schools, however, her academic work

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was excellent and her teachers found her tractable and most likeable. The first foster home placement lasted eight months, and then she ran away to her mother, taken by her older sister who was placed with her. The second foster home placement, where she was again together with her sister, lasted five months, with both children running away twice during this period to their mother's home. Both the first and the second foster families refused to take the children back. Subsequently the sisters were placed in separate foster homes, as Paula seemed not to want to be disturbed by her sister because it interfered with her schoolwork. Paula's third placement lasted only three months, even without her sister. Her removal was requested because of her severe acting out. The mothers in the neighborhood refused to allow Paula in their back yards as she was annoying and destructive. For example, she and two little boys cut up a neighbor's hose and damaged his garden furniture. In her rivalry with an adopted child, younger than she, in the foster family, Paula was extremely destructive of the adopted child's toys and sly enough always to place this child in the wrong. When the roof of a near-by house was being repaired, she got a bucket of hot tar and poured it over this younger child's head. She would stand on the street corner and attract a group of adults to whom she would relate details of the foster parents' personal life, well embellished, and also tell that they beat and otherwise mistreated her. Paula's explanation of this behavior was that she wished to go to a new foster home. Her fourth foster home was, by circumstance, a temporary one, a fact known to Paula before she was placed there. Here, Paula had severe temper outbursts, threatening a neighborhood child with a kitchen knife. This foster mother, a trained camp director, was very firm with Paula, however, at the same time giving her much attention and affection, which helped Paula begin to internalize. After this, Paula was placed in the group home, referred to hereafter as the unit. In the first two months of her stay in the unit Paula had only one severe temper outburst, but indulged in a great deal of swearing, which the housemother restricted to the house. She began to be

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very conforming and tried hard to please, becoming excessively good. With this further internalization of her anger and the consequent decline in its former expressions through acting-out behavior came many somatic complaints for which the pediatrician could find no organic basis. These physical complaints, which gave her much discomfort, were considered to be self-punitive devices for her guilt over her acting-out behavior of the past and her underlying rage, which she now repressed by her overly good behavior. When Paula was nine, the author who was the worker newly assigned to her, approached her belief that it was the hateful agency which kept her apart from her mother. I soon identified with Paula's love for her mother, believing that the mother's love had been an asset to Paula's emotional health in her first years. Since the mother's psychosis had been dormant during those years, her love had been healthier and had nourished Paula, keeping her from becoming autistic, even though it had created neurotic traits in her. In my beginning interview with Paula, I gave her outright permission and approval for visits to her mother once monthly, something Paula had done surreptitiously before anyway with the help of an older brother or sister. These visits were considered safe enough if they did not occur more frequently than once a month, as the mother was not violent and the presence of the father and older siblings, the latter visiting at the same time, was adequate protection, if needed. Paula's exposure to her mother's paranoid ideas and entirely inadequate housekeeping was essential to enable her to cope with the reality with which she would have help in treatment interviews with me. Paula came to the agency office for weekly appointments, at first because I provided candy and toys and also because I gave her my undivided attention for almost an hour each time. Added to this, my early identification with Paula's love for her mother helped to create a meaningful relationship between us. Paula had some capacity for relationships, acquired from her warm tie to her mother, even though this tie bore distortions, which Paula brought into the relationship with me to be worked out as transference feelings. Paula's too ready affectionate gestures toward me

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were her attempts to seduce me, as was her usual manner, and although the gestures were not rebuffed, they were not accepted seriously. After the third interview, when Paula began asking if I saw other children, and looked relieved when I assured her of a place of her own with me despite the other children I also liked, her real attachment had begun. During these early interviews, Paula handled her chronic angry feelings by aggressive play in my office, throwing darts and mumbling profanities when she did not win. In this period of preparing her for treatment, I not only developed the relationship, I also attempted to prepare her newly formed ego defense of conformity to tolerate some expression of hostility without too great guilt. At the same time, it was essential that I not be too permissive toward her expressions of anger as she might be persuaded by this to discard the defenses she had erected to contain her immense anger. This anger had to be kept within bounds so that it would be accessible to therapy, which is impossible when it is expressed in overall acting-out behavior. Therefore, while I did not agree with her comment that her swearing was heinous, universalizing that it helps people feel better to let out anger this way, I added that she could use milder terms, which I supplied. I also limited her swearing to my office where it would be understood and not judged as "not nice." Her chief defense of aiming to please, which she expressed to me in picking up the darts I had thrown in the game, and by trying to give me the advantage in the score, was not accepted after her first few attempts. I did not wish to be too abrupt to her in her efforts to please, so I waited a short while before I told her it was not necessary to do this for me as I was well and strong enough to do it for myself. Thus the beginning of a corrective emotional experience was established for Paula in the relationship with me as a mother-person who, being different from her own mother, did not feed on her. After four interviews, during which the stage was set, as it were, for the ensuing work, Paula first brought out her wish to return to live with her mother. The fact of her placement was frustrating her wish, and this brought out her anger. From this point on, her anger was the chief focus of the treatment, as it was considered to

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be the anger she felt at her mother for the placement. This anger was, in part, the reaction to the great pain she had suffered at the separation from her mother. It included also anger at her mother for the gross physical neglect and discomfort caused her by her mother prior to placement and resentment toward her mother for not giving her an adequate father (the mother depreciated him to the children). The forms of expression which her anger at her mother took—it came out in devious ways before she could express it directly—and her struggle to live with it due to her guilt over it and her sense of loss of it as a defense occupied the bulk of the treatment work in the next three years. Then there followed a year of resistance to treatment, together with a flight into health through many social activities and fun. This was considered a necessary rest from her struggles in treatment. Finally, in her fifth year of contact with me, Paula made the tremendous decision of giving up the chance to live with her own family despite pressures from them. She had in the meantime worked through much of the separation trauma and also a great deal of her strong neurotic tie to her family, especially to her mother, in the face of the latter's voracious claims on Paula. That therapy is a tedious, repetitious, and slow process before results appear, punctuated occasionally by dramatic interludes—as at the points of explanation of mental illness, suicide, and hospitalization in a mental hospital; the handling of sex information with the child and the conflict of loyalties with some synthesis of ties to the own and the houseparents—will be depicted in the following description of the treatment of Paula. It is most possible to achieve adequate results with therapy, given the presence of certain other factors, if the work with the child is begun well before adolescence, as it was with Paula, during her latency period. The stresses of adolescent drives and the new crises to grapple with then do not leave enough room and energy for the child to participate in such work as took place here. Whatever was achieved was not only due to the child's capacity to use treatment and my own consistent efforts to help the child free herself without completely giving up her own family, but also to the tremendous meaning which the houseparents, especially the housemother, had for the child throughout this trying period. This house-

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mother's warmth, and her skill in using it with Paula, gave Paula something by which to live while she gradually relinquished the neurotic sources of her subsistence. My role was to help the child make use of this available resource for her emotional nourishment. When Paula told me for the first time that she wished to live with her mother, I sympathized with her in this. She handled her anger in a paranoid expression, copied from her mother, by stating that her father and brothers had made her mother sick, which caused her placement. The father's meanness to the mother and her brothers' fighting, which the father did not stop, had caused her mother's sickness. She followed this by asking what kind of sickness her mother had. To my inquiry for her ideas on this, she responded with evasion, then said her mother had once been in a "cemetery," by which I thought she meant a sanitarium. She confirmed my thought by hastily correcting herself, saying, "No, she didn't go there because she isn't crazy." With this, Paula showed that she was not ready to hear the facts about her mother out of fear of her anger at her mother for the latter's desertion of her by this hospitalization, so I did not embark on any explanation. To meet her question, however, I told her gently that her mother was nervous and that this is a kind of sickness which usually prevents a mother from taking care of her children. A little later she asked if her mother would ever become "un-nervous," and I replied that I did not think so. She then resorted again to her anger at her father and brothers for having caused this. In the next interview she entirely avoided discussion of her mother, played very competitively in games with me, and showed guilt whenever she won a point because of the anger she was expressing to me in this way. Some of this anger was what she felt toward her mother for deserting her, which Paula later transferred to me, and part was in reaction to my realistic frustration of her hope that her mother would become well enough to take her home. Because the treatment had just begun, I felt it was too early to deal with these feelings directly. Paula gained some relief by expressing them in aggressive play in competitive games with me, in which I allowed her to win. I reassured her that it was all right to win and that everybody likes to win.

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In my gossip with her about neutral subjects, she brought out that she had failed in arithmetic because she had trouble hearing the teacher. I then talked about the fact that some "kids" have so many worries that it is hard for them to keep their mind on what the teacher is saying and therefore cannot hear him. I told Paula that I would like to help her with her worries so that she would be able to hear the teacher and that the housemother would help her with her homework, so that between the two of us we would help Paula get along better; she accepted this. In the next eight interviews she talked about her mother intermittently. She told me seriously that her mother might never get well, and I agreed with gentle sympathy. When, following this, I asked for her choice of a holiday gift, she asked if she could decline this gift. She expressed her defense for her aggression by saying that it was not "nice" to ask for gifts. I told her a story about a girl who thought she was not worthy of a gift because she used to be naughty and therefore thought she was no good. I added that I believe children should get a present anyway to show that they are still loved even if they were naughty, and that they had behaved so because they were unhappy about something. Encouraging Paula, I said that the children who can talk about their unhappy feelings get to feel better and do not misbehave so much. Paula took this in attentively, said abruptly that it was hard to talk, and hid behind a comic book, which she soon spontaneously gave up to eat candy at my desk and to talk. She then brought out her dislike of her mother's dirty building and crowded home, preferring the present home where she was living in placement. Thus, Paula's struggle against forming deeper ties with others, in conflict with those to her mother, stirred by her acceptance of a gift from me, while not discussed with her, gave way to her wish to "get well." In the next several interviews, her conflict of loyalties began to appear more openly, pushed out possibly by her attempt to deny it in the acceptance of my gift. She had visited her family in the meantime, and commented to me how everybody there ate lunch at a different time because her mother's stove was too small to cook for everybody at once. She added spontaneously that she was happy when she was at home, and "more sad" when she left as she

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missed her family. She stated that she knew she could not live at home because I had told her that her mother "is sick and nervous." But she would rather live at home because other children live with their parents. Next, the conflict between her tie to the housemother and that to her own mother was expressed in her play with two toy airplanes. The silver one she designated Chicago and the blue one Germany (the housemother had come from Germany and spoke with an accent). Paula had these two planes attack each other, with the Chicago plane always winning. She commented that there would be no deaths because "when people talk things over then nobody gets killed." I confirmed this, adding that since people can talk about their feelings when they get mad, they can take care of these feelings this way without fighting. She did not comment then but brought out spontaneously a little later in the same session that she was frankly afraid of getting to love the housemother as it would make her forget her own mother. I explained that people can love two or more people at the same time, adding that children do get to love the mothers who take care of them every day, that this is a good thing, and that it is right. Two interviews later, Paula began to bring out her anger at mother-figures directly; this was precipitated by her conflict of loyalties. She began with the housemother for making her do chores around the house and for being affectionate when she did not really mean it; she also expressed anger at her own mother for keeping her brothers at home and not herself. One older brother had at seventeen returned from placement of his own volition, and a still older brother had never been placed but had lived intermittently with his grandmother and his own family. Paula wished her mother were a social worker so that she would know how to understand and take care of children. I was sympathetic about her mother's not taking care of her, and then aired Paula's transference to me, saying that when she had found that her mother could not have her at home, Paula wished that I were her mother so that she could come to live with me. I expressed acceptance of such a wish, gently implying that this could not be. While showing anger at her mother, Paula was chewing bubble gum and made an extremely large bubble which broke and fell in

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her eye. She showed much consternation over the posed this would cause to her eye. I told her she making bubbles, that this would not cause injury would angry feelings, and that she must not try on account of her angry feelings.

PLACEMENT injury she supcould have fun any more than to hurt herself

Paula could not yet bear to face her anger at her mother for very long, so she spent a long discussion on her family's poverty which, she said, kept them in a poor neighborhood where the schools were very inferior. This was why she could not live at home. At another time she said her mother was not sick, that she only needed a rest before she could have the children at home. If the three youngest ones were to remain in placement long enough to allow her mother to rest and since the two older boys at home did not create much work for her, then the others could return later. She and her older sister would do the housework then, and she could wash her own hair already and would not be too much of a burden to her mother. I praised her capacities, and added that children have the right to be taken care of when they need this and that they should also have time for fun and play. I concurred in her hope by saying that "time would tell." I did not think it advisable to threaten her defenses as she showed by her extensive rationalization that she needed them badly. In later treatment when she recurrently brought up her family's poor neighborhood and school as the reasons for her placement, blaming her father for this as she was taught by her mother, I pointed out the reality that other children lived in that neighborhood and remained with their families while attending school there. Following her discussion of her mother's need to rest, Paula visited her family, and was rather defensive about discussing this visit. In the second interview after the visit, Paula shot a barrage of hostility at me for her inability to live with her mother. This was precipitated by my announcement that I was soon going on vacation. Her only response to that was to blame me because my vacation would not allow me to arrange for her regular visit to her family. After commenting that I now seemed to her to be neglecting her care as other mothers had done, I went on to correct this irrational thought she had by telling her how I had ar-

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ranged for the visits to be handled in my absence. Having cleared away the transference feelings, Paula came out with what was underneath. This had been told her by her mother the week before and was what had made her uncommunicative about her home visit. Paula told me heatedly that she could live at home and that her mother wished this, but that I was preventing Paula from doing this. Paula continued to echo her mother's oft-repeated paranoid idea that the wicked agency had taken the children away and kept them from the mother. Introducing discussion of my so-called refusal to allow her to live with her family, I told her that there was something important I wished to tell her about that. This caught her attention and she listened carefully. I then told her, simply, how her parents had both come to this office of their own volition to ask us to help take care of the children in another home because her brothers were sick and her mother was too sick to take care not only of them, but the two girls as well. Her father could not do it as he had to go to work to support the family. Our agency had then told her parents to go talk with the judge at the children's court to see if this was the best plan. If he thought so, the judge would ask our agency to find a home for the children. When the parents told the judge their troubles with the sicknesses, the judge agreed with them that they were unable to take care of the children, and he asked this agency to do it. Later, when her mother changed her mind about it, the judge still believed that her mother was not able to take care of the children adequately, and he therefore did not give permission for the children to return home. This was the way it happened: it was first her parents' idea and then the court's order that had brought about their placement. Her parents might have forgotten this as they probably wished to have her at home even though they were unable to take care of her there. The agency was only an innocent bystander in this situation, and if the parents wished to take the children back now, they would have to talk to the judge again to find out if he thought this a wise plan. If he did, then he would request us to arrange for the children's return, which the agency would do. The return could not be made without the judge's order, however, which must be

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sought by the parents themselves. ( I was well enough informed about the home situation and the mother's mental condition through the family's worker to know that the children would not be returned now, as the court would see the unfavorable home situation and the family would not request it anyway.) Paula took all of this in without argument, but her eyes filled with tears when the discussion centered on her mother's illness. She asked directly what this illness was like, and I told her that her mother was tired a great deal of the time and therefore not able to do the work necessary to care for the children. I gave Paula much sympathy and comfort in this situation which she was trying to face more squarely. She subsequently lashed out at her brothers again for using up her mother's strength. I talked about her jealousy of her brothers and her wish to be a boy so she could be like them and be close to her mother. She denied this and instead urged me to ask the family worker to persuade her mother to send the boys away so that she could recover enough to have Paula return home. I led her to reveal to me the content of her wish to live at home, and she told me of the fun she had with her mother. T h e latter would laughingly chase her around the table and give her a little pat with a small paddle on catching her. Immediately following this memory, Paula expressed direct anger at her mother in her jealousy over her mother's baby-sitting with a neighbor's small daughter whom she kissed. If the mother's worker would persuade the mother to give up the brothers for a while, Paula could return home sooner because her mother would get rested more quickly. Paula denied her resentment at me while I verbalized it for my taking a vacation instead of her mother's having one so that Paula could return to her. I reassured Paula in her guilt over resenting me for this. Shortly thereafter the housemother reported that Paula's grades, which had fallen in the first few months of placement there, were now good again. Paula, she communicated, had many friends at school and in the community near by, and was active in many social affairs with them. She was showing a greater need for affection and was trying to get it from the housemother. F o r going out one evening and leaving a relief caretaker instead of spending

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the time in taking care of the children in this unit herself, she scolded the housemother. For the past several weeks, she had been sensitive and moody, could not take "kidding" sometimes, and at other times cried easily. During my vacation, Paula was very depressed after a visit to her family, but for the most part, she was not as conforming as before in the unit. It was thought that the gradual release of her anger in the past six months of therapy had helped her to become freer, which was reflected in a more healthy adjustment in her life situation. After my return, Paula was resistive to verbal therapy, either by reading comic books or by playing checkers with me. When she refused to discuss her curt, constrained manner with me, I gave her stiff competition in the game so that I could win over her. This brought out her anger at me, which was what I sought to do. She felt safe to call me a "rat" and other such names within the context of the game, and she eagerly sought this mode of release during the next few months. She used some methods I had earlier suggested as acceptable expressions of anger—like stamping her feet and pounding on a pounding board-—and added her own of snorting in anger, smearing glue on paper, and snarling "Yah." All the while, I verbalized casual acceptance of these feelings toward me to keep her guilt down. At one time when I won a game played according to rules she made up, she became so angry that she made a gesture as if to strike me, which amazed her. I good-naturedly accepted her wish to strike me, and added that I would not let her do this as she would feel sorry and unhappy about it later. I told her also that I did not wish to be hurt should she strike hard. She complained that I did not give her as many treats as other workers here gave children, and she did not wish to leave my office at the end of the session. Accepting her complaints as expressions of anger, I did not, however, add to her treats. When she complained to me that the housemother did not help her in fights with the other children in the unit and demanded that I make the housemother handle it better, I told her I was not the housemother's boss. Toward the end of this period, Paula showed some sexual curiosity about differences between boys' and girls' bodies. She

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had led into this with a skittish reference to bras. These differences were discussed in greater detail than her present knowledge encompassed (she had shown some former knowledge of them). When I used technical terms, she accused me of talking "dirty," which was her way of covering her guilt over enjoying this discussion. I told her it was all right for children to know this and hence it was not dirty. I focused chiefly on her feelings underlying this interest, because, since she was not lacking in factual knowledge, curiosity was not the source of her need to talk about sexual differences. Her feeling that girls are inferior to boys was seen in her comment that boys are stronger muscled. Her next question was how soon it could be known while a baby was still within the mother whether it would be a boy or a girl. She then wondered aloud what a mother would do when she wanted one kind and got the other, and hastily answered herself that the mother would keep the baby as it was "her very own." Paula soon left for a three-week stay at camp, which she wanted, and after that she spent two weeks with her own family. Before the interviews were suspended for vacation, the housemother reported that Paula had for some time been more affectionate and clinging to her than ever before. I explained to the housemother that Paula needed this from her because she was facing her hostility in her transference to me. This hostility was what she really felt toward her own mother, but was afraid as yet to express to her mother. Directing this same anger to me was helping to free Paula from her mother, who, Paula felt, had let her down. This was the source of her anger. She had said this about her mother briefly before in connection with her jealousy over her mother's affection and baby-sitting with the neighbor's small daughter. Now Paula was accusing me likewise of depriving her of time and treats. The housemother then realized Paula's need of her, and I confirmed that Paula should have positive feelings from a motherfigure while she was going through this facing of anger at other mother-figures because of her realistic deprivation from her own mother. I further explained that it was natural for Paula to seek this affection from a mother-substitute who was with her the greatest part of her daily life, and who was giving her maternal

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care. I anticipated for the housemother that Paula might soon react with a conflict of loyalties, explaining why this would happen and how it might manifest itself, and that the housemother need not be personally affronted when Paula withdrew or rejected her. I suggested that the housemother give her room if that happened, but indicate continuing interest and fondness without letting her feel that she, the housemother, was pressing this upon her. During the camp period, Paula wrote first, as agreed, as she had said in a burst of anger that she did not wish to write to or hear from me because she wished to forget her problems. I had accepted this at face value, but added that if she changed her mind, she could write, and that I would not hold it against her if she did not write. She came to the office for one interview during her twoweek visit at home, and was accompanied by her mother whom she left in the waiting room. When I told Paula that I would like to meet her mother, she introduced me to her with much poise. I chatted with the mother for a while about Paula's clothing needs upon which the mother centered her attention at this time, and took into consideration the mother's ideas as to color, which I said I would pass on to the housemother for shopping with Paula. The visit to her family for two weeks during summer vacation from school was not only granted because Paula wished it, but also because it was felt that Paula's material in therapy would be stimulated by her direct encounter for a longer period than a Sunday visit with the reality in her family situation. During the four interviews after her return from this visit, she was uncommunicative about it and resistive to any approach in treatment, even to indirect release of anger in play. It was as if she guarded herself against any manner of expression. She hid by reading comic books during the greatest part of these interviews. Her resistance mounted as she read for longer periods each time. Finally, when I pointed out that she was reading here in order to avoid talking, she burst out with a torrent which lasted three-quarters of an hour beyond the usual time. She began with an angry account of a fight with another child in the unit, for which the housemother had spanked her. She was vehement in her threats to smash in the head of the other child and in her accusations about the house-

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mother for "slaving" her. For not stopping the housemother in the latter, she brought out more anger directly at me. She ordered me to write a note to the housemother for Paula to carry back to make the housemother stop the other child from teasing her and to give her fewer chores. Or else, she said, I should move her from the unit. I did not deal with these requests at all, but kept verbally accepting her anger in them. Then I explained that I could not interfere in the household matters of the unit as the housemother was the boss there. When Paula was momentarily calm, I encouraged her to tell the housemother how she felt about these matters. A discussion of dancing lessons during this session soon led into the heart of her pain and anger in the separation trauma. She was afraid to travel alone by public transportation to the studio for the lessons, as she had been fearful about using the bus and streetcar since her runaway from her first foster home with her sister at the age of six. I gave her sympathy for having missed her mother so much at that time, particularly in that this made her more scared when trying to get back to her mother then. Paula countered that "the agency should not have taken me away from my mother so young." I permitted her to vent her pain and anger about this separation, then again introduced the factual situation with the judge and all that was told her previously. This brought forth her tremendous anger at her parents, and especially her father, for going to the judge, in short, for placing her. Interspersed with her charge that they had placed her, were her rationalizations, repeated again, about their poverty, the poor neighborhood, the bad schools there, her father's unsuitable job, his inability to get a better one, the friction between her parents, and the talk of divorce by her mother which she had overheard recently during her long visit home. She alternately blamed the agency and her father for her plight. The agency had not helped him get a better job and had not given her parents the money spent on the children's placement care so that the parents could make a better home for them. Her father refused to take a factory job and worked such long hours that she seldom saw him. Then she said that there really were no better jobs available. She blamed her father for driving her mother

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crazy by his stinginess with money, then blamed an uncle for giving her mother an expensive television set when he should have given her the money to make a better home so that the children could return there. After blaming most of the adults in her life, she finally came to blaming her mother angrily for fighting with her father so much. She sharply criticized her mother's care of her while she was ill during her two-week visit at home, when her mother had fed her only milk and cookies. Her father had criticized her mother for "starving the child." Paula asked me if a sick child should not be given toast, warm milk, and soups, and I agreed that that would be better. When I tried to point out gently about this time that her mother was so full of worries that she was unable to keep her mind on what was necessary in the planning and preparation of adequate meals, Paula was definitely unwilling to accept this. I believe this was because she still had too much anger and pain, as well as fear that on account of these emotions in her, something else would come ahead of her with her mother. She claimed that her mother wanted to take care of her but was unable to do so because of lack of money. As Paula poured out these angry feelings at her parents with an intensity she had not shown before, she talked rapidly and vehemently, and moved about the office in an agitated manner. I confirmed with sympathetic understanding those realities she brought out about her parents which were valid, and I reassured her for possible guilt for being angry at them over these. I told her that I wished she could live with her parents and that I would help her to do so if it were possible. I then told her that she got angry at the housemother and at me instead of being angry at her parents, and I reassured her that both the housemother and myself understood this and why it happened, so did not hold it against her. Pointing out that it was easier to be angry at us than at her mother, I also told her that she would feel better herself if she knew the truth about her anger. I encouraged her to try to enjoy her present home, since she could not live in her own home for a while. She might as well enjoy what she had now as it was all right to do so. Before Paula left my office, she began making somatic complaints,

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about a fluttering of her heart, and I tried to reassure her in her guilt over her outburst of anger. She left in a calmer and more relaxed mood. In the next few months, Paula was again resistive to bringing out material or working on her troubled feelings, using the same method of evading as before, that of comic book reading. She repressed her anger in the sessions, and acted it out within normal limits in the unit. There she ceased to be the sweet, conforming girl, but she did not fight too much. She was appealingly sassy to the housemother, was gay and witty, and talked freely about her parents' inability to have her at home because of their poverty and poor neighborhood. During this period also, Paula went through a series of losses of valuables, such as a fountain pen and a check for thirty-two dollars for her dancing lessons, given her by the housemother to deliver. Paula claimed she was daydreaming which caused her to lose these items. She expressed disappointment that the housemother had not disciplined her more for her fault in these losses, but just took twenty-two cents from her allowance for a special delivery letter to stop payment on the check. Paula was left so uncomfortable in her guilt over this, as well as in her underlying guilt for her repressed rage at her parents, which caused the losses in the first place to gain punishment, that she felt the need to discuss the lack of punishment she thought she deserved. As she told me about the loss of the check, she was playing with a badminton set in my office, and she gave the ball such a bat at the time that it nearly went out of the window. This caused her to look at me with fearful expectation. She accepted my comments that she wished her father were paying for her dancing lessons while she lived at home, and that her anger at him for not doing so and at the housemother for doing it instead made her lose the check as she was too distracted by these feelings to be sufficiently careful with it. While this discussion was going on, Paula managed to hurt herself twice, once by hitting herself with the darts she was playing with and again by putting her finger in her eye. I pointed out that Paula got into trouble by losing things instead of getting out anger directly; also, that she kept on feeling naughty even when she did

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not show her anger so that she lost things in order to be punished for the first feelings of naughtiness. She then hurt herself here when I talked about it so that she must have thought she was still naughty. I went on to reassure her that she was not bad because of her anger at her parents. Finally, about four months after her long visit home, Paula brought out after a Sunday visit there that "my mother is nutty and my father made her that way." This was in connection with the fact that her father had found a larger apartment in a better neighborhood but that her mother had refused to move. With marked feeling, Paula blamed her mother in this, then quickly added that she still liked her mother. I explained that she could feel two ways about the same person, which reassured her. Yet she lapsed into reading the comic books for another two sessions. I then actively interfered with this resistance, giving her notice that she had five minutes before she would have to quit reading and telling her that the purpose of her visits here was to help her with unhappy feelings and that she could enjoy comic books elsewhere. I put before her what she had been avoiding—the situation concerning her parents' housing, which she had previously used to excuse them for not keeping her but which was now changed. Her mother's reluctance to take on more responsibility with a larger flat, out of the chronic depression which enervated her, was the subject to be explored with Paula. I asked her if she would like to return to live with her family now that they were moving, and for the first time she showed some of the ambivalence about this which she had been too guilty to face before. She continued to evade the choice of living arrangements for the next five interviews, and this was permitted as she needed room and time to struggle with her conflict of loyalties. She sensed that resolution of her conflict would lead her to relinquish some of the tie to her parents. She alternated in blaming each parent for not having her at home and then her brother for making her mother sick. Then she would criticize the houseparents and the other children in the unit. She said that she hated to leave her home after a visit there, as she was so comfortable there, but added, however, that she began to feel comfortable in the unit also shortly after her arrival there from a

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visit to her family. I talked about it being hard to change from one home to another, but that she could like both places and the people in both places at the same time. She maintained, however, but with much less conviction than previously, that she would like to go home to live when she reached thirteen, which was three years hence, and I said this would be possible only if her parents could arrange it. A month later, after a visit to a girl friend's beautiful home, Paula compared her parents' home to it as a "junk heap"; then she added that she could be happy in her parents' new apartment so long as she was with them, even if they were not rich. I agreed that riches do not automatically mean happiness. She then told me that she could be happy living in the unit if she could visit her family once every two weeks instead of once a month. This statement, I thought, was provoked by her guilt as she soon changed it to a wish for a monthly visit only. A few weeks later, in mentioning that she had lots of fun in the unit now, she again had to ask in the next breath to be allowed to visit her parents every two weeks. She allowed herself to be easily persuaded not to make herself unhappy twice a month instead of only once by having to separate from her family, which she described as being a sad event for her each time it happened. In her scattered play during the interviews in these six months, she brought out her need to protect her mother, by saying that when a child is sick, the mother always takes care of her, and when a mother is sick, then the child should take care of the mother. She remained hostile to me while she masochistically dealt with her anger at her mother. Around this time she was again asking to visit her family twice a month, explaining she would be less unhappy about leaving them if she could visit them more often. I verbalized sympathetically that I knew part of her wished to live with her family. She replied with a brief touch of anger and sadness, that all the girls in her classroom live with their own parents. I said it is normal to wish this, and I hoped it could be so for Paula also, but that if her parents could not do this for her, then I was glad that she had another home which she could enjoy.

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Concomitantly during this period, Paula was relating extremely well to the unit group, especially to the housemother. In planning at the early part of spring for camp and her long visit to her family during the coming summer, Paula wished both of her absences to take place when the houseparents were away on a month's vacation, so that she would not miss so much of them and be back at the unit when they returned. When I decided to give approval for her visits to her family every two weeks as she requested, I suggested that she could try this plan to see how she liked it. Saying that she might not wish to miss too much of the fun on Sundays in the unit, I reassured for guilt over having fun apart from her own family, stating that kids should have fun and that most parents wish their children to have this even from other people. Paula grasped at this, saying she would begin the more frequent visits to her family next winter, which was at least six months hence, as she would be at school then, and there would be less time for fun in the unit. About this time, too, the housemother reported some of Paula's remarks to her which openly expressed preference and appreciation of the housemother over her own mother. In response to some joke which the housemother had made in connection with Paula's doing something, Paula had said after they had finished laughing together, "I like you better than my mother because you're funny." In her continuing comparisons of her mother with the housemother, she commented, "My mother never wore a pretty blouse like you do; she goes around in a housecoat all day long." On another occasion when the housemother was braiding Paula's hair, Paula asked her to stop for a moment as she needed to get a Kleenex immediately. When the housemother handed her a fresh one she happened to have with her, Paula exclaimed in a thrilled manner, "You are a wonderful mother. You even have Kleenex when I need it." A few months later, when Paula's mother brought her back to the unit from her summer vacation with the family, Paula showed her mother through the entire large apartment which comprised the unit. Expressing her anger at her mother for an unhappy visit, Paula took her into the housemother's room, referring to it as

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"mother's room," opened the closet, and pointed out to her mother all the "beautiful clothes" of the housemother. The latter later tried to smooth this over with the mother. During the past seven months, Paula had been hostile toward me but unable to bring out much of that anger directly; she could bring out even less about her mother. Knowing that her mother was almost always sweet to Paula, it obviously would be difficult for her to show anger toward her mother in person. I therefore planned to refrain from much warmth in my relationship with Paula, attempting to fashion it so that it would be quite neutral in order to give her room to express anger at me. Then when her material began to show interest in sexual matters, and the housemother reported that Paula was showing noticeable bodily changes and also was asking questions about sex, Paula seemed unable to discuss this with me. The plan was that I handle her sexual questions rather than the housemother, so that Paula's conflicted feelings about this could be worked out in treatment sessions. The housemother was permissive about the questions, but referred Paula to me for the answers. I decided that Paula was unable to bring these questions to me in the hostile atmosphere of the current interviews, since she construed a neutral attitude as one lacking in love, meaning hostility toward her. It could not be expected that Paula in puberty would trust her sexual feelings toward a mother-figure she felt was hostile to her. Two weeks after I instituted a change in the relationship, showing warmth, Paula brought forth a series of accumulated questions about sex which caused a minor crisis in her life. Although Paula had in the past year talked briefly about sex in terms of her roommate who masturbated and liked to use slang sexual terms, all of which Paula professed to find disgusting, she had brought out little about her own sexual feelings and thoughts. At this time she began an interview by telling me that she was no longer worried about her parents getting a divorce as her mother now kissed her father after quarrels and they both laughed, at which Paula was smiling broadly in the telling. She talked next about her use of cosmetics in the grandmother's home where she had spent time out of her visit to her family the summer before.

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I was permissive of this, especially when it was apparent that her mother had not been. She followed by saying in a direct manner that she would like to ask me some questions about sex. I gave her permission to do so, assuring her that it was all right for her to know about sex. First she asked why a woman has to have periods after she is pregnant. She would not give me the background of her own thoughts on this question, and I suspected this was because of her guilt over eavesdropping on some adults' conversation. She did not know until I told her in answer to this that the menstrual periods cease during pregnancy. She wished to know why this happens, and I then explained that the woman's egg becomes fertilized by the man's egg in order to form a baby, and that then this baby gets all its food from the mother's bloodstream through the navel cord during the pregnancy. Paula knew some of these facts as the two older girls at the unit had told her about them. When I stopped to ascertain just what they had told her altogether, in order to elicit possible distortions first, Paula was too engrossed in the present discussion with me to give this information. I went on to tell her that each month when the egg from her ovaries comes into the woman's pouch, called a uterus, the blood vessels in the wall of the uterus get filled up in order to be ready to feed the baby should the egg become fertilized to form a baby. But if the egg is not fertilized and a baby is then not formed, the egg comes out of the uterus together with the extra blood supply which had been prepared for it in the walls of the uterus. This causes the menstrual flow and that is why it looks like blood, since the extra blood is in it. Paula was very much interested in this and accepted it very well. While I was describing this process I had drawn a picture showing the shape and position of the uterus, where the woman's egg comes from, how the man's egg enters to fertilize it, and where the lining of the uterus is with the blood vessels in which the extra supply of blood is stored. Paula's next question confirmed my speculation that she had overheard adult conversation she could not share with me. She told me that I had not answered the question which was causing her some anxiety that possibly stemmed

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from her deeply unconscious feeling of being rejected by her mother. (Paula's feelings of rejection were especially stirred up when her mother talked of divorce from her father and of her repudiation of her entire marriage, which would negate her mother's wish for children.) Possibly Paula had overheard her mother talk of having had miscarriages, for she asked what happens if blood is lost when the woman is pregnant and the baby then gets less to eat while in the mother's body. I believed that the feelings of maternal deprivation underlying this were not accessible now, and they were handled later with a corrective emotional experience with the housemother. Supplying factual information at this time that the doctor gives a woman medication and has the woman rest in bed until the bleeding stops, I was then asked if it hurts when the baby comes out. I said it might hurt but that the pain is not too much to bear, as the doctor helps so as to reduce the pain, and as there is medication for this purpose also. Most women easily forget the amount of pain involved by their pleasure in the baby, and are willing to have more children. Paula giggled as she said that she would not wish to have a man doctor help her in this, and she asked if there were women doctors who could help. When I said that there were, she asked if women doctors take care of men when the latter are sick. I said that they do and wondered what Paula thought about this. With more giggles she thought this was "not right," but would not elaborate. I explained that when a doctor takes care of a sick person, even if it is a man doctor taking care of a woman or a woman doctor taking care of a man, it is considered all right, just as it is all right for a parent to handle a nude baby of the opposite sex. In talking about the process of the baby coming out of the mother's body, Paula mentioned that the baby comes out of a hole where the woman makes "wee-wee." I corrected this, drawing an illustration showing that the urethra and the vagina are separate, with the vaginal canal leading to the uterus. I continued to draw and explain the male sexual organs from which Paula, in her masculine identification, may have gotten the mistaken idea that the urethra and the female sexual organ are combined. In this drawing, the penis was shown, along with the female organs

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for reproduction, and I explained how the penis is inserted in the woman for intercourse at which time the man's egg goes to meet that of the woman. Significantly, Paula did not grasp the meaning of this at the time of the drawing and explanation. This was seen in her later reaction. Paula then asked me why her roommate peeked at her when Paula was using the bathroom. I thought that the roommate wanted to know how Paula was made and that the roommate should be told that all girls are made alike. Paula then confided that her roommate masturbated by sitting on a corner of something and rubbing herself against it. She sounded shocked but fascinated at the same time, so I tried to allay her guilt over her own similar wishes. I said that this is a private thing and that the roommate should not do it so openly. Some "kids" do it because it feels good, and when "kids" are unhappy about something, they comfort themselves this way. Paula's strict conscience could not accept this, and she said that the "kids" should suck their two fingers if they need to comfort themselves, a habit Paula resorted to when anxious. I responded that generally each person has a different way of getting comfort, and if her roommate felt better by getting it her way, then this was all right, but it should be done in private. More content of Paula's feeling about masturbation came out in her later question whether "doing this," namely, masturbating, after pregnancy would hurt the baby or make it come out too soon. My reply that usually intercourse and masturbation, the latter being less usual in married people, are discontinued in the late stages of pregnancy in order not to hurt the baby brought forth a response which indicated that she had not grasped my previous explanation of intercourse in regard to pregnancy. After she expressed disapproval of intercourse for married people, she reacted with great dismay to my information that genital activity between man and woman is necessary to cause pregnancy. She kept asking repeatedly if I was sure of it. She had believed that merely kissing on the mouth caused a woman to have a baby. She kept making expressions of disgust at the idea of intercourse being a legitimate activity. She blamed her roommate for having made it dirty by the kind of discussions she had carried on with Paula

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after the lights were out at bedtime, about which Paula had complained occasionally in the past. I encouraged her to express more of her feelings of disgust, telling her that these were her old feelings which she got through the mistaken ideas of others who, in turn, gave them to her. Pointing out of the office window to a group of people on the street, she asked in wonderment if all those people knew about intercourse. I replied that all but the very young children did, and quite soon they would know also because it was all right for them to know. She next asked if her housemother "did it" to have her own daughter, and she was shocked at my report that the housemother did. When Paula conceptualized that intercourse was a job to do in order to bear a child, I universalized that people have intercourse just to enjoy it and that it is all right to enjoy it. Suddenly Paula said with resentment. "Then why can't 'kids' do it if grownups can?" I gave her the usual answers—that intercourse is an expression of love between two people and that only grownups are able to take the responsibility for the baby if intercourse results in a baby. After much more discussion consisting of repetitious information, Paula left with the comment that she still could not fully believe that only intercourse could create a baby. I then referred her to the housemother, who had a child of her own, to ask her. As soon as Paula left my office, I telephoned the housemother to discuss this interview before Paula could reach her with questions about sex. I told the housemother the content and sequence of Paula's questions, the answers I had given, Paula's shock, disgust, and disbelief, also that I told Paula that the houseparents have intercourse, and that Paula was going to question her about all this. Two days later the housemother reported that Paula had come home from the last interview in a very quiet mood, was pale, and did not eat much dinner. Immediately after dinner she had told the housemother she must talk to her privately, and when they were alone, Paula had snuggled up to her and said that now she "knows everything." Paula asked all the same questions and the housemother described how she answered in her own way, to which Paula commented each time that the worker had told her the same things. Chiefly, Paula's questions were aimed at getting

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information firsthand from the housemother. She asked whether it hurt to have a baby and whether the housemother still "did it" with the housefather and why. The housemother said she had intercourse because she "loves daddy," and that she had wished to have Susan, her child. Paula was then able to tell the housemother how troubled she was by her roommate's dirty talk and that her roommate had described her sexual activities with a former foster father, which happened to be true. Again, the question as to why grownups can do it and children not was answered with a statement about the assumption of responsibility for a baby. Paula had reacted to all this information by being more affectionate with the housemother and more preoccupied with daydreaming. Due to my unavoidable cancellation of Paula's next interview, I did not see her for two weeks, and on the day before the next interview the housemother informed me that Paula had begun to menstruate, at age ten and a half. Her first comment to the housemother was, "It's happened, now I can have a baby." The housemother told her that menstruation did not mean she must or should have a baby, repeating that it was necessary to wait until marriage. Paula was proud to announce her menstruation to the other girls in the unit, causing a commotion by her manner about it, and later accepted well the housemother's instruction as to personal hygiene measures. When I opened the door of my office to find Paula waiting for her interview, she was standing in front of it in the position of a runner about to take off. Inside the office, transference feelings came out when she told me in a muffled voice, with her back toward me, that she was now menstruating. Then her ambivalence about growing up, and her anger from frustration of both dependency and sexuality came out. Having begun to menstruate made her feel grown up, but she still longed for much childish dependency gratification. At the same time she could not have sexual gratification either for some time yet. First she raved a long time about the nuisance the menses are because of the need to wear a pad, the great bother of changing the pads, and the interference with swimming. I granted with moderate sympathy that this was all a bother, as well as an inconvenience with reference

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to swimming, but said that girls and women get used to it. Her next complaint was that as she was the only girl in her class at school who was menstruating, this made her different from the others in an undesirable way. "They look at me as if I am a cripple." She went on that boys do not "suffer" from this, and said once that she wished she were a boy. She reversed herself on this wish, saying that boys are too rough. Besides, she offered, boys have this too, at night. I attempted to get her to elaborate on this, but she did not know how and was puzzled. I supplied the information that the discharge of boys is not red, but whitish, which cleared things up for her. When she repeated that boys can still go swimming even when they have their discharge, I agreed, and added that boys can never have babies. I asked her if she felt as if she had once had something and later lost it and if that was why she felt like a cripple. When she looked puzzled, I told her many girls feel at one time or another that they were made like boys originally, but lost the penis through injury. The menses remind them of this, and so they think it is the menses that make them suffer. Paula said she knew each sex was made differently from the beginning; but I thought that this was intellectual knowledge only. Paula kept asking if there were a way to make the menses disappear, like taking medication. I said the only time it disappears is when a woman is pregnant and that then it is for nine months only. At a later time, I told her that the menses may be irregular during the beginning years, skipping from a month to a few at a time, but that they return. She moaned that she would have to wait until she was fifty years old before she would be rid of it. I said that the menses with their basis of ovulation help keep the body system in good running order, that they start the "juices" flowing which make girls and women look pretty and fresh. This interested her since she had been complaining about suspended activity and questioning whether or not she could run, jump, and eat the same sort of food during her periods as at other times, sounding all the while like a neurotic pregnant woman. Paula felt guilty over her sexual wishes, for which she was being self-punitive with somatic complaints, but I could not reach her guilt directly to help her with it. Therefore I told her a story about

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another girl I knew who told me that she was glad she had begun to menstruate because she was now like her mother and could have a baby. This girl felt she wanted to be like her mother and have intercourse now too, without having to wait until she was married. She was angry because she had to wait and wished secretly in daydreams that she could have intercourse now. Feeling that these wishes were bad since her mother had forbidden her to have intercourse until marriage, she worried a lot about being punished for these secret wishes. In fact, she felt she really would somehow be punished and thought she might become sick for this reason. Paula said vehemently that this girl was stupid, to which I responded that the girl need not have felt guilty over her wishes. Paula became adjusted gradually to the twin shocks of learning about intercourse and getting her menses. This was seen in her reactions to these in subsequent interviews. I asked her in the next several interviews whether she had more questions, suggesting that it is hard to understand and believe everything at once, and that therefore she could discuss the same matters again or ask new questions. I reassured her that believing does not have to be so hard if children learn this information a little at a time, beginning at a younger age than she was when she heard it. The summer which soon followed these episodes brought Paula to camp again, and then to a two-week visit to her own family. The mother's worker found that the mother was much worse, as she neglected her home even more than before. She had found homemaking much too great a responsibility since the return of her two sons. One son kept blaming her for his serious heart condition caused by her early neglect, which had made him suffer from rheumatic fever. The mother told her worker she felt unable to give him the care he needed now for his health condition. She was then offered a chance to rest in a convalescent home, or, if she did not want this, boarding care for the two sons outside her home. Both suggestions were refused, and Paula's mother went to her own mother's home during the summer. Paula felt that her mother did not wish her to come home, yet she would not participate in my discussion as to why she would be spending her vacation with her mother in her grandmother's home. The relatives

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did not carry this plan through, and Paula spent a miserable two weeks at her family's home. On her return to the unit, she went shopping for groceries with the housemother and commented on how large was the amount of the week's supply, explaining that her mother bought groceries in dribbles and did not plan meals. She continued in this vein, making further comparisons indicating her mother's poor management and functioning and commenting favorably on the way the housemother did things. She became reluctant to visit her family and made excuses to skip visits sometimes. After a recess of six weeks in the interviews, during which Paula had spent the two weeks with her family, she was withdrawn in her interviews with me, evasive about discussing her summer, and hid in reading comic books. When not doing the latter, she played desk games without much feeling. After two months of such interviews, she finally gave up her resistance to what she had tried to block out with me but not with the housemother. She was now readier to face the meaning of her mother's condition and its significance in terms of her mother's rejection of her. This was followed by my explanation of mental illness which she was now ready to hear. The discussion began with talk about her family's new apartment which Paula thought was lovely, as it was larger and in a better neighborhood than their previous home. In answer to my inquiry if the school was a better one too, she said she did not know. I asked what she thought of the possibility of returning to live with her family, and she brought out with whining and anguish that this could not happen. She felt that her mother did not wish her to come home. Unable to say why, she thought that perhaps her mother did not care for her but cared for her sister more. Then she corrected herself, saying that she had once heard her father say he liked her sister better, whereupon her mother had replied that she liked Paula better than her sister. Nevertheless, Paula returned to the idea that her mother did not care for her, or else she would take her home. When I suggested that her mother might feel unable to take care of her, Paula at this point connected her mother's inability to take care of her with her mother's illness.

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Paula then asked me directly and seriously what was the kind of sickness her mother had. In answer to this question, I told Paula that although some people look grown up on the outside, they are not really grown up on the inside in their feelings, that part of them feels like a child. I asked Paula to suppose herself now at age ten and a half having to take care of a home and a family of children with all the work and attention this entails, and to tell me if she thought she could do all this now. She felt she could not, and I agreed that she could not and, further, should not be expected to at this age. I told her I definitely felt that when grown up, she would be able to do this well, as did the housemother. Her mother, however, had never got enough beyond the little girl part of her feelings to make her feel able to do all this even though she grew up on the outside and looked like a grownup. Her mother got stuck at a certain place in her childhood feelings, and did not grow much beyond that point. That was why her mother found it very hard to do the cooking, shopping, and housework. A little girl finds it too hard to do all this for a family, whereas a really grown woman does not. Paula conceded that her mother was unable to do this work, and added plaintively that her mother slept all the time. I told Paula that her mother was sorry that she could not take care of her home, and worried about it. She thought she would feel better if she slept so that she could not see the way the house was and could forget about it for a while. I was sympathetic toward the mother, adding at the same time that this situation was hard on the family, especially on somebody as young as Paula who needed her mother's care. That was why the parents asked the court, when all the children were young to find a home for them so that they could get adequate care, and that was why Paula was placed away from her home. Paula dwelt on the phenomenon of a person not being grown-up as 1 had described it in terms of her mother. She at first maintained plaintively and with irritation, that her mother was grown. I said that she looked like that on the outside, and in some ways acted grown up, but that in too many ways she was not grown up. Paula then asked, "You mean she is not grown up all the way?" I con-

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finned this, qualifying it by saying that this was more true of her mother than of the average person. She asked why this had happened to her mother. I explained that her mother had probably had too many big unhappy things happen to her during childhood. These must have given her many worries with which she did not have help from anywhere, neither from her own mother, nor from a substitute mother, nor from a social worker. Had her mother gotten help from any of these or from other sources, she would not be like this now. I was sorry that her mother had not had this help and that she had been so unhappy in the first place. Paula continued to grapple with the concept of her mother's illness, and I told her it is a hard one to understand all at once and that we could talk about it further. The discussion was continued in later interviews, especially those after Paula's visits home. There she observed her mother closely, reporting again how her mother slept a great deal and did not do the dishes so that her father had to do this. Paula continued to whine as she talked about the fact that she knew now that her mother could not take care of her and that that was why she could not live at home. She suffered over her mother's rejection in this, but was not angry at her mother for it at the time. She was troubled by the fact that she was getting to love the housemother more and her own mother less. I dealt with Paula's guilt over this conflict of loyalties by explaining that she could love both and that it was natural to have more feeling for the person who gave her more than for the other one. I said a girl needs love and care in her growing-up days, and that Paula should enjoy receiving this from the housemother since she could not have it from her own mother. She then brought out that her mother was now telling her that Paula was better off where she was currently living. With this more open rejection from her mother, and with her own growing relinquishment of the neurotic tie with her family by facing her mother's condition and the lacks Paula suffered from it, Paula first turned for dependency elsewhere, in the relationship with the housemother and, in an increased amount, in that with me. She asked me to take her to the lavatory, claiming she had forgotten where it was. I accompanied her to it in another part of

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the building and waited outside. She began asking and then demanding more time at the end of each session, and this continued even after I saw her at an additional interview each week. She would not leave the office, and it was necessary to help her leave by physically escorting her out. I dealt with the anger contained in these demands, and she mumbled that every time I told her the interview was over and it was time to go, she felt that it was like her mother's telling her she could not live at home any more. I explained that she believed this was because her mother did not love her, but it was because her mother was unable to show her love in the way a mother usually does—by taking care of her. I told Paula that my termination of each interview was not because I did not like her but because the time allotted was used up, and there were other things I needed to do. I pointed toward the houseparents as her sources of love and attention in addition to that which she received from me and from her mother. Paula asked if her mother was insane, and I replied that her sickness was called mental illness. She expressed fears of being like her mother because of similarities in rapid speech and in reluctance to do the housework required of her in chores around the unit. The latter was, as described by the housemother, simply a typical reaction of adolescence. She also indicated her fears of being like her mother because she, like her mother, expressed her disturbance through somatic complaints. After helping her empty the content of her fears stemming from her identification with her mother, I differentiated strongly between herself and her mother. I told her that she had gotten much love from her mother as an infant and small child and that this her mother had missed from her own mother. Since the history indicated that the mother had been consistently sweet and affectionate with the children even though she neglected their physical care, 1 explained this to Paula, which reduced her feelings of inferiority over her mother's mental condition and over a sense of having been rejected. To her question as to why her mother did not give her both love and care, I replied that some women do not have enough strength to do both and that their worries keep them from having enough energy for both. I went on to give her more favorable mother-figures in the

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persons of the housemother and myself for identification, explaining that although the housemother and I also had worries, they were not such big ones as her mother had, so we could manage them better. Pursuing this further, I pointed out to Paula that she had worries also, as does everybody, but that hers too were not so big as her mother's since she had had her mother's love and subsequent help from me and the housemother and that consequently she would not be sick like her mother. Paula handled her feelings in the next several months by indirectly expressing anger at me, swearing provocatively, and complaining angrily about the housemother to me. She was, however, direct in asserting herself in the unit with the houseparents and the other children. Seeking gratification chiefly through many social activities at school and in the community, with numerous girl friends, she went out to parties, was very active in a club from her class with innumerable telephone calls, participated in scout work, attended Sunday school, and took dancing lessons, all on her own initiative. All this was a flight into health, or into a healthier reality, away from her inner problems, making the material in the interviews very sterile except for anger at men and boys, such as the housefather, her own father, and her brothers. This she was loathe to deal with in the treatment, however. Since her activity was socially acceptable behavior and necessary for her ego growth at this time of her life, she was allowed to skip appointments and to be otherwise resistive. She probably was in need of a rest from having dealt with such painful material during the three preceding years. My contact with Paula was maintained by continuing scheduled appointments despite the fact that the relationship was not used for therapeutic progress. It proved a sound course to follow, for the relationship served well in a reality crisis which occurred later. About three years after I began to treat Paula, and when Paula was about eleven and a half years old, her mother attempted suicide by drowning, but was rescued. This appeared in the newspapers. The housemother and I decided that I would tell Paula about this before playmates or her own family could tell her cruelly, because I would be better able than the housemother to

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give answers to her questions requiring technical information. The housemother would stand by to give comfort. After a few minutes of casual talk from Paula in her next interview the day after the event, I told Paula gently that I had something to tell her which I feared would make her very unhappy but that she would have to know. I immediately went on to tell her that her mother was now in a hospital, and paused for reactions. Since none came through, I went on immediately again, so as not to keep her in suspense, telling her that her mother's worries had got so big that she could not stand them, even with a lot of sleeping. In order to get rid of the worries, she had tried to end her life. Paula could not absorb this at first, so I told her that her mother thought she could get rid of her worries by drowning and that she had therefore gone into the water. Paula's face became slightly contorted, and a very small tear came out of her eye. She reacted with shock as her long silence and soft voice later testified. Her first words, however, were in the form of an angry question, "Why did she do it? Didn't she think of me and the others?" I said her mother must have worried about all of them in her inability to take care of them. Paula kept repeating, "It's impossible," and, with irritation at times which she tried to cover up, "Why did she do it?" Paula then asked if the housemother knew and when I replied that she did, Paula seemed to take comfort from this as she said, "That is why she called here while I was waiting to see you to ask how I was feeling." After thus struggling emotionally with this blow, Paula tried to master it by seeking intellectual knowledge. She asked if she would ever see her mother again, and how soon, and whether her mother would ever be allowed to leave the hospital to live at home. All these questions indicated that she had some awareness, though a vague one that her mother had been hospitalized before. That had happened because of a previous suicide attempt made shortly before the original request for placement. I answered these questions factually, saying that when her mother improved enough she could be taken out for Sunday trips and that Paula could see her then. This might come about within a few months, or even less. Furthermore, it was very likely that her mother would improve enough to

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be allowed finally to live at home, and would not have to stay in the hospital forever. The reason for her staying in the hospital was to give her time to get the doctors' help, with medicine and rest from the sight of things which worried her, such as the stacks of dirty dishes and soiled clothing at home. Then Paula said she did not wish to talk about it further, and became engrossed in a comic book. When she giggled while reading it, she said guiltily, " I can even laugh now." I told Paula that her mother would want her to be happy and that that was why her mother had told her she was better off in her present placement than at home. Paula requested privacy in this situation from the other children in the unit, which I assured her the housemother had already done. I said there was no shame in a person's suffering, which causes certain behavior to ease the pain, but that I understood it would be easier for Paula to have her privacy in this. As soon as Paula left the office, I telephoned the housemother to describe what had happened in this interview. The latter was waiting for Paula when she arrived at the unit, and Paula came directly to her asking to see her alone. The housemother took her into the study where Paula flung herself into the housemother's arms, without a word but weeping profusely. The housemother held her and wept together with her. Paula did not let the housemother out of her sight all the next day and did not go out to play when called by a friend, but she ate well and by the day after was back in her usual routine. She began to make restitution for the guilt she felt over her underlying anger at her mother, and possibly for feelings that she had caused her mother's illness, by taking a younger child to the movies, a task she usually abhorred. About nine months later, the mother was released from the mental hospital. Paula had already seen her on the mother's visits home in the interim. The mother was still depressed but rational. Paula wished to spend the summer at home taking care of her mother, who was now home permanently. She was discouraged in this with the argument that the doctors from the hospital would not think a girl of her age capable of undertaking such responsibility. Then I added that a girl her age needed to be free for fun during the summer. I could not get at her guilt prior to this

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discussion, as she had met every attempt with hostility, but this discussion helped her with it. She did go to camp and enjoyed herself there, especially with horseback riding, but toward the end of her stay, she became ill with a sore throat which required bed care. During the fourth year of my contact with Paula, she was almost entirely resistant to treatment, and I believed she was really in need of treatment because of her great guilt. She objected to coming for interviews, and when I suggested that she take a vacation from these, she objected to that also. She then decided on more infrequent interviews, coming every two weeks, and she used these occasions to express her irritations at her own family, as well as her angry complaints at people in the unit. Her feeling toward me as toward the others was ambivalent, but a strained atmosphere existed because of her unspoken resentment. Further evidence of her hostility was seen in her excessive demands for material things and in her attempts to control me. When attempts were made to deal with the anger, ¿he denied that she had any problem with it, which, objectively, was valid since she did not get into trouble over it. In her social life she was as busy as ever. She did not think it mattered that she had fights with the children in the unit or felt angry at the houseparents as she felt justified in both areas. Paula continued to avoid and deny her feelings after the sudden death of her brother with the heart condition at age twenty. During the funeral and the period of mourning, of which Paula spent about ten days with her family, her detachment from her family was first noted definitely both by agency personnel and by her family. While the family openly grieved intensely with much weeping, Paula seemed sad but not deeply touched. She was more interested at times in the fact that there was no food in the refrigerator. The housemother accompanied Paula to the home after telling her the sad news, to which she had reacted in a stunned manner, as if not able to comprehend it. The housemother helped the family and relatives during the next few days, visiting them often. Paula stared at the corpse in fascination but with no tears. On this occasion the father purchased a family plot in the cemetery with enough graves in it for all but one, whom he named to the family worker as being

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Paula. She was eager to return to the unit before the formal period of mourning was over, but tried to hide this from her family. Back in the unit, she was subdued for a few days, and sat close to the housemother who was engaged in soothing the mother through long telephone conversations, which the latter initiated. With me, in subsequent interviews, Paula would not talk about this tragedy, even though she had seen me at the funeral and in the family's home after that and I alluded to this. Very shortly after the son's death, the mother's psychosis changed and she went from the depressed stage to a rather manic one with much hostility expressed to all around her. She went on buying sprees, getting herself three cocktail dresses at one time, and felt herself to be a very young and attractive woman with whom numerous men on the street or at social gatherings would fall in love, but whose love she did not reciprocate. In open narcissism she fed herself through these delusions and was most possessive in her claims on her children to give to her. By the end of the sterile year of Paula's treatment, the mother had become so aggressively engulfing of her children that Paula's sister, age seventeen, still in placement, yielded to her mother's demands to move back from a foster home which she, the sister, had come to enjoy. Then the mother placed pressure on Paula to return to live with the family and this brought Paula into treatment again, requesting weekly interviews. During the entire next year, her fifth year of contact with me, Paula worked on her conflict about returning to her family. While working through her ambivalent feelings, Paula's excessive dependency on her mother was also dealt with. Paula appeased her conscience by telling her family that she wished to stay away until after her grammar school graduation a year later, to which the family consented. As the year wore on, the real conflict came to a head when Paula decided that she did not wish to return to her family until after she had finished high school. They called her a snob for the criticism she made of their home, and this criticism strengthened the mother's intent to have Paula return home soon. In approaching Paula's conflict, which she frankly stated, I asked her to discuss both sides of her feelings. She talked at

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length as to why she did not wish to live with her family. There was inadequate sleeping space with only two bedrooms for the four adults besides herself there. There were no children in the neighborhood with whom to play. It would be lonely even in the home as one brother was already in the army, another would soon go, and her seventeen-year-old sister would soon marry. She contrasted this household with that of the unit, where there were other "kids" and where there was therefore fun. She thought her parents too ignorant or stupid to create family fun as did the houseparents by taking the children on picnics, to outdoor concerts, or dinner in an unusual restaurant followed by a movie. When I suggested that she might make friends at school, Paula brought out more material in the direction of the crux of the problem at home, stating that she would be ashamed to bring friends home because of her mother's queer talk. She spoke of the cultural advantages in the unit and of being able to learn from the houseparents how to live right, then asked if she should be blamed for wishing to have this. She commented that she would have a solitary life with her parents with the other children gone, as her mother would not allow her to go out with friends, adding, "My mother wants me all to herself." Throughout this outpouring, Paula was shouting and weeping angrily, especially at her mother. When I attempted to be sympathetic, expressing understanding and identification with her feelings, she turned angrily on me, saying that I was not doing anything to settle all this for her. I urged her to try to convince her parents to allow her to remain where she was until she was through high school, on the grounds that she was settled there and it would be undesirable to change on account of that at this time. When Paula stopped the torrent and seemed most hopeless about her future in terms of having to live with her parents some day, I offered that after high school she might go off to college or to work and share an apartment with another girl. In order to obviate some of Paula's guilt at deserting her family, I said she could visit them sometimes on weekends and still be friends with them. Paula continued alternately to vent her anger at me and to show positive feelings toward me, both in her ambivalent transference

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from her mother. When I pointed out her anger, she retorted that I had told her she could get rid of it here. I agreed and added that this privilege and the gratification derived from it carried with it the responsibility for learning the reasons for the anger and then how to handle it constructively. I also pointed out that her anger at me was much greater than anything I might have done deserved and that therefore she was blaming me for what others had done to her. This first brought an outburst of angry complaints at the agency and its various personnel, and then suddenly she shifted her anger to her mother. She gave this content in her complaints about her mother's filthy home and the ignorance of both her parents. Paula continued to scream at me in pain and anger for several weeks and also to me about the houseparents and her own family because she could not face the other side of her conflict, the tie to her family based on her guilt feelings and on her own great dependency, which kept her from freeing herself from the family. After I thought enough of this had been ventilated, I limited this extensive expression and told her that the underlying cause of her misery was her inability to decide which mother she wished to follow. I then described her identification with her own mother from her early love for her and from the great indulgence her mother showered on her during current visits. This consisted, as Paula had told me herself, of staying up to watch television until past midnight, sleeping until noon the next day, spending long hours at frequent movies where she and her mother sat close together, and no household chores. I described how a childish part of Paula liked all this and wanted to live the way her mother lived. But there was, on the other hand, a part of Paula which wished to be like the housemother, to be grown up eventually, and to do things well while still having fun. The choice of which motherperson she wished to be most like was Paula's. When she decided this, then she could decide about whether to go home or not. I helped to dispel some of her unconscious illusions about how she would receive dependency gratification from her mother if she someday returned home to live. These were left over from her early childhood with her mother. Should Paula return to live there soon, I pointed out, she would be taking care of her mother instead

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of the reverse, as she had told me herself on other occasions. I said that, nevertheless, the choice was still Paula's. When she then felt that she could not refuse her parents' plea, especially that of her mother, I counseled Paula how she might find some help for herself while living with her family. Paula spent the next several months describing the shortcomings of her family after visits there. Yet she could not abandon them as she felt left out and ignored when she withdrew from her tie with them, and she did not wish to lose them. She was afraid that they would ignore her completely when she returned at seventeen. I suggested that she might not have so much need of their attention at that time. In addition to working through her dependency tie, I also attempted to work through the guilt in this tie which caused her to be bound neurotically by making restitution. I asked her if she felt she ought to stick to her mother, even while feeling that she did not wish to live there, because she believed she owed her mother something. She then brought out her idea that she had hurt her mother by adding to the heavy burden she was already carrying of caring for so many children. This was what had made her mother sick. When the others had left the home, then it would behoove Paula to come there to take care of the mother. To this I pointed out that Paula was born because her parents, down deep, wanted her. Paula then had nothing to do with this decision. People who have children know that they have to raise them, and they do so if they can. Paula therefore did not owe her mother anything for this. I tried to work out her guilt over now being angry at her mother by showing her that this was what made Paula wish to make it up to her mother. To this I added reassurance by telling her that all children have anger at their parents and that she could not help it if her mother had to take care of the children when they were small since this is expected of all mothers. For the first time she then mentioned her brother's death as having been caused by her mother's neglect of him as a child, which made him contract rheumatic fever. During the year of dealing with this conflict, Paula had been concomitantly depressed and quietly angry, complaining persist-

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ently of feeling social discomfort at parties and with the right crowd at school, which, she felt, did not accept her. The boys especially did not like her, and she was a wallflower at parties. We spent a great deal of time exploring her lack of success with boys, and it came out that she really did not like boys as much as she thought she did. Her chief wish was to be accepted by the leading girls so she could be "normal" like them, and in order to be accepted by them, she had to be popular with the boys. In discussing her wish to be her mother's baby long past the time for this, I related this wish to her lack of success with both boys and girls. I brought out that she could not feel as good as the other girls when she felt so babyish, and that she could not compete with them. Also, when she spent most of her feelings on girls and women, she had less room for boys than most other girls do. Later during this period, I helped her to look at her attitude toward boys and men, which was as she had learned it from her mother. Her mother would insult her father in Paula's presence, and this caused Paula to think very little of him. Further, her mother had given Paula the impression that her father was a brute in his physical manners toward her, the mother, as they were always fighting. Some of their fights over sex had been thinly veiled in Paula's presence, and though Paula never revealed her knowledge of this, she must have had an awareness of it which colored her attitude toward boys. I told her to look toward the houseparents as an example of affection and devotion to each other. I later learned from something Paula dropped, that in her dependent manner of relating, even to peers, she had been telling girl friends continuously, and had been on the verge of doing so with boys, of her problems with her parents. I limited her in this, explaining the social disadvantages in it, that peers would not understand it and would feel prejudiced by this information. Except for one or two trusted and close friends, as well as myself and the houseparents, she should not reveal it. Upon my return from a long vacation, during which, Paula said, she would be thinking of a decision, she greeted me by ing me she had decided she would tell her mother that she not returning home for two years. She would explain to

had tellwas her

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mother that her sister was allowed to stay away until age seventeen and that the mother would have the sister at home for another two years before the sister's boy friend returned from service and they were able to marry. Hence the mother would not need Paula for another two years. Paula maintained she was not guilty in making these arguments, which, she felt sure, she would be able to tell her mother. She did so a month later, and her mother did not argue with her, so Paula assumed that she had accepted them. The family worker reported that there was bedlam in the family home now, with the mother planning a divorce and fighting with the father and grown children more than ever. She expected to take Paula with her during Paula's usual summer visit, on a twoweek trip to visit relatives in another city. The family worker suspected that the mother was not openly objecting to Paula's attitude because she planned to keep Paula at home permanently after the trip, just as she had done the year before with the sister. The latter had easily succumbed as she could not cope with her neurotic tie to her mother. Since then, the sister had been regretting her move but had been unable to take herself away. In view of the fact that the sister was seventeen, the agency had felt it was too close to the end of the juvenile court's jurisdiction to deter the move. The child of seventeen was not considered to be so much in need of protective casework; not so the child of thirteen. When Paula disclosed her anxieties about her trip with her mother because of the latter's phases of excitement and confusion, yet insisted on going, I felt that I could not maintain Paula's confidence for future work, nor risk the mother's increased paranoia and acting out at me, by my indication of disapproval and by using the court's authority to forbid this trip out of the state. Instead, I counseled her how to manage on the trip with cabs, telephones, and the conveniences of the train. I continued to tell Paula that it was still her decision as to whether or not she wished to remain in her parents' home permanently after the trip. When she maintained that she wished to return to the unit, I asked her what she would do if her mother forbade or prevented her from going. Paula said she would run away from her mother's home in

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that event. I then told Paula that it would really not be running away, as legally she was supposed to be living in the unit, according to the court's action in authorizing the agency to find a place for her to live. If her parents wished to have her return to their home, they would have to apply to the court to rescind the order for her placement. This procedure had not been enforced with her siblings because they were almost of an age when the court would no longer have authority over them, but Paula was a long way from eighteen. I cautioned her not to make an issue of this matter with her parents, unless it became necessary. Otherwise she might make it harder for herself with them unnecessarily. I had told her about this court situation to help her feel less guilty about running away, as she put it, which it was not because the unit had a legal right to have her there. In the meantime, Paula's grammar school graduation had come up with exercises in the afternoon. Paula wished to have a family party at the unit. Her own family also wished to give her some sort of celebration, but were unable to mobilize themselves to do so. It was arranged with the housemother that she would invite Paula's family to the unit for the celebration. The housefather had taken time off from his work to be present, but Paula's own father had not. The housemother gave Paula's mother the place at the head of the table. Present also were Paula's maternal grandmother, Paula's other brother, now twenty, her sister of seventeen, and all the other children in the unit, together with myself and both houseparents. Paula opened gifts from all those present, kissing each from both groups in a spontaneous manner. For a few hours, there existed a harmonious and pleasant atmosphere with both families sharing together in Paula's big event, and with Paula having synthesized her affection for her own family and the houseparents with whom she had a strong tie. The mother was superficially friendly, and kept herself together with the aid of a great amount of personal attention given her both by myself and by the housemother when the latter had the time. The trip with her mother took place a few weeks after this, and upon returning to Chicago, the mother brought forth an attorney she had located to help her win a divorce. She demanded that

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Paula testify that the father had struck the mother in order for her to obtain the divorce. This Paula refused to do, and she also refused to become a victim of her mother's illness by remaining at home until the divorce went through, which the mother had requested of her. She returned to the unit and took up her life there and in high school with much enthusiasm. At the same time, she had great pain for having to deny her mother's claim. She attacked me for not having solved her problems for her, angrily demanded all kinds of financial gratification, and ridiculed me with personal insults reminiscent of her mother's type of thinking. After one interview like this, I pointed out that she was displacing the pain and anger generated by her home situation to me and to the housemother, whom she also attacked in the interview. She was told that having missed so much elsewhere—mainly in her own family—she was trying to make up for it with material things, but that these would not do it. At the same time I told her that I would see what could be done about increasing her allowance, which was realistically small for a high school girl. Soon thereafter, I was able to tell her that all allowances, not hers alone, were to be increased that week, which pleased her. She then complained in the next two interviews that she found it hard to keep up with her studies and chores, and to undertake a baby-sitting job to augment her allowance, which I had encouraged. I suggested that she limit the frequency of her visits to her family as she had told me she was upset by them for a few days after each visit. I said she was really not helping her parents by her emotional exhaustion from their quarrels, and was simply depleting herself of the energy she needed for her own adequate functioning. She demurred at reducing the number of visits because of her guilt, and I did not press the point. I intended to watch how often she was visiting her parents, since for the past two years I had permitted her to decide on the frequency. If visits had become too frequent now, say weekly, I would take a stand to limit them, which I felt our relationship could risk at this point. The next week, Paula herself announced that she was not going to visit her family so often, as they took too much out of her. In the last few months of my treatment of Paula, the beginning

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half of her sixth year of treatment, there followed several months of exhaustive work with the transference dependency on me. I kept pointing out that her endless complaining was angry demanding from me out of the part of her which was babyish and wanted me to take care of her as she wanted her mother to do. During this time, her parents separated and her mother was left alone with only Paula's sister. The mother's psychosis became aggravated, and she expressed hostile feelings toward the housemother and toward me to Paula. Specifically, she told Paula that I had influenced her to desert her mother. Paula told me this with equanimity, without reflecting the mother's attitudes as she had formerly. Further evidence of Paula's growth and freedom was seen in the housemother's report of a telephone conversation she had overheard between Paula and her mother. The latter had called Paula, who stated maturely and in a calm but firm voice, wtihout any show of anger, that she would listen to the mother's advice but might not take it and that she must hang up then as she had an appointment. Paula, now an attractive freshman in high school, lagging in social activity, but freer of her dependent clinging to motherfigures, had begun to concentrate on her problems in relationships with boys. She was particularly dismayed that she "goofs things up" when a boy showed interest in her. She either discouraged him too much or became overly eager so as to frighten him off. She did not like the way the boys addressed her by her last name only, as to another boy. Objecting to my suggestion that she might not like boys as much as she thought she did, she denied the possibility that she acted or felt masculine, claiming that she was a girl, but she made a slip in repeating this by saying, "I'm a boy." She was immediately aware of the meaning of this, and launched into an account of her confusion and disgust from her recent visit home when her mother permitted her father to be affectionate and went out with him when they were getting a divorce. She also felt that her father should not make intimate gestures toward her mother in Paula's presence. With this, her disgust and distrust of men came out with real feeling for the first time. I pointed out that her anger at boys came partly from this feeling toward her father, and that

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when she talked to the boys, this underlying anger made her voice sharp and rough like a boy's so that they addressed her like a boy. Trying to hide her anger at boys by being overeager in her responses to them was why she "goofs it." The same thing happened when her disgust and distrust made her withdraw from them prematurely. I pointed to the affectionate, stable, and poised relationship between the houseparents, where the housefather treated the housemother with respect and vice versa. I said there were boys who were well brought up who would not embarrass her with crude jokes as some boys had done in school that day, and as her father's crude behavior with her mother had done, and referred to a boy who had dated her on her grammar school graduation night as an example of a well-brought-up boy who liked her and whom she deserved. Paula seemed lighter in mood after the above material was worked. She shopped on her own initiative for holiday gifts for each member of her present household, as well as for each one in her own family, and for the worker also. She spent much care and thought in this giving, and used money she had saved from her allowance and earnings at baby-sitting for the three previous months. In the third interview after the above significant one, I had to tell Paula that I was moving away from the city. On first hearing about it, she said that she could bear it better now than she could have a year before, to which I agreed, but she did not deal adequately at this point with her reactions to my departure. Immediately thereafter she began to date two boys, both of whom were very acceptable. She thoroughly enjoyed their companionship and went steady with one whose ring she accepted. She received numerous telephone calls daily from both these boys and from girl friends. Although the housemother reported that Paula was showing her more affection out of her blissful mood over her boy friend, Paula told me matter-of-factly that she did not love the housemother as much as before as she did not need her as much. Without pointing out that she meant this in regard to me also, which she would have need to deny, I only commented that this was natural in growing up. She reported that she visited her

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family less frequently and sometimes telephoned her mother that she was too tired from late hours of dating to visit her. She intended to remain in placement until after high school graduation and just let her "mother talk." Thus, the intensely neurotic tie to a family was reduced to a point of freeing the child to heal over enough of the pain of separation to permit new ties for growth and a synthesis of both sets of ties. All of this helped her gain strength to protect herself from being victimized by poor family relationships. THE NEED FOR TREATMENT OF ALL CHILDREN IN PLACEMENT

Although not all children in placement can use the same type of treatment as Paula, nevertheless all placed children require treatment. Not all placed children require as extensive treatment as Paula, but, on the other hand, some require more. Attempts are made by personnel of some child care agencies to treat psychotic children with bizarre behavior or other ego defective children who act out while they live in a foster home or in a residential treatment center connected with the agency.10 Ideally, attempts should be made to help every child in any sort of placement with treatment of his conflicts attendant to the trauma of separation from his parents, as well as those conflicts derived from damage done before the placement. The child who grows up apart from his beginnings needs help in clarifying his identity. The normal conflicts which ensue in the process of growing up become weighted with these complications, even though the child is adjusting relatively well in a favorable, long-time placement. It is true that such a child as the latter will be the last one reached, if ever, when treatment efforts are being planned, as the openly disturbed child, whether he acts out or is withdrawn, must necessarily receive first attention. The conforming, achieving child may progress well until the usual conflicts of the maturation process set in—either in the years between three and six or, when it is more obvious, in the adolescent years, at which times the child has greater challenges to meet. At these crises periods of life, the defenses for this trauma, which previously were successful, are broken down by the weight of the

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stress indigenous to them, the pressures from increased sexual and social needs. There follows the release of accumulated underlying disturbances which can seriously disrupt social functioning. These facts show then that child placement work is really child guidance work, if placement is to be an adequate treatment measure. Additional aspects to be dealt with simultaneously are in the dynamic environmental work, with both the natural family and the foster family. The environmental treatment is vitally important to the welfare of the child. Without this work to provide a stabilizing and nourishing framework for the child's development, the treatment of his underlying problems is limited and sometimes even impossible, just as the benefits from placement are limited and sometimes not accessible to children without the direct work with their emotional disturbances. Herein lies a great challenge for the child placement worker. From firsthand experience the competent therapist will find that he has to lend just as much attention and skill to the measures he must take to obtain a secure and enriching environment for the child as to the direct approach he makes to personality damage. There is still further challenge for the child placement worker in a large field of yet relatively unexplored child guidance or treatment work more frequently encountered in the child placement field than in other settings— that which includes the severely acting-out or withdrawn psychotic child, who was described in the chapters on types of placement facilities and attempts to classify parents. These children are found more often in child placement agencies as they cannot live with their parents. Treatment of these children was not described in this chapter, nor did Paula have features of either serious disturbance. Some description of the treatment of such disturbances can be found in this author's writing elsewhere 11 and in works by others. 12 The skill, time, and emotional investment which the total treatment plan of the placed child requires can well overwhelm the worker in this field, given enough time, regardless of his stamina and the extent of his resources. The physical and mental effort necessary represents only a part of what the work takes. The constant exposure of the worker's own emotional self to the severe

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pathology of the child and his parents, out of the worker's need to identify to gain emotional understanding of them, takes its toll on the worker's psyche. His responsibility for the child's total life situation, both in the present and in the future, deepens his concern for the child more than it does in work in other agency settings where parents are functioning to some degree in this area. The reduction of caseloads may help to ameliorate this aspect of emotional drain in the quantitative sense. An understanding relationship with and active support from the agency administration can further aid the worker's effective functioning in this immense task. Lastly, the worker's accepting attitude toward the goals to be striven for can spare him from wasting his energy—if these are realistically set and yet leave some room for idealistic aims to ensure progress in professional growth. The placed child is always an emotionally crippled child, but as in any deviation in growth, even physical crippling, there will always be some spontaneous healing from the life stream of the individual. More extensive healing can be obtained from skilled treatment, and equally important are the compensations developed from both these sources for the lacks and distortions in the child. Sometimes compensations gained directly from enriching experiences derived from foster care with the help of psychotherapy will accumulate in a sufficient, though always limited, degree to offset in relative measure some of the original lacks which were so damaging. This child's personality can never be whole or "normal" as described in the textbooks on personality development, and this obtains in some degree in all life situations. Realizing that the ideal whole is unattainable in any human being, the child placement worker must make his peace with this and yet must not sacrifice his efforts to strive for better results. If the child is given that which his basic needs call for—namely the food, shelter, and the sort of emotional sustenance and guidance necessary for healthy personality development, all of which are his rightful heritage—plus the freedom through treatment from blocks to assimilate this when it is proferred, then placement will serve its purpose when all of this could not be provided by his

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own family. With skilled help, his bitterness toward his family, apparent or submerged, will be softened, his loyalties become less conflicted, and, with understanding, his hopes for himself in the future be less blighted, in fact, even lighted.

7

WORK

WITH FAMILIES

AFTER

PLACEMENT

IMPORTANCE OF WORK W I T H PARENTS AFTER

PLACEMENT

A child cannot derive maximum benefit from placement unless his parents' needs are recognized and dealt with, according to the parents' reality circumstances and emotional framework. If the parents are absent from the present picture, by death, desertion, hospitalization, or any one of a number of causes, their images and the impressions left over from them must nevertheless be dealt with in the work with the child as described in the chapter "Work with Children after Placement." If the parents remain in contact with the child at either regular or sporadic intervals, direct work with them is essential. Family ties do not vanish when the organic unity of the family is disassembled, and these ties continue to exert great influence on the parent-child relationship, even after placement. Not to heed the natural family means to neglect that part of the child which is tied in with the parents, whether positively or neurotically. This still constitutes a large part of the child's life. The child feels himself inadequately accepted by the worker if the latter has no real acceptance of his parents. His realization that his parents are different from other parents in not rearing him creates in him strong feelings of social inferiority over and above the personal feelings of inferiority instilled earlier by parental rejection. Feelings of social inferiority create yet another barrier to his efforts to find compensations elsewhere. It will help

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to reduce this barrier for the child if the worker shows him in concrete fashion, as well as by real feeling, conveyed to him, an acceptance of his parents. This can be accomplished most effectively when the worker accepts the parents in the child's presence. It cannot be done, however, unless the worker has a genuine feeling of acceptance of the parent or a readiness for it. Otherwise, the child will sense the worker's conscious or unconscious defection at this time, as he will also from the worker's attitude toward the parents in discussions about them at other times. The child's burden of distress due to awareness of his parents' shortcomings is reduced when he sees the worker accept his parents despite their defects. Even when a different worker deals with the parents, the child's worker should look for an opportunity to make at least one contact with the parents, preferably in the child's presence, for this purpose. When both the child and the parents visit in the agency office, or meet on some such special occasion as a graduation or confirmation, the child's worker, who usually attends, should take the initiative in showing acceptance in a natural situation, not disruptive of the parents' relationship with their worker. 1 In the field of social work, the general understanding of function by a variety of agencies is that work with the parent for his own sake, without primary reference to the child's welfare, but for the mutual welfare of the family group and its individual members, usually falls within the scope of a family agency or psychiatric clinic. In the child-care agency, the presenting problem is the parent-child relationship, with concentration on the welfare of the child, and traditionally, work there has remained childcentered. But the focus on the parent himself, apart from the child at first, has since been found necessary in order to involve the parent in the ultimate goal of improving the child's lot. Until the past few years there has been very little meaningful contact with parents by workers in the child placement agencies, and in too many instances little or no contact of any kind even when the parents were available. Activity with parents was generally omitted unless precipitated by the parents themselves. Then it became a problem to be dealt with simply for purposes of getting

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it disposed of, or a routine matter to be taken care of among the mechanical aspects of the work, without dynamic consideration of the parents themselves. The worker resented what he regarded as an intrusion of the parents, especially if the parents disturbed the child and the foster family. If the worker was not provoked by the parents' contact, then he viewed it either with tolerance or indifference. The parents, in turn, saw the worker as an enemy, whether the placement was voluntary or forced. When the parents did not seek contact with the child, and hence not with the agency, even when such contact was possible, the worker allowed the situation to drift on the invalid assumptions that the placement would be indefinite and that the parents were entirely uninterested in the child. If a worker felt kindly toward the parents, the relationship was still not put to definite therapeutic use. Altogether, the worker seldom made efforts to seek out and involve the parents in relationships for diagnostic and treatment purposes. It has since been found that a more positive and scientific approach to parents has proved to be necessary not only for the maintenance of a constructive placement, but also, in itself, for the direct value to the child in placement and to the parents. WORKERS' SUBJECTIVE ATTITUDES

Even with an awareness of the importance of working with the parents of the placed child, a positive approach to them can be blocked by the worker's own feelings toward them. As in all casework situations, the worker's responsibility is to make himself aware of his emotional reactions so as to be better able to handle them in order to avoid their obstruction of the helping process. One of the usual reactions the worker experiences when dealing with parents of foster children is anger at these parents for having damaged the child prior to placement and then for hurting him more by their rejection of him through placement. The anger comes also when the parent continues to upset this emotionally disturbed child after placement, in the face of the worker's efforts to undo or mitigate the ill effects of the past. To be able to accept these parents with a positive attitude requires that they be viewed as sick people who suffer now as they suffered during

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their own childhood despite attempts to develop defenses for their pain through their acting-out, bothersome behavior. Often a worker cannot relate to these parents with understanding out of fear of identification with the serious pathology usually found in these parents. This stirs up anxiety in the worker over his own unresolved conflicts, which exist universally to some degree. The worker forgets that there is a difference in the amount of the conflicts and also that he has made some good defenses for his own functioning or else he would not have achieved to the point he has. Or the worker fears his identification with the child's tie to the parent, and therefore reacts with resentment toward the parent because of the child's tie. This might be especially true of the young worker, still close to his own adolescent striving for independence from his parents, who needs to deny the strength of the child's tie to the parent. Actually for the worker to feel closely empathie with so much pain both in the parents and in their placed children can become too great a drain on the worker. It is like being overexposed to the strong rays of the sun lamp or the X ray which make the skin and tissue raw just as the other overexposure leaves the feelings open and raw. In this depleted state, the worker feels overwhelmed and too discouraged at times to work effectively. In this situation, his short-termed use of the intellectual knowledge itself provided by his profession, without involvement of much feeling, in order to gain a respite, can serve him temporarily for function until he can recuperate his emotional resources. THE MEANINGFUL RELATIONSHIP WITH THE PARENT

The primary tool for working with the parents of children in placement, even more so than in the helping process with other people, is the conscious use of the relationship. This is because there is a greater prevalence of weak ego structure in these parents than in those at other agency settings. The relationship here must be fashioned according to the specific needs of the individual parents who are described in the chapter "An Attempt at Classification of Parents." Careful watch must be kept at all times for transference elements which have to be cleared away from the

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relationship in order not to burden or even block its beneficial use. The transference of feelings from past experiences to the interchange of present feelings cannot be interpreted as such to many of these parents, for their ego structure is not sound enough for such differentiation. But a warm firm explanation of the "mistaken" attitudes which appear may help clear the "misunderstanding" between the worker and the parent. There is an over-all feature in the relationship with most of these parents which makes it different from the therapeutic relationships used in other settings. This feature is the more active use of the relationship according to the parent's needs, going beyond the corrective emotional experience characteristic of other therapeutic situations.2 In this, it is similar to the two-pronged relationship of the worker with the placed child.3 Since the child placement setting imposes a dual role on the worker in regard to the child—namely, that of parent-figure who handles the child's situation, as well as that of therapist—skills have been developed to combine these two roles whenever possible in the same person. Out of this has grown a method for dealing with the immature and emotionally disturbed parent in a similar manner. It includes much giving, warm authoritative attitudes for lending strength and setting limits, and active guidance and advice. This approach is structured on mental hygiene concepts which prescribe dealing with aspects of training which are germane to the various stages of personality development, applied here irrespective of chronological age but with respect to the adult ego form. For example, a mother whose daughter's placement was made by court order because of sexual delinquency was left with three small sons who were later placed. Before they could be placed in the most constructive manner possible, the mother attempted to place pressure on the worker for their immediate removal by allowing herself to be evicted from her flat. She claimed she could not find another dwelling and would have to leave her children in the flat she was to vacate. Since she had played a minor part in contributing to the delinquency of her daughter, for which her husband had been imprisoned while she was left free in order to take care of the other children, her impulsive, ir-

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responsible behavior was curbed by the following advice. At her adult ego level, she was addressed in terms of recognition of the hardship involved in rearing three children without a father's help in providing shelter. This gave her sympathetic support. Pointing out to her the natural consequences of her behavior, as is done in the discipline of a child, she was told that leaving the children alone would bring them to the attention of the court where she was known with regard to her daughter's placement. The court would blame her this time for leaving her children, and the worker hoped that the mother would not allow the court to punish her any more than she, the mother, would allow the children to suffer. The choice of action was thus left to her. Two days later she called the worker to report in the pleased manner of a good little girl that she and the children had found and moved into new quarters. This type of approach is appropriate with the parent who has, on the whole, a weak ego and whose dependency is undefended. It is less appropriate and hence to be used with discrimination with parents who are struggling with conflicts and trying to maintain defenses. Experience in child placement work, however, reveals that the largest number of parents at the point of maladjustment requiring placement of their children have an unusually weak ego structure. In many cases, other agencies have found these parents unable, with the usual casework techniques, to use help for purposes of keeping the family together. However, work with such personalities need not loom altogether hopeless if both diagnostic understanding is gained and limited goals are sought. DIAGNOSTIC UNDERSTANDING O F

PARENTS

In view of the aforementioned needs and advantages of working with parents after placement of their children, a planned approach to parents should be followed, and a trend in this direction has recently been begun. It has been shown how this should be instituted from the first contact, how it should be carried out during the diagnostic process in the intake study and during preplacement work, as well as in the handling during the actual separation at the time of placement. Further contact with the parent after place-

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ment has to continue to be based on the diagnostic understanding already secured and on that which is gained further from the way the parent deals with his own life and with the child, once placement is effected. A more refined measure of understanding of how the parents' ego functions will yield valuable guides to the work with them. Concepts of Ego Energy. When the construction of the ego is understood in terms of vital and changing elements, as described by Paul Federn, 4 rather than when it is considered as a static phenomenon, the sense of futility in working with such difficult personalities can be decreased. Instead of being static, the ego is seen as fluid and comprising many ego states. On this basis the entire ego will not be measured by its weakest part or believed to be altogether like that part. An ego is composed of both strengths and weaknesses,5 and it is necessary to seek out both. It has a variety of ego states, some of which have been repressed. An ego state is an emotional experience in which there has been contact between the libidinal drives and reality; the latter is invested with libidinal power which then becomes a part of the ego.® In the predominantly weak ego, the amount of energy referred to as libido is deficient, the more so in schizophrenics and in other egodefective people. This lack of energy in the ego has caused them also to be unable to learn mastery over their impulses in order to establish ego boundaries. Ego strengths stem from ego states which are comprised of emotional experiences of libidinal gratification which have been integrated. Frustrating and painful emotional experiences without positive compensation make for ego states of weakness. Ego energy used in the latter experiences is wasted, and this distracts from the total functioning of the ego. Some lives have more and some have less of each kind of experience. These, together with constitutional factors, determine the amount of ego energy in the personality.7 It is known that emotional experiences, either positive or negative, cannot all be remembered at once. Some are repressed and superseded by later emotional experiences which create other ego states, but although they may remain buried, none are lost to the personality. The individual's history, or current behavior in another

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situation calling forth a previous experience, may point to the existence of underlying ego states to be tapped for sources of strength and to be understood in terms of lacks. Hence, the worker who left the choice to the mother of whether to find a new flat or abandon the children knew that this mother had some strength, despite her poor performance as a parent, to use in finding lodgings, provided she was helped to apply it there, as described. The worker had noted this mother's well-groomed and poised appearance in the court, even though this well-organized appearance was not usual, and also noted her good-natured but firm handling of her own disorganized, clinging mother from whom she had run away at age sixteen. These phenomena indicated strengths, which were present from some past experience of a positive nature. Unfortunately, of course, they were not representative of most of her ego, as experiences for building strengths had been too meager in her life. The following case example illustrates ego strengths and ego weaknesses as derived from former ego states of early emotional experiences. Mrs. C. hated housework and the care of the home and children. She preferred to work outside her home, making arrangements for partial day care of the children after school. Her house was cluttered and disorderly, but there was one positive area in her housewifely duties; this was her preparation of good meals, which she did not find burdensome in the morning before a busy day, or even after a day's work outside the home. Mrs. C.'s history disclosed that she had had a very strict and efficient mother of impeccable taste and appearance, about both her person and her home and in her preparation of good meals. Her mother had sewed fine clothes for Mrs. C. during the latter's childhood, but gave her little feeling of worth despite the finery, which was meant to show the outside world her high standards. Instead, she made a household drudge of Mrs. C. and in this way depreciated her real feelings of femininity. At age ten, Mrs. C. had to make all of the beds and wash the family's breakfast dishes before going to school, even though her mother was well able to do this

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housework. Also, Mrs. C. had to help her five-year-old brother get dressed for school, putting on neatly his long stockings over his long underwear while she worried about being late for school herself. Small wonder that she hated housework and the care of small children. During her childhood, however, Mrs. C. had spent each summer on her grandmother's farm where she had freedom from her strict mother and an enjoyable companionship with her grandmother. Mrs. C. lived for these summers as they were the brightest time of the year for her. Her grandmother taught her to cook and bake, and Mrs. C. continued to do this easily and adequately after she became a housewife without actually stopping to remember the happy experience of doing this together with her grandmother. This example illustrates how ego strengths and ego weaknesses are created, chiefly by the early gratification or lack of it, which governs the supply of ego energy. The charge of energy from the libido, which was originally invested in the ego, is referred to as ego libido," and determines the basic capacity to apply oneself to social living such as giving parental care and achieving at work, as other forms of giving of oneself. Here is seen also how past emotional experiences constitute different ego states which continue to function as ego strengths and ego weaknesses, even though the original experiences have become part of the unconscious. The discovery of a former positive ego state gave access to strengths from that ego state and a guide for handling it for present usage. Emphasis on this ego strength in Mrs. C. gave her support to compensate for ego deficiency in other areas. The other aspect of scant ego energy causing the ego weakness often encountered in parents who place their children lies in the parents' seeming indifference to standards of right and wrong, referred to as lack of conscience or being without guilt. Some of these parents have such poor capacity for testing reality in the face of die strong pressure of their impulses that the impulses always win over judgment. Having and even stating an awareness of correct standards, they show a lack of control in carrying out their

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behavior in accordance with these standards, known as a lack of superego. Herein is found the parent who says the right thing but does the opposite, who acts on impulse rather than with judgment or self-control. This is not a matter of acting out unconscious needs or defenses or of acting without a conscience, but simply one of acting without foresight and internalization, since integration, even the kind based on neurotic defenses, provides a system of checks and balances which contains the impulses. The parents without controls of any kind may be psychotic or in some other ways ego defective in that they are lacking in ego boundaries. The defect lies in the perimeter, so to speak, of the ego structure, and this is what governs the relating to reality and the checking and regulating of impulses. So in addition to the lack of ego energy with which to apply oneself to objects and object relationships, there is the lack of energy at the boundaries of the ego by which to regulate the behavior. When this phenomenon is referred to as the superego, the concept is a static one, not seen as having variable quantities of ego energy in the same person, but seen only in terms of the quality of its function, by which the person is evaluated. Since both of these aspects of ego weakness are prevalent in many of the parents whose children are in placement, the treatment of these parents is planned to deal with both. This is done by using approaches aimed to conserve and increase their supply of ego energy and at the same time to build and strengthen ego boundaries. For the former, both the kind of gratification which has to be given, and the manner of giving it must be as nearly akin to that which was originally lacking as is possible.9 The mother who shows primitively intense feelings toward her children for purposes of feeding on them as if she wished to swallow them up needs to be fed similarly by the worker in an extensive amount. This may help her to release the child sufficiently from her engulfment of him during visits after placement that he will have room for growth in his tie to her. The worker could, for example, first take this mother out for a treat before a visit by her with the child in order to feed her emotionally in the concrete way it is necessary to show a small child that she is loved. Along with this she should be given sympathy for her woes as she complains of

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them, but the worker should also make light, entertaining conversation as if gossiping with a visiting youngster, and should even try to make this mother laugh. This happy exchange in a warm relationship is exactly what she lacked in her early childhood to increase her ego energy. In fact, she must have received exactly the opposite, and the barrenness of it left her so little ego energy at the early ego state that she constantly needs to feed on others, which is the natural need of a small child. Care should be taken not to make too many demands on the parent with such a meager supply of ego energy; in this way she will be helped to conserve her supply. Such parents are not to be expected to think and plan with regard to their children's welfare first, or to become involved in a treatment approach which includes struggling with guilts, anger and its meaning, pain, and confusions for the purpose of working through these to become freer to take care of their children. These parents do not lend themselves to such treatment because realistically they do not have the energy for it. Rather, the pain, guilts, anxieties, and other disturbances in them must be diluted by the dynamic giving of gratification, renewed at intervals, so that these debilitating ego states will place less strain on their meager supply of ego energy, and hence leave them with more energy available for better functioning. Many workers give up on these parents, believing that the parents are not interested in being helped in regard to their relationship with their children. Actually, the parents seem uninterested because they do not have enough ego energy to use in considering and planning for their children both before and after placement. Hence, they do not respond to the workers' efforts with them in that direction. They will respond, however, to approaches made to involve them for their own sake. This is because they are so in need of gratification themselves and so lacking in ego resources for obtaining it. They have to be given to in order to replenish their own ego energy first before they can muster any to apply to the problems involving their children. Where there are defects in ego boundaries—when it is said that an individual is lacking in superego—work should be directed at training to contain impulses. Gratification must be given simul-

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taneously with this guidance to provide the power for the act of renunciation of other immediate gratification of the impulse when this is undesirable. Failure in renouncing or deferring impulse gratification suggests that there is a deficiency of ego energy because it was not originally invested in their formative years for this purpose. The simple aspects of disciplinary training in its positive sense, for purposes of establishing self-containment and selfregulation are used as guides in the approach to the immature part of the personality shown in defective ego boundaries. The task is a continuous one since the ego integrative mechanism is poor. This parent does not learn as readily from repeated experience as does the one with greater ego strength eventually to function by himself. Constant renewal of the relationship with repeated guidance in regard to feelings and activity, since there is little carry-over from the gratification given by the worker and from recent experience, is needed to replenish the defective ego in order that it may function more constructively. This continuous work has value, if not for permanent growth in the amount desired, then at least for maintaining a healthier environment for the child's growth, since the parent remains part of the child's environment even after placement. Sometimes the results from different behavior can be so gratifying to the parent that he will gain additional strength from the satisfaction derived from his achievements to promote even better functioning. This is shown in a report of a case in another work by the writer, 10 wherein a predelinquent girl of eighteen, whose history revealed large gaps in superego from her poor training for regulating her impulses, began to establish these self-limits after marriage. She was given much warmth by her husband, even though he was ineffectual in other areas due to a depression at the time. His warmth was different from the harshness of her mother, as was that of his relatives who also accepted her warmly. She began to show responsibility and capacity for adequate homemaking and for mothering her new baby, which the worker assessed as the beginnings of ego boundaries foreign to her former behavior. Even though these ego boundaries were maintained by compulsive defenses, the worker built on the sound beginnings while respecting the defenses. Through a relationship characterized by strong de-

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pendency on the worker, the young mother was fed support for developing these capacities for responsibility, in the way that a child is taught by his mother. The worker noted and praised this mother's efforts at housekeeping and at care of her child, from which the mother was already gaining satisfaction, because they made her home so different from her own mother's filthy home. At the same time the worker drained the mother's guilts over her previous behavior to avoid their consuming her ego energy. Freed of this burden and supported thus, she could replenish her supply. With this additional capacity, she was even able to take her older child back from placement. GOALS OF

PLACEMENT

Cumulative diagnostic understanding of the parent, together with that of the child, determines the goal of placement, as to whether it will be only temporary, or indefinite for a long time, or definitely permanent. In applying to a given situation, including its social factors, the understanding of usual patterns in the parents and in the parent-child relationships, as described in the chapter attempting to classify them, with allowances for individual differences within those categories, the goal of placement can be prognosticated. For example, an autistic child, whose parents turn to shaping plans for a life without him, can be considered as being in placement indefinitely but probably not permanently. The cold, detached parents of such children have a rigid conscience which, rather than love, would bid them take him home after following the recommendation for the child's "cure," without regard for his current condition, let alone his ties to the foster family. The mother who is fiercely possessive of her child, in order to feed on him, will repeatedly seek his return for her own needs, while her poor prognosis for change strongly indicates that he will remain in placement for most of his growing years. Some parents with seriously defective ego structures, as in the first category, may seek another life for themselves, leaving behind most of their feeling for their child. Such a situation indicates a permanent placement, and total separation through legal means should be sought in order to make the child available for adoption. A permanent placement

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without adoption may also be planned for the child of a chronically psychotic mother whose functioning has been grossly impaired for a long time, especially if the father shows interest in the child. T h e parent with a narcissistic character structure usually waits until the child is old enough not to be a burden and then claims him for return. This then points to a placement limited by the age of the child as the parent will request his return, usually in early adolescence, for the parent's own gratification. T h e mother who functioned fairly adequately until some unusual stress caused a family breakdown will require only temporary placement of her child until she recovers her former competence. T h e widower who had a stable family life before the mother's death, but for whom homemaker services were not available, will need usually only a temporary placement for his children until he remarries in due time. These illustrations of the goals of placement given here and many others given elsewhere indicate that the character structure, either alone or together with the social situation, is an essential factor in assessing the goals. LEVELS OF

TREATMENT

The above factors determine the level of the parent's treatment, with the content of the treatment influenced by the goal as well. The level of work with the parents can consist of merely deterring the parent, either by emotional holding or by emotional feeding, from disturbing the child and his placement. It can be a dynamic supportive level with dynamic handling to help the parent function better, even though he is still unable with this to rear the child. Or such a level of treatment can be aimed at helping a parent previously able to rear the child to recuperate from a severe shock which disrupted the family. Finally, the work can be on the level of remedial treatment in terms of helping the parent to work through underlying conflicts to effect some change in personality and hence in the life situation for possible family restoration. The content of the treatment at any level should be related to the goal of placement. F o r example, the chronically psychotic mother, whose prognosis is poor, is treated on the level of holding her, through a relationship of strong dependency, while helping her

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to live in less pain without her child. Here, indefinite, long-time placement is the goal, and her pain is increased by her awareness that she will never be able to rear her child. The once adequately functioning parent whose family was broken by unusual reality stresses is helped with dynamic supportive measures while the fact of family restoration after temporary placement is kept before him. This is the goal of placement in this situation. Such references to the temporary nature of the placement can keep him from feeling too discouraged about his failure as a parent. It is not so necessary to reduce discouragement in the conflicted parent whose neurotic equilibrium was disturbed by inner conflict so as to precipitate placement, since the placement, once effected, may take care of the ambivalence of his conflict. It is important, however, to keep before him the possibility of family restoration so that he will not tend to drift away from this goal. Whatever the level of treatment and goal of placement, it is also necessary to make some plan regarding the parent's contacts with their child during placement and to work with both child and parents around the plan as necessary. TREATMENT APPROACH TO EACH CATEGORY O F

PARENTS

As in all treatment work, the approach in general is to involve parents at the point of their specific needs and defenses, and then to proceed more definitively according to these specific needs. Emotional Holding of Ego-Defective Parents. The first group of parents described in the chapter "An Attempt at Classification of Parents" is the most lacking in ego energy for effective use of themselves and for handling their impulses. They are the alcoholics, the confidence people, the prostitute mothers, all of whose reactions to placement of their children are crude devices of self-defense. These range from blustering about achievements in fantasy, to expressions of grandiose intentions for their child, to promises to the child of unrealistic plans, to attempts at bribes and seduction of the worker, to giving a quick but unreliable show of cooperation. Their extensive glib talk shows gross inconsistencies. Some of these parents finally finish their story pitifully drenched in tears of guilt, self-pity, and deep discouragement about themselves. All of

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this is reflected in their need to place the child and by their realization of the impossibility of their dreams of power. Thus, there is nothing to offset their sense of ineffectiveness. Or these parents in the first category, especially the chronic criminals, are sullen and evasive and threatening to the people who did them wrong; they even make veiled threats to the worker. Also in this first group are the actively psychotic parents, who may be outright delusional; or incoherent, confused, or dazed; or else under great pressure of speech and extremely suspicious or openly paranoid, accusing the agency of working in collusion with "other enemies" against them. After recognizing such behavior as expressions of defenses, the manner of handling them is the next concern. Counseling these parents in order to decide whether or not placement of the child is indicated is obviously redundant, since the diagnosis of placement is almost always clear in these cases. Most frequently these parents have no choice either because of court action or because of the impossible circumstances of their own living arrangements, as, for example, in the case of a vagrant. They need to be helped, as far as they can comprehend, to accept their child's placement, even after it is effected, as the most advisable action. The first step in this direction is for the agency to treat them with respect, granting them a hearing of their viewpoints, despite possible distortions. Their blustering speeches and irresponsible promises should be listened to and accepted as defenses, for this will temporarily reduce their sense of failure. The exaggeration in these defenses will show how little their poor tortured selves have within them to give to their children. It becomes apparent then that their need to feel themselves of some value is all the more tremendous just because they are able to achieve so few, if any, of their aspirations. For the duration of the time that parents hear and are listened to in their exaggerations, they believe in it themselves. Therefore, not to listen would eliminate even these few minutes of surcease from pain. To help in creating this temporary relief from time to time is to help in establishing a temporary brake for these parents' destructive attention to their child. Such listening may even result in some positive contact, from which may possibly come involvement of these parents in a relationship through which they may be

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deterred from disturbing the child's placement. Because these parents are so deficient in ego energy, the relationship with them has to be renewed and nourished by extensive and repeated attention to the parents' need to focus on themselves. Such procedure must be followed almost each time it is necessary to deal with them on a matter pertinent to the child, as these parents need to be given to first before they can act responsibly toward their child, even in a small measure. Since these parents are not capable of sustaining enough of a positive relationship to provide a sound background for work with them as needed, it seems usually to be necessary to begin all over again at each contact to develop a relationship with them. The best that can be hoped for is that they may vaguely remember that the worker was kind in the past. Although respect is shown such parents by listening to them, it is not sound to permit this type of parent to unravel themselves too much by their talk. This is likely to happen because they have so little self-control and because their tremendous discouragement while they talk overtakes them. Too much encouragement to talk of themselves, and too great sympathy shown them by the worker, will melt the gates to their limitless dependency. In view of the little actual gratification they have had in the past, their ego energy is scant indeed, and this leaves them with thoroughly inadequate ego boundaries. Their easily uncovered feelings overrun their ego boundaries, which are far too weak to withstand the pressure. The effusive talk on their part builds up to a sudden realization of how little they actually have in the present. It is especially necessary to limit their extensive review of past hardships and pain, as it serves little for catharsis, probably being oftrepeated material, and only wastes their meager supply of ego energy. When copious weeping emanates from such unraveling of themselves, despite the worker's efforts to contain their outpouring, it is best to limit this also by giving friendly reassurance that they are doing the best thing possible for their child by placing him and that in this way they are being good parents. It is wise to confirm and utilize the latter part of the oft-heard statement from these parents, to wit, "Even if I'm no good, I'll give my child a chance to grow up decent with a nice family."

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With the sullen parent of the criminal record, who comes with a chip on his shoulder, a meeting can be made at his point of defense by empathizing with his feeling of having been grieved against. That he should not take permission from this to wreak further revenge against society, a brief statement to the effect that feeling justified by this to act on it will not be worth the trouble it brings him may negate any encouragement he finds in this sympathy to act out more. This parent's feeling that he has been wronged by society has much validity, since authorities in the field of delinquency hold that society has really not dealt constructively with the individual who becomes delinquent or criminal, either at the origin or in the treatment of this malady. The worker's approach out of his understanding of this can be, "I know this is tough on you. You've had bad breaks, but your child should have better breaks. Surely you want this for him. I can see him getting this in another environment." Emotional Feeding of the Parent in the Symbiotic Tie. In the approach to parents of the second group, namely, those mothers who use their child to maintain their own mental health equilibrium, there is also no point to beginning in terms of the child, for to them the child has no need to exist for himself. Markedly lacking in ego energy, they need to feed on their children to supply themselves with emotional sustenance for survival. Once placement of the child is accomplished through the intervention of an outsider, such as a relative or the family physician, or is enforced by the court, the cold, aloof mother will drift away from contact with the worker. But she will not relinquish interest in the child unless a career or another absorbing intellectual pursuit intervenes." This frozen, emotionally isolated mother needs to be warmed by a relationship which does not come too close to her or make demands on her.12 Often the contacts with such a mother seem sterile and shallow, the surface conversation punctuated by uncommunicative silences. To offset this, the worker can gossip about everyday occurrences in the mother's life which are not highly charged with emotion. These topics are not threatening to or demanding of the mother, and can serve as vehicles for the exchange of superficial thoughts and mild feelings by which the beginnings of communica-

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tion can be established. Warmth can be conveyed through the worker's interest shown in this way, by impressing on the mother her importance even in regard to the simple details of her life. A continuing relationship with such content eventually deepens imperceptibly, with a consequent thawing of the mother's feelings and an adding to their warmth. With the increase of feelings, this mother can be guided and educated for more thoughtful and enriching contacts with her child, even though he remains in placement indefinitely. If the child is helped to free himself from the symbiotic tie, intellectually he will know she is his mother, while the amount of his emotion in the tie will fit the distance in the relationship, which will be like that with an aunt. Hopefully, the foster mother will supply him with real mothering, as the natural mother will not be able to give enough of this even after her improvement. If the child is young enough at the time of placement so that reversibility of his atrophied mental and emotional faculties is possible, then much can be achieved for him through the mothering he will get from a mother substitute and through extensive direct treatment. This also requires continuous work with the natural mother so that she will be able to make room in their tie for the child to grow away from her in order that he may be an individual himself. T o o often the child comes to placement at a later age, such a mother having denied his problems until they reach dangerous proportions, at which point society intervenes. B y that time he may require custodial care in a closed institution, if a residential treatment center is not available for his care and treatment. But whenever the placement occurs, and to whatever facility, the mother will require extensive support to help her relinquish her use of the child as a crutch and to permit the placement to continue. The intellectual appeal that this is a prescription to be followed, especially if a physician is involved in the planning, will give her the kind of rationale that permits the continuance of the separation since this reason involves her feelings least and is a manner of doing mechanical as has been her habit with the child. The second type of mother who feeds on her child, the one who does so in an intensely primitive tie, becomes desperate in her

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wish to place the child when the pressure of his care becomes too intolerable for her, even though she needs him for herself. While she seeks to be relieved of the responsibility for his care, she is at the same time in a panic over the loss of the child's presence for her own mental survival. An intense relationship with the worker, and also with another key person in her life, can help her to bear the separation. Here is where the worker has to be actively giving and directive. This mother becomes distraught and must have such support. An illustration of this work is given in the chapter "Preplacement Work" in the case of Miss H. and her son Bill. After placement, the worker's strongly giving relationship must be continued in order to hold the mother emotionally from disturbing her child by her attempts to engulf him during visits and by her alternating dependency on and verbalized suspicions of the foster mother or treatment facility. The child will need to express hostility toward his mother before he can free himself from her, but she should be kept from awareness of his hostility as far as is possible. Otherwise, her mental equilibrium will break down with strong repercussions on the child. This will result if she realizes forcibly by his anger at her that she no longer possesses him entirely as in the symbiotic tie. As described in the chapter on classification of parents, this mother needs to be fed by the same worker who treats the child. In her dire need for the child she will feel neglected, and in her symbiotic relationship with him she will likewise believe that he is being neglected in his placement situation. The worker in feeding the mother relatively enough can help her feel that the child is being taken care of adequately, and she will not disturb the placement. By supplying a crutch for the mother the child is thus helped to get away from the excessive bond she created with him. Dynamic Handling of the Narcissistic Parent. The third group of parents, highly self-centered, immature, and exceedingly pleasureloving, while not as grossly disorganized as the first two groups, can present most trying reality situations to be dealt with for the child's welfare. The mechanisms and their derivations of this third group were described in the chapter "An Attempt at Classification of Parents." Their selfishness in deserting their children in the

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face of their apparent adequacies to take care of them (such as visible earning power, good grooming, poise, and pursuit of high standards of self-satisfaction) will generate resentment against them in the community and in the professional worker as well. As their feelings of great inferiority are hidden, these parents appear in a role of adequacy which is really beliebig. Their extreme sensitivity to affront out of their feeling of not being of value, and their quick pride defended by hostile outbursts, often makes them most unreasonable. Their plans and activities around their children are in terms of their own needs—for pride and for the sake of appearances. Their children are not objects of consideration for their own sakes, just as the parents were not valued during childhood for themselves either. The parents feel that the fulfillment of their own needs, through use of the child if necessary, is more important than the welfare of the child. Defending this by angrily claiming parents' rights, as well as knowledge of what is best for the child, they are again for the sake of appearances clinging to the outlines of parenthood, but in this they are at best shortsighted. All of this is due to their scant ego energy, which will not spread far enough to supply gratification both to the parents themselves and to the child. Because of their excessive narcissism, their deficiency of ego energy is seen largely at ego boundaries which makes them unable to contain their impulses when the latter press for self-gratification or expression. The wisest approach in dealing with these parents is to avoid making a contest out of any issue, or else they will feel called upon to go to extreme lengths to defend their adequacy to the detriment of the working relationship and to the child himself. These situations come up in regard to impromptu and ill-advised visits, gifts, and other such matters pertinent to the child in placement. The mother may suddenly visit with a new boy friend when the child is home ill with a cold, and insist on taking him out to show him of! to the boy friend. Or the father will take the child to the ball game and flaunt his generosity by filling the child with so much soda pop and so many "hot dogs" that the child will be ill upon returning to the foster home. It is advisable to find some way to give dynamically to these parents for their own needs before they

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make angry claims on the child for their own gratification and to circumvent their need to use him in keeping up their pride. The claims of these parents on their child are so unreasonable because they hold earlier claims for themselves from a deprived childhood. To tell these parents first while planning with them that they need things for themselves as persons in their own right gives them a sense of being given to without having to earn it first as they did in childhood. Directed toward the mother, this might be such things as freedom from difficult burdens so she can rest and having adequate housing and good-looking clothes. From her gaps in personality development, she is truly in need of the gratification she seeks to give to herself, hoping to feel worth while from it. Her demands for so much self-gratification are insatiable as long as somebody important to her is not giving her things, thus stamping her as important. Since it would require intensive psychotherapy and much involvement in a transference relationship to undo the effects of the early deprivation and to help her face the importance of that relationship, none of which this mother is motivated to undertake, then handling her according to her dynamic needs, is the next-best method of working with her. Hence a worker can be truly giving at points of need from the parent's early deprivations by stressing the parent's worthiness for having these things. This is not merely overindulgence of the parent without a plan. Although the results will not be basic change in personality, the hostile defense will be allayed, the rigid pride will yield at least temporarily to make the parent amenable to reasoning in plans for the child's welfare. Another approach is to appeal to this parent's narcissistic pride, commonly known as vanity, since he strives for high standards in every area. On this basis, the worker can express his own belief to this parent that the latter would like his child to be everything he can be proud of. The worker places himself on the side of the parent in this goal, and offers help in working together with the parent toward this end. The worker is then not on the opposite side of the issue with the parent, as in a contest. Discussion on this basis should precede the time when it is anticipated that a certain issue will be made by the parent. This occasion should not be one in the

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immediate future, but one far off, so that this parent will not feel that control of the situation is being taken from him. While pointing out hazards which can deter a child's achievements and appealing at the same time to the parent's chief desire, that of feeling pride in his child, various plans suggested can become acceptable to the parent. For example, if it is known that such a parent will object and even sabotage a plan of direct treatment for the child, and if the child presents an obvious difficulty which affronts the parent's pride, such as failure in school, he can be told that the treatment is aimed to help the child do better in school so that he can be a source of pride to the parent. What has to be guarded in working with this type of parent is the opportunity for the parent to save face, a matter of great importance where extensive false pride exists. When a firmer approach has to be taken with such a parent, as in stating an ultimatum when all other measures have failed in the face of the parent's stubborn spite to defend pride, then especially should a way out be provided for him to save face. This parent finds himself in conflict by having to gratify his self-interest and by having at the same time to defend false standards, the latter at a cost to his self-interest. It is the common situation described by the commonplace phrase, "cutting off one's nose to spite one's face." But here the child becomes the pawn and suffers by it. The task becomes one of funding the deficit of ego energy at the ego boundaries in the parent who cannot withstand the pressures of his impulses and so acts out on these impulses. As in the discipline of the child who has not yet learned adequate self-control, the parent is given a choice of courses for a later occasion without making an issue of a present one—the choice either of foregoing the immediate gratification of his impulse or of taking the consequences which will naturally follow the immature way of gratification. Thus he is given opportunity and time to decide which is ultimately to his best self-interest, and he can choose to avoid the situation of a contest, which, he has time to realize, will be to his disadvantage. With this realization, he may even not bring up this same issue again, out of enlightened self-interest. In this way he does not have to suffer the consequences of impulsive acting out. Since he

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succeeded in having his way before the ultimatum was presented, he can save face by not repeating his action. This plan and other aspects of work with this type of parent is depicted in the following case example. Mrs. T. placed her three small children after her husband's desertion, as she felt she had the same right to freedom from responsibility that he had taken. She earned a substantial salary as a secretary, and in planning her financial contribution for the children's support, she was encouraged to use a large proportion of her earnings for pretty clothes and a pleasant apartment for herself. She had secured a divorce and wished to remarry. The worker acknowledged the mother's need to make a good appearance and secure an attractive residence for the purpose of making a good marriage, that is, good by her standards. This was discussed and approved with the mother before she could do it surreptitiously, as she would have, angrily defending her actions later, had not advance approval been given. In this way the mother's cooperation was gained in such ways as in her increasingly greater financial contribution to the children's care. When Mrs. T. did remarry, her new husband was willing to rear her three children, but she did not wish to have them with her and she continued to work. She wished to have this husband's affection all for herself, and she also wished to use the children's placement as a means of revenge toward her first husband, should he return. From her expressions, it was thus seen that she was not free of her feeling for her former husband. Another important factor was that since her husband supported her she had much more income from her own salary to spend on herself. She defended her need not to take back her children by maintaining a hostile attitude toward the agency. Nevertheless, she also needed to keep up appearances for the benefit of her husband and his relatives by having the children visit in her home on Sundays. These visits became great trials to the children who always returned to their foster homes very much upset from them. The children saw that their mother now had the means to take them home, and they could not accept the pain

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from knowing that she did not wish to have them. They found it easier to hate the agency workers against whom the mother instilled anger and blame in them. When they would return to their foster homes, they would long for their mother, even though while they were with her, she was bored with them and gave them scant attention, leaving them to their own devices to amuse themselves. Frequently their physical care was neglected as she fed them either too much of the wrong foods or irregularly; or, when the foster mother provided the small boy with a hat for the beach on a hot day, the own mother forgot it and the child was brought back ill from the effects of the hot sun. The children were glad and sad at the same time about returning to their foster homes; they remained conflicted between the security from the care they found in the foster homes and their sense of loyalty to their mother, who inflamed them also against the agency's foster families. Any attempts to curtail these visits to the mother in frequency and in length to reduce the travail for the children met with the mother's refusal, as this implied her inadequacy and naturally piqued her pride. When she was not given permission to take her small son on certain weekends, she would appear at the foster home and physically abduct him. When the mother demanded that her children be ready to spend a long holiday weekend with her after a recent visit which had been particularly upsetting to them, the worker first considered placing an ultimatum before the mother, that she either abide by agency advice recommending a shorter visit or else that she keep the children altogether. It was thought that she would choose the latter course out of spite, and make an independent placement where she would disturb the children even more. It was also known, however, that she would have to pay for the children's entire support there. It was thought therefore that if she had time to think of this, she would not for this reason remove them from the agency's care. In the meantime, her husband had been able to persuade her after the worker's appeal to him that she not keep the children over the long, three-day weekend but stick to the usual half day's visit on Sunday. In this abdication of rights, she allowed

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her husband to act for her so that she would not be in the position of giving in directly to the agency. To avoid further contests of this nature between the worker and the mother, who disturbed the children with it by telling them that the agency did not wish them to visit with her, the following approach was planned, predicated on her character structure. She was told after this brief visit, that the worker was glad that her children could visit her as both she and the children wished this. Instead of making the issue immediate, one was posed which would give her time to think it over in the light of her self-interests rather than stimulate her to act impulsively. She was told that in the future should she act against agency advice on such matters pertaining to the children's welfare, she would not be allowed to return the children to the agency's care. It was pointed out to her that the choice was left to her and that if she could not cooperate with the agency, then she would have to suffer the natural consequences of her act, as forewarned. She could express anger at this, but it was noteworthy that she did not test the ultimatum. In such situations, however, the agency must give forethought to the possible effects of such an ultimatum on the children, as to whether or not following through with termination of placement would be the better plan for them than what they suffered otherwise. This dilemma is discussed in the chapter "Termination of Placement." Such attempts at management of character structure is the least desirable method of working with parents of children in placement, but it is the only procedure left sometimes with parents in this group. As stated in the chapter describing the categories of parents, this group is not motivated to accept the sort of help which brings about changes in attitudes. They are not troubled in the way that would make them interested in seeking relief from anxiety or clarification of confused attitudes. They have none of the moods which motivate people to use help. The course of these parents is clear; they must pursue self-gratification. Obstacles to this meet with anger expressed in spiteful acting out. The pleasure secured

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through the chief defense in their character structure appeases their need for help. Given all this then, the level of treatment for these parents remains at holding them through a giving relationship, thin as it is, and handling them according to the needs in their character structure to prevent disruption of the child's placement. These parents are overly critical of the foster mother whose care of the child is by itself a blow to the parents' pride, for it shows obviously that they are not adequate enough to rear the child. From this source will emanate many instances of the parents' disturbance of the child's placement. Further, there is a positive reason for maintaining this parent in as unruffled a state in regard to the placement as any means can achieve. The pleasure-seeking aspects of this kind of character, when not frustrated, contain a type of warmth and fun which the children enjoy, and this makes them long for the parent. So long as the parent's capacity to share this warmth lasts, he will play out the role of the adequate parent in keeping with the standard to which he aspires for feelings of self-worth. Despite the nature of the motivation, this warmth has value for the child as it helps to dilute the bitterness from the disappointments he has suffered from the parent. It was this amount of warmth, at the least, given by the mother in the child's infancy, which kept the child from becoming autistic. The later damage that the instability of this warmth inflicts may be somewhat averted by a strong approach in the individual treatment of the child if he is reached at an early age. Dynamic Support and Remedial Work with the Neurotic Parent. Work with the fourth group of parents who had formerly maintained a neurotic family equilibrium which broke down is more complex than the treatment on other levels. Because of a stronger weight of positives in the parent's capacities to give to the child, and a higher degree of ego energy and integration, the struggle in the parent's conflicts and with the ambivalences stemming from them is greater. There will appear in this group all types of character structure except the ego-defective one, and there will be a noticeable difference in the emotional economy, witli more ego energy available for them to be motivated to strive for change in unsatisfying situations. Their old defenses no longer functioning

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usefully, new ones are raised for self-protection. When the diagnostic study, beginning in the intake process, reveals what broke down the equilibrium, what existed before, and the changes which followed, then the level of treatment and the starting point can be charted. The study may reveal that the capacity to be a parent has been exhausted by severe reality difficulties, and the history will show what such capacities are from positive ego states. Also, current evidences of remaining strengths can be seen so long as some genuine motivation for being a parent remains. In such instances, instead of placement, referral to the proper agency for rehabilitation of the family may be indicated, by measures already described in previous chapters. If the family situation has worsened to the point where such measures are inadequate to restore the family balance, then placement of the children is indicated, but most likely it will be a temporary placement. Dynamic supportive treatment of the parents, or remaining parent, is necessary when the parents' exhaustion of ego energy is due to excessive depletion from external crises, causing a reactive depression to set in. There is not only the actual loss of the object or situation which supplied gratification from which came ego energy for functioning, but there is also the grief and the guilt over anger in this frustration which further depletes the ego energy. In this state of emotional and physical exhaustion, a parent is not able to handle the responsibilities of child care as before. The matter of making decisions, as well as planning and meeting the child's daily needs, which cannot be postponed as can other household matters, all are too great tasks. Temporary removal of the children gives this parent a period to rest from the reminders of his neglect, which also produce guilt, and a chance to muster strengths and to recuperate old defenses or to realign them to meet the new situation. Dynamic support from the worker helps in this process of recuperation, and often makes the difference as to whether the parent stagnates in his discouragement and never restores the family or never regains his former level of functioning even without the children. In situations where the two latter possibilities are potentially operative, it is clear that the gaps and disturbances underlying the reaction to the

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recent crisis are major ones. These underlying problems, formerly well defended through the family structure, would have been released by the family upset to augment the stress from precipitating problems. In either instance, whether the disruption of the parent's functioning is a reaction largely to crushing current tragedy or involves more from unconscious conflicts, the immediate goal of treatment is to restore old defenses for functioning at some level to reduce feelings of complete failure. This is preferable to the further uncovering of conflicts in an attempt to effect basic change at this time. When the individual is overwhelmed with pain and discouragement, it is folly to add to this burden by opening up those disturbed areas which release more pain and guilt. The ego cannot be expected to manage the additional burden and will disintegrate further, owing to loss of ego energy in a losing struggle. The worker's dynamic support consists of actively helping the depleted ego to make decisions by giving advice and guidance until the individual can take over. The ego strengths formerly useful are then discovered, supported, and encouraged to rally. The negative areas, with their conflictual content, cannot be worked with for basic change until after the initial exhaustion from the depression is past, if then. Airing hostility and relieving guilt over it by clarification and reassurance about anger reduces the load which saps the ego energy, and the basic sources of this hostility cannot be worked through until the load is reduced and possibly not ever. On the whole, the number of parents in child-care agencies with whom work can be carried further to effect basic personality change is small, for they do not have the ego resources necessary for participation in such treatment if their ego energy is so spent and deficient as to warrant placement of their children. But remedial treatment is feasible with some of those parents in the fourth category whose functioning through maintenance of a neurotic balance became impaired by exhaustion of ego energy from either external stress, or internal conflicts, or both. Where internal conflicts predominate, the onset of the breakdown of the neurotic equilibrium extends over years. In the early years, prior to the accumulation of strain, the parents were able to give more to the children, but

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their giving gradually diminished as the breakdown approached. Sometimes the family equilibrium can be restored on a new basis afterwards, with shifts due to subjective changes brought about by treatment of intrapsychic conflicts. This, in turn, can bring about changes in the life situation. Thus can the parents' capacity to care for the child be redeveloped. It may be argued that such treatment focused on the deep personal problems of a parent does not lie within the scope of the child placement agency's function. However, when such personal problems directly affect the parent-child relationship, in regard either to making restoration of the family possible or to achieving better acceptance of continued placement, then such treatment would certainly seem to be within the province of the child-care agency. Most parents would not admit the need for this treatment for themselves or accept it if referred elsewhere for it. They can tolerate such focus on themselves only when it is introduced through the point of their interest in the child, at least at the beginning. These parents are more defended about their needs than the openly dependent parents of the first two groups who can accept direct care for themselves, albeit on an infantile level. Those parents who receive treatment at a psychiatric clinic or by a private psychiatrist without referral by the child-care agency have begun their psychotherapy usually out of some acute situation occurring before that which provoked their request for the child's placement. Parents with a post-partum breakdown or psychosomatic illness would have been referred for psychotherapy by their attending physician. Other situations causing referral for help at psychiatric sources are marked by clearly defined clinical symptoms which are handicapping—for example, a pronounced street phobia or obsessive compulsions which are frightening. However, seldom have the parents who finally come to a placement agency reached psychiatric help for their disturbed family relationships, and few of those who come without having already reached therapy do so in the future. If the latter do reach it, it is found that they do not remain in therapy long enough to gain appreciable benefit, and the therapist in those situations cannot go far enough in following them up to keep them in treatment.

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Referral of the parent to a family agency for therapy for personal problems also has the drawback that it is difficult to keep the parent in treatment when the process becomes painful for him. In the child-care agency, the contact with this parent is seldom lost, as he has enough of a bond with his child that it will keep him in touch with the agency. Too, in the collaborative work with the therapist of another resource, especially the first two mentioned, the private psychiatrist and the psychiatric clinic, it is usually found that the focus of treatment is entirely on the parent, without relating it to the problems of the parent-child relationship. When these are introduced by the child-care worker, the parent's therapist cannot be expected to be sufficiently oriented to the experiences and needs of the child in placement to assess the emotional pressures arising from them affecting both the parent and the child. This creates a gap in the treatment work with a parent around the situation of his child. In undertaking direct treatment of the parent's underlying problems, the child-care worker should not attempt extensive work with the entire personality, but should focus on a partialized area directly pertinent to the disturbance affecting the parent-child relationship and to the breakdown of the family unit. However, even though not exploring the entire personality of the parent, it is helpful to know as much as can be learned of the general trends of what is operating there, as such knowledge can guide the worker in the direction of what to leave alone and where to focus. It is necessary, then, to ascertain the pattern of the neurotic area of the individual parent which either directly or indirectly influences the parent-child relationship, and to direct the treatment to this area, and then to relate it to the parent's problem with regard to the child. Even in those instances where a parent lends himself to remedial treatment by working on underlying problems, the extent of basic personality change can be only limited because of its circumscribed area. After progress is made from this treatment, however, the parent will have greater ego strength for undertaking more thoroughgoing psychotherapy elsewhere, if he is so motivated. The parent who can benefit extensively from even circumscribed

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treatment of underlying problems often does not reach the child placement agency as he is able to use help in other settings, enough help to keep the family together. Nevertheless, there is the occasional parent who, while able to use such treatment, has arrived at a current life situation, created by long-time internal disturbances, which makes placement of the child mandatory. Such placement will usually be temporary, terminating when the parent has been able to improve sufficiently from treatment. The following case situation describes remedial treatment causing some personality change, and with it possible restoration of the family, in a mother who was described in the earlier chapter "An Attempt at Classification of Parents." There it was given as an example in the fourth category of parents, those who need to place their child. The emotional depletion from the grinding away of this mother's underlying conflicts made her life situation so unbearable that placement of the child became necessary. The mother's current situation in which she had little ego energy left and in which she was making unconscious attempts to resolve her conflicts precipitated the placement. Her lifelong habit of quiet suffering and self sacrifice was evident in her endurance of her child's bossiness of her and in her marital difficulties. Mrs. K.'s fear and guilt over her anger during her early Ufe experiences originally created this type of reaction. Herein was the pattern of her character structure which stemmed from her basic trauma. Her fear and guilt over anger had continued until now they were affecting adversely the neurotic equilibrium in the relationship with her child. Here is the sphere most pertinent to this placement situation and hence the one to which focus of the treatment had to be directed. She suffered her daughter's and earlier her mother's domination in order to gain dependency gratification. This immature dependency need clashed with her healthier needs for dependency in marriage, and this was the core of her neurotic conflict. With such analysis of the situation a worker can proceed to direct treatment in a partialized area, related to a particular reality goal namely, with Mrs. K., the improvement of the parent-child relationship. How this was done is described in the following.

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Mrs. K.'s early history, which she gave in the first part of her treatment, revealed the general nature of her character structure which the recent events and her current behavior had indicated. Her mother died of a second childbirth when Mrs. K. was about a year old. She had a stepmother who was killed at the time of her father's death in a pogrom in Russia when Mrs. K. was two. Later she was told that her father was murdered while he was running with her in his arms to seek safety and that afterwards surviving neighbors had picked her out of his grasp. She received meager care after that from relatives and neighbors and remembered being hungry and forlorn. At six, she was sent to an orphanage in Rumania where she remained until she was twelve. She recalled with affection the housemother she had had in the small orphanage, and the worker therefore helped her talk at length about this former mother-figure to draw out Mrs. K.'s ego strengths from the gratifying ego state she had at that period. At age twelve she traveled alone to this country to be adopted by the couple she has since referred to as her parents. Nobody was at the port of entry in this country to meet her and she was afraid that she would be returned to Europe as she was ill. Finally, she was sent alone by train half way across the country, arriving in the city where the adoptive parents lived at midnight when they met her. The adoptive father, who had died a few years ago, was a warm, affectionate, and understanding man, while her adoptive mother was devoted but critical, harsh, and penurious, and so domineering that Mrs. K. was cowed by her. Mrs. K. married a man whose own relatives described him as unstable and irresponsible. The couple first lived with her parents in whose business he worked. When he could not get along with her mother, they moved to his parents' home. Here Mrs. K. was verbally abused by his mother even though she nursed her for two years in a terminal illness. After that, her husband started a business of his own in a clothing store, but was hardly diligent in it—he preferred to go fishing too often. Mrs. K. worked in the store even after Betty was born, and Mr. K. would leave Mrs. K. and the baby while he went out to night clubs and on excursions. He entered the navy during the war to get away from his family,

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and just before his discharge, wrote Mrs. K. that he wished a separation. Mrs. K. reported that he had never consented to a divorce even while he was living with another woman, but his relatives stated that, rather, it was Mrs. K. who had refused his request for a divorce, as she had hoped for a reconciliation. It is not difficult to see where Mrs. K. developed the idea that suffering was her lot since that is what had dominated her formative years. When her natural dependency needs were frustrated in childhood, she did not show her justifiable anger at this as she had learned that anger would only deprive her further of dependency gratification from the strangers in whose care she was. She was therefore willing to suffer quietly without show of anger in order to be accepted and to have her dependency needs met to whatever extent this was offered her, since she no longer had the security of own parents. This pattern of repressing anger was reinforced by her domineering adoptive mother, and later Mrs. K. was willing to accept abuse and neglect from her husband in the hope of getting her dependency met by him. She was classically the masochistic character who remains immature, still searching for the early dependency gratification of her childhood which she had missed. This, Mrs. K. sought in her small daughter. The price she was willing to pay in order to get this was to suffer for unfair or unjust cause without show of anger. The anger remained hidden, and her guilt over it demanded her further suffering as self-punishment to appease her guilt. The suffering gave her pleasure also as it brought her some dependency gratification, and she came to connect the two. The partialized area on which treatment concentrated was the mother's need to suffer and not show anger for it. If she could be helped to free herself of this pattern, she could grow out of her childish dependency, for in taking responsibility for her anger she would be growing up emotionally. She would thereby progress in resolving her conflict between her natural drive to outgrow dependency for fulfillment in marriage and her opposing wish to cling to suffering in silence whereby she had formerly gained her childhood dependency gratification. If she succeeded in sufficient resolution of her conflict, she would be free enough of it to be able

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to conserve ego energy for the restoration of her family, since she had managed to keep Betty with her for seven years before the balance in their relationship broke down. Clearly Mrs. K. was not ready to verbalize her real need for treatment or for Betty's placement but had presented Betty's excessive temper tantrums as the precipitating cause of her placement which was valid by itself. This was used in presenting to Mrs. K. the goal of her regular talks with the worker. She was told that she could learn thereby how to handle Betty's tantrums so that when she became ready to make a home for Betty again, she could handle Betty better. In the meantime, the focus was concentrated on Mrs. K.'s own needs first since she was depleted emotionally. Mrs. K. was seen by the worker on a weekly basis at first for several weeks in order to develop a relationship with Mrs. K. in which she would be dependent on the worker, and thereafter the interviews were held twice monthly over a period of two years. More frequent interviews were not arranged as Mrs. K. indicated her wish for the semimonthly frequency, and the worker avoided making Mrs. K. feel that she was pushing her as had her own domineering mother. In the first few months, Mrs. K. was helped to talk of her early life and emptied much of the pain of her traumatic childhood, weeping as she talked of memories of hardship, fear, and desolation. She was given a great deal of comfort, as if she were a little girl. When she later brought up current grievances wherein she was made to suffer, she was then told that it was not necessary for her to bear the present suffering. She was helped to understand that she had come to believe from her early pain that she must suffer in order to feel safe. She was further told that she had come to feel that she must never show anger over her pain or assert herself if she were to keep any of this thin security. This was especially true with the strangers who she was not sure would keep her. It was pointed out to her repeatedly that this was a habit she had learned when she was a helpless child but which she still followed in current situations because she still felt like that helpless child. Much comfort was then built in at the points of her early depriva-

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tions with encouragement that she could help herself better now because she was no longer a child. From this gratification at the gaps where she had originally lacked it, she gained strength to deal with her current life situation, especially after she was helped to see the neurotic pattern she followed there of being submissive in order to feel safe. She gained permission from the worker's support also to be less afraid to assert herself when she felt unjustly treated. She was not given any sympathy for her complaints and grievances about her present situation, but it was indicated that she was expected to learn to deal with them by using her newly found understanding and strength gained from these talks. Discussion also took place frequently about Betty's care in placement, their visits on weekends, and the problems Betty presented both in the placement situation and when she visited with Mrs. K. At times, Mrs. K. showed genuine interest in this topic, and at other times she became depressed when these subjects felt too burdensome to her. However, the worker maintained such regular discussions in discriminate amounts, as they provided a tool for keeping Mrs. K. coming regularly to interviews and also helped to appease her guilt for placing Betty by taking this much responsibility and interest in Betty's care. Mrs. K.'s inadequate handling of Betty's willfulness and temper by allowing Betty to control her was related to Mrs. K.'s basic and universal pattern of suffering to keep safe and get dependency gratification. Attempts were made to reassure her that Betty would still love her even if Mrs. K. limited her; in fact, Betty would like this as it would help her to feel safe through knowing that she was being helped to control her rages. Stress was placed on the point that Mrs. K. herself would feel better when free of her helplessness before Betty's temper outbursts and bossiness. When Mrs. K. attempted earlier to free herself from her mother by moving away from her and finding work outside her mother's store, her mother became punitive and harshly denounced Mrs. K. The latter wept while she told that her mother had said she disowned Mrs. K. and had returned the Mother's Day gift Mrs. K.

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had sent, at the same time informing Mrs. K. through relatives of her lone state and her illness resulting from old age which worried Mrs. K. While comforting her for the rejection in this, the worker also verbalized for Mrs. K. some justifiable anger which Mrs. K. could not show herself. Soon after, however, Mrs. K. began to tell her irritable aunt with whom she lived that she did not wish to be criticized and served with the bitter friction of the household when she came home for the evening meal after a hard day's work. The aunt thereupon made a noticeable effort to control herself in this. About the same time, Mrs. K. quietly but firmly told her employer about the extra work she was being made to do through unfair assignment, which the employer subsequently adjusted. Soon Mrs. K. began to show anger at Betty's demands on her but did nothing about it at the time. She talked of having to ignore her own mother's anger and to stop worrying about it. Since movement in therapeutic gain is not steadily progressive, there were many relapses into old patterns, but gains already made were not lost. Mrs. K. began to hope for reconciliation with her husband on the condition that he had changed. Even without evidence of such change, she maneuvered contacts with him through Betty, who was also instrumental in trying to get the parents together so that she could return to live with them. After several months Mrs. K. faced her husband about their future plans, and he indicated he would not return. Mrs. K. was depressed at this, and clung all the more to Betty, whom she then did not try to handle constructively. With her emptying of her depression and mild anger at her husband during interviews and with the worker's encouragement to make a life for herself, Mrs. K. moved from her aunt's home to a room by herself. The precipitating cause for the move was the increasing jealousy of the aunt toward Mrs. K. on account of the devoted attention given her and Betty by the uncle. Mrs. K.'s oedipal situation was not worked, as this would have led the treatment outside the area partialized for the purpose of working through the core of the neurosis directly related to the breakdown of the family. This material was handled, however, by reassuring her in her guilt and supporting her to reach out for new contacts whereby she might meet an eligible man. Several

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months later she moved again, as she could not tolerate the hostile relationship existing between her landlady and the latter's grown daughter. She has since enjoyed relaxed living arrangements in a pleasant household. During the last year, the focus was directed toward Mrs. K.'s handling of Betty, since Mrs. K. was bringing in complaints showing her growing irritation with Betty's defiance and willfulness. Mrs. K. was encouraged to empty this anger and helped with her guilt over these new feelings toward Betty, then counseled as to how she could be the stronger of the two, which both of them needed. Mrs. K. subsequently disciplined Betty on her own initiative, and as is usual in trying out a new pattern, she overdid it by being too stringent. Betty gave in, however, to her mother, seeking comfort from the housemother. After a few such occasions, Mrs. K.'s handling of issues with Betty lost its harshness, and Mrs. K. seemed freer and stronger while she was still soft to Betty. The latter did not provoke or control the mother as much as formerly, but Mrs. K. still needed support in handling Betty firmly when her ego energy was depleted by other stresses. Following this, Mrs. K. brought out the growing relationship between herself and a widower in another city with whom she had been corresponding. This had been initiated through a woman friend who was his cousin. After he and his two adolescent sons had visited Mrs. K. and Betty here, Mrs. K. was very much taken by him. She reiterated, "He's so different," comparing his fine qualities with the irresponsibility of her husband. She enjoyed his companionship as their conversation seemed endless, while her husband had sought all his diversion in night clubs and in other commercial recreation. Nevertheless, a few weeks later when she saw her husband to discuss getting a divorce, she had lost some of her enthusiasm, and was willing to wait almost a year at her husband's plea, as he would then be able to settle affairs with her before he moved to the West Coast. She accepted this despite his previous default in paying Betty's support and his resistance to court procedures. Further, Mrs. K. could not find herself sure in her feelings about the other man as she hardly knew him. She resisted the idea of accepting his invitation to visit him as she felt

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she was not legally free on account of her marriage to involve herself emotionally with another man. When the worker pointed out the mother's pattern of clinging to the situation which would hurt her at a cost of sacrificing a chance for possible happiness, she argued assertively, which she had never done with the worker before, that she wished to remain friends with her husband especially for Betty's sake. When Mrs. K. rationalized that she could not get time off from work to visit the suitor who lived at a distance, the worker placed the reality against these statements to show that the visit was possible. Mrs. K.'s face hardened with anger at the worker, the first time she had overtly felt this in the relationship with the worker, but Mrs. K. could not bring herself to express anger further. In her typical fashion, she allowed the issues to lie fallow in the discussion, but she found herself still accepted by the worker who continued to show an interest in her welfare despite Mrs. K.'s anger at her. Mrs. K. missed the next two appointments, but she sent the worker a holiday greeting card. When Mrs. K. did come in at her next regular appointment time, she was not much interested in the worker's efforts to air the transference feelings of anger at the worker for pushing her. She denied that she had found the worker trying to boss her. With a glowing face, she told of her recent trip to visit her suitor, how she had met his relatives and friends, how they all had liked her and she them, about the visit to his home, and about this discussion of their future plans. She brought out point by point many of his assets, contrasting them to the habits of her husband. She said she wished she had met and married him in her girlhood instead of her husband. On her own initiative, she brought up her wish to begin divorce proceedings now rather than nine months hence as her husband had persuaded her earlier. She requested the services of the agency for obtaining legal aid, offering to pay part of the costs. She hoped now to have the divorce completed, not just initiated, by the end of the nine months, by which time Betty would be having her grammar school graduation. She would not leave Betty here alone by marrying before this, and she wanted to see Betty graduate from the school which Betty was enjoying now. Her fiancé had agreed to this plan.

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While Mrs. K. showed capacity in this for being a good mother, she was no longer allowing Betty to dominate her. Betty had been more subdued in the months since she had begun to realize that her mother was separating herself from her neurotic dependency on Betty. The latter moved closer to other ties also during this period. She liked the prospective stepfather who had been writing to her and the fact that her mother's remarriage would make it possible for her to return to her mother's care. Betty was at the same time expressing fears that the relationship between herself and her mother would be different after her mother married. Attempts therefore were made to help the mother anticipate and prepare for some of the problems Betty would present in her new family situation. Betty continued to talk to save face as if she still dominated her mother and as if her mother was still in a dependent relationship with her. She had told others that her mother would take her to the other city to visit the fiancé as the mother could not find her way around without Betty; but Mrs. K. had gone without her, and Betty made no issue of it as she would have before. CONTACTS BETWEEN THE CHILD AND HIS RELATIVES AFTER

PLACEMENT

As part of the work with families after the child's placement, attention must, of course, be given to the contacts between the child and his family during a child's placement. Whether restoration of the family will take place or indefinite long-time foster care will be the plan, the child and his family will wish to see each other in the majority of cases. This includes visits between the parents and their children as well as visits between the children and other relatives, such as grandparents, aunts, and especially brothers and sisters, who may or may not be in placement. It is important to keep constantly in mind that family relationships, although broken in the organic sense, in many instances remain intensely meaningful to each family member. This is particularly true for the child in placement who basically longs for the rightful place assigned him by nature. Going further than this basic claim, it is necessary to learn what other meanings there are in each specific relationship in order to plan wisely the contacts between family members after

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placement and to help make such contacts to be as constructive as possible. Contacts with Parents. Contacts between family members, especially parents and children, are indicated even when they do not have an altogether favorable influence, for the child's longing for the parent persists whatever the parent is like. Such longing may be based on illusions out of the wish to belong, but the child cannot make new ties while still committed too intensely to old ones through this longing. The working through of these neurotic ties to gain some freedom from them is helped by the child's testing them by experiencing them in reality. The parent realizes how difficult it would be to care for the disturbed child after a few hours' visit, and the child can discern the parents more clearly as being not as glamorous as fantasied, or in some instances, not as formidable as imagined. The inevitable frustration of the child by his parents is thus brought out into the open to help him bear it, as described in the chapter "Work with Children after Placement." On the other hand, some children are already well aware of the reality and would prefer not to see their parents. With such a decision, however, the child will suffer guilt derived from it. This will cause him to repress the entire distasteful situation which will deter him from making deep ties to other people just as does longing for his own parents. The child's repugnance toward his parent may best be handled in some instances when the child is in contact with his parent, and it is at such times that both child and parent require help from the worker. In many instances, the rights of parents, whether or not supported by the court, make visits to their child unavoidable even though these are extremely unfavorable. If not granted this right of contact, the parent will sometimes only act out the more to disturb the child in placement. When work through a gratifying relationship to hold the parent from disturbing the placement does not accomplish this, then protective measures are necessary. Visits are held in the agency office where they can better be controlled, since some very disturbed parents may either kidnap or otherwise frighten the child. Such office visits should be supervised by having the worker present at all times to actively prevent either physical

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or emotional harm to the child. The work with such a parent is described in the following case example. Mrs. F., the mother of Henry, described in the chapter "An Attempt at Classification of Parents," was voraciously hungry for him after his placement. In her fear of losing him completely, she made efforts to hold him in a tie to her by promises to take him home soon and by presenting him with lavish gifts. Since he was only four years old when placed, and his tie to his mother was still vital, his need for her was stirred up and kept alive by her promises, while he was left disappointed and unsatisfied when she failed to fulfill them. The worker had developed a strong relationship with the mother, first to help her make the placement, and then to help her bear the separation afterwards. Before the placement the worker had also created an attachment to herself in Henry. After the placement, the worker's attempts to explain to the mother that her unrealistic promises made Henry unhappy and depressed, even as the mother herself felt, could not help the mother to contain herself sufficiently, and her own needs for him continued to break through with such promises and gifts. In subsequent visits, the worker planned to see the mother for a little while just before Henry was to arrive at the office in order to replenish the relationship with the mother to make it easier for her to bear the frustration which would follow. When the mother slipped under the pressure of her impulses and told Henry that she would take him home next month, the worker quietly intervened at that moment to nullify the promise. The worker sympathetically told the mother in Henry's presence that she knew the mother wished to have Henry with her, but that the mother really knew from what she had said to the worker before that this was not possible. With the mother's positive feelings for the worker renewed just before Henry's arrival, the mother was led to agree with the worker who, in turn, gently explained the reality to Henry. Thus the worker's and the mother's statements to Henry were not contradictory, and he was helped by this discussion in his presence to feel that he was wanted even while he could not live at home. In the next five years, treatment of Henry helped him under-

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stand his mother as the helpless person she really was and that this was why he was placed. This understanding, together with his release from his mother through it, helped him to form new ties to mother-figures necessary for his growth. As his mother sensed his growing away from her, she circumvented the worker's interference with her efforts to possess him. She found out the telephone number of the housemother with whom he lived, and telephoned Henry frequently, making impassioned pleas to him not to forsake her and yet more extravagant promises of gifts and of his return home. By this time Henry did not wish to hear these promises, as he had come to know the difference between healthy mother-love and that from his own mother. Yet he was at first distressed by her telephone promises of sending a toy which he had asked for, remembering he had never received any. The housemother then helped him realize immediately after the call that the promises would not materialize so that he would not be too disappointed. Soon such help was not necessary as Henry, at later calls from his mother, realized this for himself. He neither wished to come to the telephone, nor did he wish to continue the conversation as long as did the mother, because she kept begging him to tell her what he wanted so that she could send it. The housemother would then take over when Henry could not tolerate it much longer, and the call would be terminated with the housemother's limited expressions of interest and sympathy for the mother's personal life. Even when Henry finally refused to come to the telephone at all, the mother was graphically shown that the agency was not frustrating her, for the housemother upon answering the telephone, would call loudly to Henry that his mother wished to speak to him, so that the mother could hear this and know of the housemother's good intention. The plan was for Henry to learn to deal with his mother at his own pace, so that the mother and Henry would not get the impression that the agency was trying to keep them apart, and so that he would gain from working through the separation from her. Nevertheless, some protection for Henry was necessary while he was helped to overcome his fear of his mother so he could learn to deal more effectively with her by himself. When Henry was ten, the worker to whom both he and his mother were attached left

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the agency. While Henry turned more to his foster mother in his need, his own mother became more desperate as she had not yet formed a relationship with a new worker. During an office visit with Henry about this time, she brought a greater abundance of goodies than usual to give to Henry. When he finally indicated that he did not care for more than he had already eaten, she kept pushing him to take more while he kept refusing. In her anger from her desperate need to have his love, she pulled him onto her lap and literally force fed him which frightened him. The worker then intervened when the mother tried this again, pointing out to the mother that Henry was now too big a boy for such handling. The question might be raised as to why contacts were permitted at all between Henry and his mother, now that Henry had lost interest. The reasons are threefold. The mother had a thin semblance of normalcy but became openly psychotic when frustrated, as when the visits were spaced farther apart. In such a condition, she acted out all the more to disturb Henry and his placement situation. She could not be committed to a mental hospital because she would be able to cover over the psychotic material before she could be judged committable. She had proved this through convincing a court not to remove a child from her by appearing there in an organized manner. Nor was her committment necessary or desirable so long as she was otherwise able to function, even if marginally, in the community. Most important, there were some shreds of a tie from Henry to her, and he would feel better about them as he grew older if he did not forsake them. Where parents' contacts count the least but are yet sometimes indicated is in the permanent placement. There are no contacts naturally where parents have either disappeared or have been in a mental hospital for many years either before or after the child's birth, or both, making social rehabilitation of this parent very unlikely. Nevertheless, even in these situations, the worker must not permit the foster family to be lulled into the belief that there will never be any contact by the natural parent. Because of laws in many states, the children in these situations cannot be placed for adoption, and the next best plan is that of a permanent foster

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home. If a parent in the community whose history and current maladjustment points entirely to incapacity to function as a parent, and if he has little, if any, meaning for the child, then a permanent placement is also indicated. Usually, this is the parent who does not relinquish the child for adoption because he has an investment in the child in terms of his future relationship with him on which he hopes to lean. He will request to see the child eventually although he has never reared him and although the child has no memory of a bond between them. This parent's request will have to be granted in order to avoid the parent's acting out to the point even of taking the child home where he will be grossly neglected and shocked by the separation from the foster mother. In many instances, the court grants the right to the natural parent to have the child back permanently or at least to visit. The child needs preparation before the visit with this parent and help in understanding it after the visit. An example of such work is given in the following case. Mrs. F., the mother of Henry referred to earlier in this chapter in connection with the work with her in her contacts with Henry after placement, had a daughter Dora, from her first marriage, in placement since she was four months old. Mrs. F. refused to consent to this child's adoption even though she never talked of taking her home and it was clear that Mrs. F . could not rear her. Very infrequent contacts occurred, with little meaning for Mrs. F. herself and with hardly any impression on Dora, who had spent all her life with the same foster family. She considered them to be her own family, and they regarded her as their own child. At age six, Dora was prepared for one of her visits with Mrs. F. by explaining the status of natural parents in the same way this is done with an adopted child. She was told then that Mrs. F. was her "first" mother, the one who bore her, but that Mrs. F. was unable to take care of her even though she wished she could. Then the foster mother designated herself as Dora's "second" mother, who wished to rear her and was able to do so and that therefore Dora was with her. Out of Dora's prior knowledge of where babies come

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from, her relationship with her natural mother was placed on the fact that she had come from Mrs. F.'s body. The experience of being mothered was described as the daily loving care and devotion she had actually had from the second mother. In this way, the term "real" as applied to the natural mother, with its connotation that it is the most valuable relationship, is explained away, by pointing up the actual experience each mother-figure has had in relation to the child. For a child to know that the biological mother wished to keep him but was unable to do so helps reduce the feelings of unworthiness stemming from knowledge that the parent who bore him had found him of no value to keep. When Mrs. F.'s worker, to whom she was attached for five years, left the agency, Mrs. F. grasped at all ties she could muster, and insisted on seeing Dora at that time. Dora was then almost nine, and when Mrs. F. saw this growing girl, she imagined a haven for herself in dependency on Dora. She grabbed Dora, covered her face with kisses, crying desperately that Dora must not leave her as she was Dora's "real" mother. Dora recoiled from this onslaught, and later wondered what Mrs. F. meant that she was her "real" mother, vowing that she did not wish to see "that crazy woman again." Although Dora had known intellectually during the past several years that Mrs. F. was her "first" mother, this had no meaning for her in terms of Mrs. F.'s being her "real" mother in either word or deed. This aspect had not been handled with her sufficiently either in her preparation before each visit or in her impressions after each visit because of the foster mother's reluctance to do so. Nor was the term "real" as applied to a parent interpreted clearly enough to Dora because the foster mother's subjective feelings blocked her in this. Thereafter, however, the mother was physically restrained when she embarked on such overwhelming approaches to Dora in order to curtail them and in order to protect Dora. If a child is actually afraid of the parent, the court's authority may be sought to prevent contact between the parent and the child, thus supporting the agency in withholding information re-

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garding the child's whereabouts. In many courts throughout the country, such a request would be granted only in the most extreme situations, as disclosed in the following case. The psychotic mother, described in the chapter on the classification of parents as an illustration of the first category of parents, had attempted suicide by slashing her wrists and had then slashed the wrists of her five-year-old child. After the mother's release from a mental hospital a few years later, still in a disturbed condition, she sought information from the agency as to her child's whereabouts because she wished to visit her. Since this child remembered with horror the mother's homicidal attack on her, she was too afraid to face the mother even in the presence of others It would have been too much of an emotional ordeal for her in view of the child's own precarious mental condition. With the psychiatrists' statement testifying to the child's own serious disturbance and to the devastating effects on her which contact with the mother would wreak, the court was convinced, due to the gravity of past circumstances, that the agency should not permit access of the mother to her child. Even when a parent's influence during a visit is not overly destructive to the child, it can be withering to the foster family. In such cases the parent can be advised to take the child out of the foster home for a visit to avert any real contact between the parent and the foster family. But even this curtailment is not enough in some cases, for some parents simply in calling for the child can provoke great antagonism in the briefest space of time. The parent may take this opportunity to criticize the child's appearance in the presence of the foster mother, saying that the child looks pale and underfed, or that the child's clothing is inadequate or unattractive. Or the parent may bring vegetables or other foodstuffs for the foster mother to prepare for the child, or a blanket to insure that the child is not cold in the night. Even when the foster parent is helped to understand and tolerate such gestures, other behavior by the parent may not be accepted at all by the foster parents, and the child will certainly feel the resonance of the foster parents'

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prejudice. An instance of such behavior is the extremely seductive behavior of the parent toward a child of the opposite sex, as the father who holds his sixteen-year-old daughter on his lap and kisses her on the mouth, or the mother who calls her son "lover boy" and fondles him excessively. Other behavior by the parent which wears out his welcome with the foster family is that from the parent who seeks dependency gratification from the foster mother. He will spend long hours talking of personal problems, all the while indifferent to the child, and thus confine the foster family's time and attention from their own plans and activities. Similarly, the parent may tie up the foster family's free time over the weekend by coming hours later than the appointed time to meet the child. The foster family will then be further upset by watching the child suffer from anxiety while waiting, worrying that his parent will not come. While some foster parents can be helped with their reactions to these trying situations with the parents, there are also practical measures that can be worked out to circumvent the parents' acting out in contacts with the foster family. "Holding" therapy with the parents may help reduce their need to strike out at the foster family or provoke the latter in other ways. When this approach is not adequate to preventing the situations which antagonize the foster family, then the contacts between foster parents and natural parents should be eliminated by arranging for the parents and the child to meet in the agency office, if visits can be held on weekdays. The worker's presence during these visits is not always necessary and would sometimes be detrimental because it would be resisted as an affront. The office is merely used in these cases as a convenient meeting place. One closely knit family with five children, all in different foster homes, met in the office, not only because the tyrannical father disturbed the foster homes, but also because this plan helped them to hold family gatherings. It simplified matters for a separated couple, where the mother worked and the father was an invalid, to visit their five children who were in five different foster homes by meeting at the end of the day in a large room set aside by the agency for a definite period. They all convened there on a semimonthly basis and brought their own refreshments.

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If the diagnostic picture during the intake study and preplacement work overwhelmingly points to valid anticipation of trouble between the parents and the foster family, then such visiting plans as described above should be set up from the beginning to avoid friction between the two families. The ill feelings which can grow out of the initial visit by the parent to the child in the foster home can contaminate the child's feelings toward the foster family. These effects may remain with the child even after the visiting plans have been changed to eliminate the friction. The total prohibition of visits to the foster home from the outset can be presented as an agency decision that these would be too upsetting to all involved. Sometimes a parent who feels very guilty needs the support of the worker while facing the child. Office visits are then planned, at least until the parents no longer feel this need so strongly. Such procedure may be necessary when a parent resumes contact with the child after a long absence, having deserted or having been detained by imprisonment, hospitalization, or other like cause. A case report elsewhere by the writer 13 describes vividly the guilt a mother felt toward her child during their first visit together after an absence of a year and a half. In this instance the child withdrew from the mother, and both required the worker's presence to support them until they became reconciled. Leaving behind the most negative aspects, there is definite value in contacts between parents and children. The parents through the contacts will feel less a failure and less bereft of their children, even though they are unable to be full-time parents. The child's sense of total loss of the parents when no contacts occur and he knows that the parents are alive leaves a void soon to be filled with pain and compounded with confusion as to why the parents do not wish to see him. Although a brief interlude with the parents does not give enough of what the child needs from them, the satisfaction from this partial interest from the parents nevertheless is of value to the child. At the same time, however, it is a two-edged sword. It brings into focus the question in the child's mind as to why the parent cannot give him entire care if the parent seems able to on Sundays. Since the reality is that many of the parents have only enough capacity for brief fulfillment of the parental role, the child

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needs to be helped to realize this gradually and to make his peace with it. A detailed description of this process and eventuality is given in the chapter "Work with Children after Placement." It can be said that in this situation the child dangles between his natural family and the foster family and that he is confused by the two sets of family ties. Because this does happen, the possibility of the restoration of the child to his own family should be diagnostically considered to ascertain if this would be a sound plan, despite some negatives there. 14 But when the child's return to his own family is neither probable nor indicated, the alternative is to help him deal with the separate parts of his life so as to make it as much a whole as possible. Making a whole life cannot be achieved by denying the old part, as some workers believe. They think that in order for the child to settle down and better integrate his new ties, his contact with the old ties should be diminished or, better yet, eliminated. The sounder psychological validity in these circumstances is that the old ties cannot be eliminated, even if contact is diminished or excluded, for these ties of the past hold much of the child's feelings. If the feelings are repressed because his longing for the relatives is not satisfied, even in a small measure, then a large part of valuable ego energy is lost to the development of his personality. Much is also lost in the lives of his relatives, which is unnecessary, if their contact is not harmful to the child. Usually, however, the child's feelings for his natural family will not be repressed, and if he is thwarted in them by whatever source, he will seek ways of expressing his feelings which are not constructive for him. When the placement is temporary, while the parents are working out some solution to enable restoration of the family, the contacts between parents and their children are highly valuable to both because of their bond with one another. The contacts will also serve to sustain the family members while they wait for the reuniting of the family. Contacts with Siblings and Other Relatives. Doubts spring up as to the advisability of contacts between children in placement and their siblings, and with relatives other than parents. What sharpens this question in regard to foster children, when such contacts are

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considered of great value generally to children living at home, is the feeling that children in placement will be deterred from making new ties when they do not forget these old ones. The desirability for such contacts is determined primarily by the meaning these contacts hold for the child, the meaning in the relationship itself, the influence it exerts on his adjustment, and the goal of the placement. These will be discussed in turn as to the implications of each for such visits with the placed child. An evaluation of the relationship with the relative or the sibling, and what it holds for the child and the others involved, should be the initial guide to the decision as to whether there should or should not be contact. Visits between siblings who are separated by placement have been known to raise some questions and doubts as to their desirability, because they may result in confusion for the child between his new ties and that with his sibling when he is not living with him. Again it is necessary to appraise what these relationships hold and to evaluate them in the light of the meaning of sibling relationships per se. The normal sibling relationship has a common base, not only that of the blood tie, but also that of the mutual emotional experience of sharing the same parents. Out of this sharing comes, of course, the inevitable sibling rivalry. If parents have a great deal of capacity to give to their children, then each child will receive a larger share and be better satisfied. This makes the sibling rivalry less intense, and it is easier for it to give way to the love the child will come to feel for a sibling out of a positive identification with the parent who loves this sibling. When parents have much less capacity to give to their children, the sibling rivalry will become very great in the children's scramble to get as much as they can, each for himself, as a hungry mob riots among themselves for food. There are many degrees of intensity in sibling rivalry, and there are also many ways in which the child learns to manage it other than by identification with the parents' love for the sibling. Often the resolution of sibling rivalry is a combination of some of the identification with parental love for the sibling and adjustment through defenses for the rivalry. Some children erect defenses for sibling rivalry by becoming overprotective toward the sibling, thereby extending the identification with the

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parent to cover over hostility. Or the child may be solicitous of his sibling out of identification with the needs of the sibling and thus be giving to the sibling what he wishes for himself. He thereby will gain comfort and gratification for himself vicariously. Or a sibling's bossiness and control of other siblings, especially of younger ones, in the guise of concern for them, can provide a channel for the expression of hostility to those siblings. Since there may be some real positives in a sibling relationship along with such neurotic ties as these, it would be desirable for the child in placement to have contacts with his siblings, whether or not the latter are in placement, on the basis of these positives, which have value even if the other factors exist. Jealousy of the child who remained with the parents would have to be worked out in the treatment of the placed child. T h e extent of the influence from the negative aspects must be evaluated and contacts arranged accordingly. T h e weight of the values may vary, as can be seen in the case of the overprotective older sister, who may be handling underlying hostilities through this, but still gives care and devotion to the younger siblings which is satisfying to them if not too stifling. If, on the other hand, a younger brother was given a markedly preferential position in the family, thereby creating hoards of hostility in the older brother and provocativeness in the younger, so that their meeting will provoke little but fighting, not much of value will be gained by either through their contact. The parent in this situation should be guided to visit each separately and to have the brothers together only at infrequent intervals. There are many mechanisms in sibling relationships and as many motivations for the contacts after placement. Even a neurotic motivation in a child to see a sibling may have validity for arranging a visit between them. For example, a boy who hated his younger sister for displacing him, and had death wishes toward her so that he could get rid of her, may need to see her after their separation by placement to allay his anxiety that his death wishes may have caused her disappearance. Even if he is told of her existence, he needs to experience the proof of it to convince his underlying anxieties of its reality. In addition to the sharing of parental love, in whatever measure

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it was available, there will have been other shared family experiences, and also shared play and adventure between the siblings. If these were gratifying in some degree, the memory of them will have created a bond which is not eliminated by placement. T h e rejoining of the positive tie by visits together will provide enrichment for each sibling in his current life. Lastly, even if the tie was weak between the siblings due to early separation, or if it was hostile and barren of warmth due to the paucity of parental love, the curiosity of each sibling about the other should be satisfied as they grow up separately, if each desires it. When the child is too young at separation to remember a sibling and hence does not show curiosity or have a tie toward the other sibling, then visits between should be arranged automatically on occasion, simply so that the children will not grow up as total strangers to one another. Even if emotional significance is lacking in their relationship, their kinship will be a known fact to them to be shaped by whatever meaning appeals to them. In this way, a child's later bitterness over possible loss of his siblings can be averted. When he grows up, he will not be in a position to say that he does not know his brothers and sisters because of the agency's indifference or objections. Once he is old enough to make his own decision regarding these contacts, the agency should follow his lead. The agency's responsibility to maintain contacts between siblings pertains to all goals of placement at whichever frequency each goal indicates, including even the permanent home, because of the significance of the sibling relationship as described. It can never be known when the natural parents may appear to make their claims on the child even in the permanent home when legal proceedings are lacking. If the family is then reunited, the siblings will not be totally strange to one another having visited each other. Infrequent contact with a sibling does not detract from the child's feelings for his foster family, as the actual experience of a daily loving relationship with them counts more heavily in the long run than any rare contact. Confusion is diminished for the child rather than created by such contacts, for he will know the reality of his family situation while he knows the reality of love and security

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from the foster family. If a conflict of loyalties results from earlier ties to the natural family, he can be helped to feel that he can love and be loved by more than one set of people at the same time. As stated earlier, all placed children need treatment for the clarification of their self-identity. All of this is discussed more fully in the chapters on work with foster families and work with children after placement. If the relationship with a relative held something positive for the child in the past, and current visits will keep this alive, then the child and the relative will both be enriched by the contact. If the child's visits to these relatives hold such satisfaction for him from favorable attention and sharing of pleasures and warmth, then the benefits from these contacts will hold the same, or even greater, value for him than they did before the placement. If a grandmother or an aunt reared him for a time, or was an oasis during visits while he was living in a turbulent family situation, she may serve him well when his meager feeling of security has been diminished by placement. Otherwise, he leaves behind him much good feeling, if only of past experiences, which he could now fall back on, if it were periodically renourished, to sustain himself. The foster child realistically need not be deterred from making desirable ties to his foster family while these contacts continue to contribute to his feeling of being loved, even if some negatives exist there also. The two sources of family ties, if both are loving, can be synthesized. More about this is written in the case of Paula in the chapter "Work with Children after Placement." If the relatives comprise a closely knit clan, despite frequent hostilities among themselves, the parent may request that the child be allowed to visit these relatives with him as he goes the rounds to visit them out of his own dependency needs. For example, a divorced father brought his two small sons to visit his aged mother or his married sister and her family, as he himself wished to get attention from these relatives. With the boys' mother deserted and her relatives in another state, these contacts gave the children some sense of belonging to the natural family, even if only in a

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removed fashion. Family celebrations and holidays provide other occasions for visits with many relatives and can add to the sense of belonging. The effects of such contacts on the child as seen on his return to the foster home from them are valuable indexes as to the desirability of these contacts. If he appears merely lonely for what he has left behind, and seems unable to settle down again in the foster home, then the frequency of these visits should be decreased to avoid the child's feeling of being continually uprooted and left dangling without family ties anywhere. If he cannot accept comfort offered him by the foster family for missing these old ties, then exploration is necessary to ascertain what creates this barrier. If some exchange of friendliness between the foster family and these relatives occurs, even if only brief, it serves to bridge the emotional gap between them for the child. He can then transfer his feeling more easily from one set of relationships to the other. For this purpose also, arrangements should be made in some instances for the child to participate in a part of the holiday festivities in the foster home, while joining his family and relatives for the rest of the festivities. When the child's disturbance after visits to relatives other than the parent is more than a reaction of loneliness, a careful evaluation of what occurs during the visit is indicated. If constant fighting among relatives stirs up his earlier turmoil with his parents, or excessive drinking and violence there frighten him, these visits may need to be eliminated or at least circumscribed. When a boy of twelve, after some overnight visits to a psychotic grandmother, impulsively made an intimate gesture toward the foster mother, exploration of the visits was indicated. The boy's story that he slept with the grandmother during these visits pointed to cessation of them, or at least to conducting them in a situation where they could be observed. Another determining factor in the advisability of the foster child's contacts with relatives is the goal of placement. If the placement is to be temporary or indefinite, the meaning of the contact and its effect on the child count the most in deciding the plan. If rehabilitation of the family appears most improbable, and the par-

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ents and other relatives appear disinterested and give little of value to the child, visits with them are not to be encouraged. If, however, they are requested by the relatives, they should be spaced infrequently to protect the child from frustration over these lacks. He should be helped to free himself from such meager contacts to devote more of his feelings to the foster family whose relatives include him as part of their own larger family. For the sake of the natural curiosity generally felt toward blood relatives, some rare contact can be arranged. If the child's placement is to be a permanent one, because of the absence of parents or their scant or nonexistent interest due to extensive personality deterioration, attempts should be made to eliminate all contacts with relatives after a few preliminary ones to satisfy the child's curiosity, and to confirm his status as a foster child. He can then be helped to develop closer bonds with the foster family, one which is chosen specifically for this purpose when the placement is expected to be a permanent one. THE IMPORTANCE OF FAMILY IN OUR

RELATIONSHIPS

CULTURE

The population of child-care agencies shows a decreasing number of orphans and an increasing number of children who are separated from parents who either remain in their life, or appear sporadically, or are known to be alive even though altogether absent. Since the family unit remains the strongest social institution for the development of the individual, for better or for worse, the influences from family members, especially from parents, remain strong even after the unit is disassembled, and hence has to be reckoned with after placement. In the application of dynamic knowledge of family life and, in addition, of the special meanings of his own specific family relationships to the child in placement, much ingenuity must be used to shape this knowledge to meet the needs of the particular situation of each family unit existing in separation.

8

TERMINATION

OF

PLACEMENT

THE TERMINATION OF PLACEMENT may be the happy stage in the placement process, or not, depending on the circumstances surrounding it and the means by which it was brought about. Termination can occur either by plan of the agency, or by decision of the parents with or without the agency's participation, or by order of the court, or lastly, by the child's coming of age. TERMINATION BY AGENCY

PLAN

True Rehabilitation of the Family. When the return of the child to his family is by agency plan, it can mean, although it does not always, a true rehabilitation of the family, which is now ready to serve the child constructively. In one kind of situation rehabilitation depends first on an adequate improvement in the child's emotional or mental disturbance if it had been necessary to place him in order to treat him. Then the parents here need to have been helped sufficiently with their feelings toward the child so that they will now be able to handle him more constructively. This type of family situation exists, however, where the child's disturbance has been so severe—and the parents have been equally disturbed and unable to change enough—that return to the family is undesirable for the child even after he has improved. The family which is most frequently rehabilitated through the efforts of the agency seems to be the one where the emotional disturbances of the child and the parents were compounded by difficult, although not always crisis, reality situations. The latter are

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either ameliorated by casework help or improve spontaneously with changing life situations. In other cases it can be that the parents' own emotional needs, rather than the child's disturbance, had motivated the placement. Subsequent casework help then salvaged and increased their ego energy to improve their reality situation so that they again became capable, even though only in a relative sense, to assume the responsibility of rearing their child. The writer describes elsewhere how she carried out measures for the restoration of a child to her family when she saw potential in the parents, unobserved at the time of placement, but which grew and became more apparent due to an improved life situation. 1 As the parents' remaining ambivalence would have delayed the restoration indefinitely, the worker initiated the plan rather than wait for them to do so. The plan was successful because it was based on diagnostic understanding which indicated that positives were present, pointed to the meaning they held, and intimated that they could be supported and augmented. Support was given since the beginnings of the parents' motivation in the direction of restoration needed help for growth. The negatives in their ambivalence were also worked on in order to remove some of the blocks. This case illustration confirms the need for commencing the evaluation of the family to ascertain this potential with reference to the goal of placement from the beginning of the contact at intake. Further, it illustrates the need to keep following the family situation of the parents and the progress of the child after placement has occurred to ascertain if restoration of the family, despite some negatives there, could prove desirable and possible with casework help. Premature Termination as a Treatment Measure. In other circumstances the agency's plan of returning the child to his family will not come about under such favorable conditions as are described above. Sometimes the best skills cannot at a given time modify the erratic, destructive influence exerted on placed children by parents who use the placement situation for their own ends. The children become pawns of the parents, whose interests come first, and who use the children's placement to implement their own needs. This is a method for spiting an estranged spouse, or for

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retaliating toward a foster parent or the agency. The child may be thwarted in making ties to the foster family or the worker by the parent's feeling of anger against them. Or, if the child already feels some attachment to the foster parent or the worker, he may be caught in a conflict of loyalties, which tears his feelings apart and thus renders him all the more disorganized. Such attitudes in a parent toward the foster family or the agency are often irrational, as they are reactions to the implied accusation, by their very function, of the parent's inadequacy. Then, too, the foster parent or the worker may have onavoidably stirred up a parent's deep feelings of rage at his own mother, which he acts out thus on a transference level. The clearing away of these feelings cannot be accomplished with some types of character structure. Any reference to them would be construed as criticism directed to the parent himself, and this would only further affront his feelings of adequacy, the point at which he is most sensitive. As a result, his defense of wrath would only heighten, and he would consequently become more difficult to deal with. Sometimes it is necessary to judge whether the placement, under such circumstances as these, hurts the child more than it is helping him. If there seems to be no other way to mitigate the harm being done him, then it would be advisable to return the child to his parents. It is quite possible that the child will also be hurt by returning to his own family, but if this hurt is less than that which he suffers by their disturbance of his placement, and if circumstances point toward the eventuality that the child's replacement will make conditions more favorable for controlling the parents, then it is worthy of trial. If the family situation worsens after the child has been returned to them, the parents may return the child to placement either directly or through applying for unspecified help at another agency which will refer them back to the placement agency. Or the court may be called to step in by neighbors or by the school and may be instrumental in replacing the child. Despite the unfortunate experience this replacement will have been to the child, there are gains to be derived from it also, to be utilized on his return to placement. The child will now have come to know that it has not been the agency which was hurting him, but rather, his

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own family. This opens up the possibility that the child may be able to accept help from the worker to face the reality about his parents and to heal the damage this has done him. Eventually, he will become freer to make new ties to nourish his growth. Great care should be exercised before proceeding with a plan like this to weigh the possibility that the child might be more hurt by such a move than he would be helped. Termination of placement, as described above, should be considered as a treatment measure only when necessary as a last resort. It should never be used as a gesture of hopelessness or even of revenge toward the parent. In some instances, it would actually be extremely dangerous to return a child to his family, whatever havoc they may wreak in the placement, which might point to such a move. The agency has to assume a protective role in these situations, and should appeal to the court for help in controlling the parent from disturbing the child in placement. Casework with the child should follow this move to help him understand the reality of the situation and also to help him learn how to live with it. Further work with the parents is also indicated when the court has granted the agency this authority to restrict the parents. If the worker bears in mind that the use of court action is another treatment measure, he will be able to approach the parent more positively to enlist his cooperation within this authority. When confronted with a situation in which termination of placement is being considered as a treatment measure, it is to be hoped that the presentation of the plan may in itself prove a deterrent to the parent. It is to be hoped further that the parent would be helped to refrain from taking the child home as a result of hearing this plan if the home situation is unfavorable as is most likely. Wisdom in using this measure is gained from understanding the character structure of parents, and thus, what each type of parent might be expected to do when advised that it would be better to take the child home than to leave him in placement so long as the parent continues to disturb the placement. Parents of the first two groups may not be capable of weighing the situation in terms of what it would mean to the child, nor in terms of the advantages to themselves to have the child remain in

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placement. Their immediate impulse must be satisfied, and if the hostile one is the strongest in these severely disturbed parents, then they will decide in terms of satisfying their anger by directing it at the agency and also at the child. If their whim of the moment is to have the child to use in gratifying themselves, then they will attempt to satisfy that impulse. The disorganized, distressed mother, who will be overwhelmed by the care needed by the child, can be reminded strongly of how miserable she will feel when she cannot sleep most of the day due to the child's demands, and this may deter her from deciding to take the child home. Some method of delaying the mother's action for only a few days may give her enough time to relinquish this decision in favor of the more direct gratification of some other impulse which may become uppermost. If not, since the deterioration of the situation sets in fast and is rather extreme when these parents attempt to give care to their children, it would possibly be dangerous to permit the child to go home. It might be easier in these extreme situations to convince the court of the need to use authority, as the disturbances in these parents are often quite gross and obvious. It is the parent of the third group in the classification of parents who, better organized than those of the first two groups, gives an impression of adequacy and of being wronged, and this will deter the court from granting the agency authority to restrain this parent from disturbing his child in placement. However, because of this very same better organization of personality, the parent can more readily be dealt with in terms of his own needs, without court action. Knowing that this parent, especially this mother, wishes freedom from responsibility so that she can pursue her own pleasures will remind the worker that she will plot by using reasoning, rather than immediately gratify her impulses, if given time to think things over. Therefore, she should be warned in advance of the agency's plan to terminate the placement, unless she complies with the agency's objectives for the child's welfare, on the next occasion this issue arises, when the child will be returned to her care. It is highly important, when stating such an ultimatum to the parent with the narcissistic character structure, to leave room for her face-saving. Her need to spite makes her act quickly, out of

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defense for her tremendous pride. Hence, the agency's ultimatum should state clearly that it will be applicable to the next occasion, not the present one, so as to give the mother time to think it over before she again acts destructively. This gives her a chance to avoid bringing the ultimatum into play, and she can save face by averting such issues and not having to give in. On the other hand, this mother may be capable of still continuing as she had before the ultimatum or even of scooping the agency by taking her child home before creating another issue, just to show that she is in control. This would be dictated by her need to bulwark her sense of self-worth. Again, an appeal to her quest for self-gratification might prove it stronger than her defense of controlling, since the original unmet needs for gratification, which she is seeking to fulfill by giving to herself first, are underlying this defense. Before she can remove the child to an independent placement—with either a relative or a neighbor, or through an advertisement—or keep him at home, she should be reminded that she will have to bear the entire expense of the child's support, which the agency previously shared or supplied in full. So that this comment will not add fuel to her spite, the worker should point out that the mother needs to have this money for herself, since she lacked so much consideration when she needed the latter as a child. Such giving at the point of the mother's need may serve to soften the anger which impels her to be uncooperative. Even though this superficial change in the mother is due to her interest in her own welfare rather than in the child's, and the mother has not really changed at all, something has certainly been gained if the termination of the placement under such ill-favored circumstances has been averted. Having learned from this encounter that the agency intends to do as it says it will, this mother may attempt to decrease her future disturbance of the placement out of enlightened self-interest. Parents of the fourth group in the classification are more accessible to work for decreasing their disturbance of their child in placement. Some even strive consciously to cooperate and disturb the child only inadvertently. Education and guidance will serve to mitigate this tendency in them, without influencing its unconscious roots, and termination of placement is seldom considered

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out of the need to handle it. Rather, termination in these cases more often than not comes about for positive reasons, as will be discussed later. TERMINATION AT PARENTS' REQUEST

More favorable auspices under which a child will return to his family arise out of a change in the parent's life situation. Even if little or no subjective change has taken place to improve the capacity to be a parent, the improvement in the life situation may add to whatever capacities had been there before and thereby make this plan relatively favorable for the child. Whether or not it is desirable, however, the child's return to the parent whose life situation now makes it objectively possible cannot be avoided. The remarriage of the widow or widower, or of the divorced parent, or the reconciliation of separated parents, or the recovery of mental health to the point of being able to function relatively well in the family's care are some of the usual changes in a parent's life situation which will bring about restoration of the family. Some of these situations do not hold much promise of stability, but the parent's wish (partly genuine and partly out of a sense of duty) and the child's longing to return (which hampers his adjustment in placement because he knows that his parents' situation makes it possible for them to keep him at home now) are pressures in that direction. Frequently the decision to take the child home occurs without the agency's participation, but if there has been a continuing contact with the parent during the placement, and especially if it has been a meaningful one, the parent will count on the worker's interest in his plans. The worker can thereby counsel the parent in these plans with focus on the welfare of the parent as well as on that of the child if the plans are to be made cooperatively and soundly. It well may be that the child can still derive more gratification and security in his own family, despite drawbacks existing there, than in a good foster home, when the ties to his own family are very strong. Even when the own family, restored as described above, may be unusually unstable and unable to cope adequately with the care of a disturbed child, the court's approval, given on the basis of a semblance of an adequate physical home and family group, makes

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it necessary for the agency to concur in such a plan. Court action should be invoked only on request for the child by the family, which is referred by the agency to the court for a decision if the court originally gave guardianship to the agency at the latter's request. The agency then has to take a stand of being subject to the court's decision in both the arrival and the departure of the child. F o r the agency to initiate court action for the express purpose of opposing the child's return when past experience has shown that the court will return the child to these parents would only obstruct the parent from bringing the child back to the agency sooner if they find they cannot keep him. The decision of the grossly disturbed parent to take his child home will most likely not be upheld by the court, especially if the situation is well presented there before the hearing. PREPARATION OF T H E CHILD AND HIS FOR

FAMILY

REUNITING

In all these circumstances bringing about termination of placement, work should be done both with the child and the family, in advance of the child's return, to make the reuniting of the family easier, sounder, and more productive for all concerned. Work with the foster family is also needed in order to help them relinquish the child emotionally and for them to help the child leave without too much upheaval in the uprooting. Such work is possible if the plan for the child's return is known to the worker sufficiently in advance of the actual moving. Several weeks to a few months are needed for working out the reintegration of the child with the family. If the worker has been in close touch with the parents throughout the placement, he will have had portents of the change to be made in their life situation, or as previously stated, the parents may even share it with the worker as it is developing. Otherwise, if the request for the child's return comes as a surprise, efforts should be made to persuade the parents to allow at least a month or two for the preparation of the child and his family for the reunion. An appeal to the parents both for their own sake and for the child's welfare can be made on the following basis. The child, although eager to return, needs to be helped to separate from his present surroundings, or else he will miss some

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aspects of them which will make him feel strange and restless at home, and hence difficult to handle. Also, the child has to be helped with his feelings toward his parents for placing him, for they will remain with him, even if covered over, and lead him to acts of revenge once he has returned to the family. A parent whose guilt over the child's placement is accessible will be relieved to have the child receive this help. In this instance, it might not be as difficult to acquire the parents' cooperation as it would in others to attempt not to divulge the decision to the child until the worker finds that the child is ready for it. This readiness in the child to hear the parents' plan for his return is described below. Lastly, the appeal to the parents on behalf of their own need may reach them more effectively than the foregoing. They might accept the suggestion that they need a period of time with a new spouse, or to stabilize a reconciliation, during which they do not have the children around to distract them or to add to their responsibility while they are becoming adjusted in their marital relationship. The parents can be advised that they need to integrate their new experience first, whatever it is, and that then they will be able to take on more responsibility a little at a time. T o appease a parent's guilt over wanting to do this, since the guilt does not permit him, he should be told he can do more for the child in this way. When time is allowed for the preparation of the child and his family for the reuniting of the family group, the feelings of both about the placement should be worked through as far as possible. When this is done with the child without his knowledge of the contemplated return, he will be less apt to cover over his real feelings toward his parents for placing him. Otherwise his eagerness to return may give him the illusion almost of never having been placed, for his sights will be set on the family in its glamorized form as he longed for them while separated from them. He sometimes will project such a glamorized version of his parents onto the last scenes he shared with them before placement in his attempts to connect with them for his return. It is obvious that these fantasies must be replaced by the reality into which he is going, and his former feelings, including those about the separation, cannot be obscured to form a barrier to a sound integration.

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The child may fear that he will endanger his chance for return, if he expresses anger or other negative feelings at his parents in the face of their plan to take him back. Without the child's knowledge of his impending return, his anger at his parents for placing him, as well as his fears and guilt, has a better chance to be elicited. After these feelings are aired sufficiently in the limited time before his return, they should be accepted as justifiable, and explanations made as to how he has reacted in other ways in his behavior, unfavorable to himself, out of these feelings. He can be encouraged that he need not act that way now that he expresses his feelings directly, but he should be advised not to express all his anger at once. Lastly, explanation of the parent's action of placing him has to be given realistically yet sympathetically to allay the child's bitterness. Hopefully, much of this work will have already been done as discussed in the chapter "Work with Children after Placement," as little and sometimes none of this can be achieved in such a short time before termination. Once the neurotic elements in his tie to the family are weakened, or at least the top layer of these feelings is cleared away, the child should be encouraged to revive realistic memories of his past, either positive or negative, to help him bridge the gap in his feelings between the old family situation and the relationships he has developed with his own family since his placement. The pain which the child felt at separation may have caused him to repress these memories and perhaps to replace them with unrealistic fantasies. Thus a little girl of five, after expressing to the worker anger at her mother for placing her, was then able to bring out the frightening memories around her grandmother's sudden death which she had witnessed and which had finally led to her placement. She was later able to recall during a visit to the home in preparation for return a happier memory of how her mother used to place her in a large pan in the kitchen sink to bathe her. The news of his impending return should not be given the child too far in advance of the date set for his moving back, for the anxiety of waiting for this to happen is too hard for a child to bear. For instance, dangling between the foster family and his natural family, he may tell his foster parents that he no longer has to obey

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them and become most difficult, if he is inclined to take permission to act out his aggressions. About four or five weeks may be an optimum period of notice, and this should be varied, either by extending or decreasing it, according to the needs of each individual child. The knowledge of the imminent return to the parents can also stir up unexpected feelings in the child which require at least this much time to be dealt with in sufficient degree. The child's first glee may give way to strong ambivalent feelings, manifested by anxiety and depression. The anxiety may be out of fear of facing a new layer of anger at the parents for placing him, which this news will stir up; or it may result because this is the first time his anger at his parents has ever come close enough to the surface to be recognized. It will have been brought this close to awareness, after he was successful in repressing it, by the unexpected idea that now that he is returning, why did they have to send him away in the first place? When the child's defenses against this anger do not hold, and he is experiencing it consciously for the first time since he was placed, he may react with depression which will contain much guilt over the anger. The guilt will be increased if the anger is recognized at the same time he feels that the parent is being kind enough to take him back. This is what always happens when anger is felt in the face of kindness from the one at whom the anger is directed, either openly or without expressing it. Anxiety may alternate with depression as the child worries that if his anger is discovered, the parents will refuse to take him back. In the worker's efforts to deal with this guilt and anxiety, he must first reassure the child that his sharing of these feelings with the worker will not jeopardize his return home, but rather, will make it easier for him. The worker must stress the confidentiality of their discussions, especially if this is a new experience for the child in working on feelings. Explanation is needed that thoughts and words, even when uttered aloud, have no magic in them to make them come true by themselves, especially when they are brought out only for understanding and not for action. The uniqueness of the relationship with the worker, to whom things can be told for purposes of understanding, must be pointed out again. Since the worker in a child placement agency has the dual role

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of therapist and substitute parent-figure, who makes arrangements for the child's life, then the worker must promise, and hold to that promise, to discuss with the child any move he plans before making it. In this way will be built the child's trust in the worker to do the right thing by him, which is necessary before the child can be encouraged to share the feelings which he fears would threaten his return to his family. If there has existed a continuous relationship between the worker and the child prior to this occasion, then the child will already have developed enough confidence in the worker to weather this test. On another level, the child's ambivalence about returning to his family will be concerned with the present and the future, rather than with the past happenings which stirred his anger. In many instances, the child will already have made ties to the foster family, to friends in the current neighborhood, to a teacher, and also to the agency worker. The return home spells loss of these ties in which he has much of himself invested, and his grieving over this loss will cause him to be depressed. The worker should help the child to acknowledge these feelings of loss and to share them. The child may first need reassurance for his guilt over having these feelings, as he probably believes they constitute disloyalty to his family. When shared with a sympathetic listener who reassures him that they are valid and good feelings, his guilt over them will be assuaged and he will find comfort for his sense of loss. He should be reassured that since he was so well liked in this setting, he will be liked in other surroundings also. If reality conditions permit, he can be promised some return visits to the current objects of his affections so he will not experience a sense of total loss. The worker should take the responsibility for fulfilling these promises after the child has had enough time to settle down with his family. Further anxiety in the child pertaining to the future will stem from his fear of the unknown which awaits him when memories or exaggerated fantasies do not suffice to reassure him. He should not be allowed, in so far as he will permit work to be done, to return with the idea that the home situation will be a glamorized version of what he left, a version he has made of it during placement, ofttimes with the parent's help. These distortions can gather

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momentum if he needs to meet a growing anxiety about what he may find there. If he is allowed to keep his fantasies, his disappointments will be harder for him to bear than will be disillusionment about it before he moves back. Toward this end, visits by him to his family, brief at first, but growing longer, should be tried. He thereby will encounter disillusionment in small amounts, and he can be given help to bear and compensate for the disappointments. Without this, when left to suffer the disappointments quite alone, since his parents may well not be able to help him, his behavior upon return can become more disturbed than it was before, thus creating severe problems between him and his family. His happiness about being with his family is then severely marred, his reintegration hampered, and there might even result his replacement. The child who has fewer illusions about his family still will have much anxiety about what awaits him there since this is not known to him, while he can feel more sure of what he has now in the foster home. Having once been placed by his parents, he may fear that they will do this to him again. So why should he trust them and get settled in their home only to perhaps re-experience the awful pain of separation? Signs of these doubts and fears must be watched for and opened only when the child shows anxiety around them. If the worker cannot feel sure of recognizing these signs, or if the child's anxiety about them, even when they are obvious, is still too far removed from his awareness, then they cannot be treated so directly. Instead, the worker might hazard a suggestion that these feelings exist by telling a story about another child he knew in similar circumstances who had revealed these feelings to him about going home and by pointing out that the worker had then been able to help that child feel better about it. He had explained to the child that a person can feel two ways at the same time about going back to live with his family, that he can feel both happy and worried, glad and sad. Part of him loved his parents and longed to be with them all the time, as all children do, yet the other part of him was afraid that they might not treat him right, and might even send him away again. Or part of him was so used to where

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he was then living and liked it so much that he hated to leave as he would miss it. Anyway, he was sure that his foster family was treating him well, and he did not know whether or not his mother and new father would treat him as well. Then the worker had told the boy that the happy feelings would not be hurt by the worried ones, that he could enjoy the happiness of going home by understanding that his parents meant to do right by him, and that the worker would try to help them do this. And even if the family would not wish either to see the worker themselves or the worker to see the boy, there would be happy things there to make up for any unhappiness should everything not go just right. Also, the worker had told the boy that he could still love his foster family without hurting his love for his own family, and that he could visit the foster family later, and hence not lose them altogether. The gist of these explanations can be given to a child directly as it applies to him, or for the child who cannot face his feelings of doubt and reluctance about going back to his own parents, it can be given indirectly. From this account of another child, he can take some reassurance for himself. He may enter into the explanation by telling of his own similar feelings, or he may remain silent but carry away some comfort and relief from this narrative. If he spontaneously denies that this story has anything to do with him, his need to deny it verbally indicates that he has really great fear of facing his ambivalences. Either he may need to continue to hide behind his denial, or he will feel safer in examining some of his troubled feelings when he is alone, at which time he may be able to take comfort from the explanations by the worker that he carried away with him. There is the possibility that explanations like these actually do not pertain to a particular child if his circumstances produce an unconflicted reaction about his return to his parents. This obtains either when placement has been very brief, or when the foster family has not been at all satisfactory for him, or when he has maintained a shell around himself to avoid new ties and has clung to the old ones through intermittent contacts with his parents. His denial of having mixed feelings about rejoining his parents can then be valid, and he will remain untouched by this indirect interpretation because it does not apply to him.

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While the work with the child's feelings is proceeding in preparation for his return to the natural family, work with the-family's feelings should also be attempted, especially with those of the parent responsible for the child's placement. Such work consists largely of alleviating the parent's guilt for having placed the child and of reducing the parent's fear of the child's hatred which he might show upon return home in retaliation for this act. In addition, parents may have mixed feelings, too, about bringing the child back into the family group. A mother may be dubious about her decision to do so because of the extra work the child's care may entail for her. Or the immature father who divorced an inadequate wife and married a strong, motherly woman may resent sharing with his children his new wife's mothering of him. A similar reaction may ensue when an immature mother does not wish to share with her children the dependency gratification and protection she finds in a new husband, who turns out to be an affectionate, kindly person. Another source of the parent's anxiety about the return of the child lies in whatever underlying conflicts existed prior to the placement and were a part of the motivation for the placement, despite any reality problems used to mask them. These basic conflicts, dormant while the parent is free from the responsibility of the child's care and close contact, are stirred up again at the thought of resuming the active relationship with the child on a daily basis. Whatever may have been worked through in this area of conflict in the parent-child relationship prior to the decision for the reunion will make the reintegration of the family sounder. Even if much has already been worked through, however, it is not unusual for the parent to be seized by fears that the old problems will reappear, since changes brought about by treatment have not yet been tested in reality. This layer of reactivated feelings or that surging forth from a deeper level, needs to be worked out during the period of preparation of the parent for the child's return. If no work has been done prior to this point with the parent's underlying feelings toward the child, whatever becomes accessible now, on the very eve of the reunion and precipitated by its imminence, should be dealt with to some extent in this period of preparation. Because it

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would be rather too late in the agency contact to begin exhaustive, long-time work, or because the level of treatment might be such as to require work not feasible in the child placement agency, the parent should be helped to accept a referral to another agency for more extensive help after the child returns. However, if the bulk of the work with the parent's conflicts has been done by the child placement worker before the child's return or if it appears likely that the parent will feel too rejected by the worker to accept help elsewhere, it is strongly advisable that this worker continue with the parent's treatment after termination of placement. This is necessary in order that the meaningful relationship with the parent may be continued. Without that the parent may not be motivated to struggle with the problems presented by the child's return. 2 The larger part of the above areas of feelings in both the parents and the child should be worked before any action is taken in the process of restoring the family unit. But even if they are so worked, more of these feelings will be brought forth by the actual steps taken in this direction, and these will need further handling. Just as the separation from the parents at the time of placement should be planned as a gradual weaning, with visits to the foster home by the child before he moves there, so the reintegration of the child with his parents should be established gradually, with even more visits to his own family than is allowed to the foster home before placement. Visits of the child to the family in their home should be introduced during the period of preparation. The first ones should be short, subsequent ones longer. In this way the child can have the security of what is familiar to him in the foster family to fall back on while he accustoms himself to the experience of living with his parents. This he will gradually learn is different from the brief Sunday visits he had with them during placement. Those visits were usually not to the parent's home and were largely in the nature of a treat. Then the parent did not need to restrict or discipline the child as much as is necessary in the full-time job of being a parent. Tensions from this and from other differences found from the relationship maintained during placement can be weathered better when experienced gradually and discussed in the treatment relationship with the worker. After visits of a few

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hours during the day, there are overnight visits, and these can be followed by a few weekend visits. This gradual lengthening of the contacts serves to provide an easier opportunity, with the help of the worker with the rough spots, for the natural parent-child relationship to fall into place. 3 The child is given one step at a time to integrate, as much can be new to him after an absence during placement when changes have occurred in his family and physical home surroundings. Activity in this process of introducing these changes should be formulated in accordance with the dynamics of family interrelationships and with the particular dynamics of the specific personalities involved, as in the following case example. Janet, an only child when placed at three, was being prepared for her return to her parents two years later. During the placement, the parents had had another baby about whom Janet was told before she knew she was moving back to her parents. On her first visit to the family's home after she had been told about her imminent return there, the worker arranged that she and Janet should arrive while the infant sister was napping in the afternoon. This made it possible for Janet to be with her mother in the home from which she had been placed without having to share her mother with the baby on this first occasion, which was important since there had been no baby when Janet lived with her parents formerly. Thus she was able to reenact in part her old relationship with her mother, which she had lost by placement. She had been dealt a double loss of this relationship by the sister's arrival. Ordinarily this kind of loss of the mother through the birth of a sibling is borne with the support of the parents, preferably the mother, and Janet needed to catch up with some of this as she had missed it because of her placement. It would have been much more difficult for Janet to bear the rivalry she felt toward her sister without having recaptured some of her old relationship with her mother in this familiar setting, as it was before she was placed. This course provided a base of security from which she could better meet the stressful situation of sibling rivalry. The plan for Janet was postulated on the dynamic that sibling

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rivalry, although inevitable, can be tolerated by the child out of the security he feels with the parents, especially the mother. The less security the child feels in his parents, the more intensely is the sibling rivalry felt. A frequent change in the situation of parents, for which a child needs help in order to accustom himself to it, is the parent's remarriage, as this is often the forerunner of the child's return to the parent. Many shocks to children on hearing of their parent's remarriage could be softened if the children were forewarned before the event took place. Given advance notice, the child is then being presented with a coming occurrence, rather than an accomplished fact, and he can make peace more readily in the former type of situation, since there is less there to accept at one time. Many parents, out of guilt toward their children, find it too difficult to tell a child anything about their plans to remarry, and appear, without warning, bringing the new mother or father, who is introduced as such. The following case illustrates how a parent can be helped to tell his placed child gradually about his remarriage. Mrs. P. placed both her children, Edward, age seven, and Nancy, age four, when she divorced her husband and had to go to work because he did not support them. Edward was a bossy little boy who was able to control his mother since her attitude toward him was one of adoration, which had developed when her husband failed her in affection. When Mrs. P., two years later, planned to marry another man, older and more adequate than her first husband, she dreaded telling her children, especially Edward, whose reactions she feared as she needed his approval. Her original guilt for placing him, plus the guilt from her sense of being unfaithful to him, made her wish to elope and then tell Edward. Since Edward's control of his mother was the chief defense by which he was able to manage, as this was the only way he could obtain his dependency gratification, he would have been shattered emotionally had his mother produced a new husband for Edward to rival. Furthermore, Edward's trust in his mother would have

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been badly damaged, had she married behind his back. Therefore, Mrs. P. was helped to tell Edward of her plans for her future marriage and to maintain her decision to do so despite his resistance to it. Also, she was advised to bring her fiancé to meet Edward and Nancy before the wedding. This gave both the children an opportunity to integrate a situation distasteful to them one step at a time. When Edward then demanded to know when he would return to live with his mother, she was helped to tell him that it would be a while yet as she needed more time to work in order to get a new home ready. Although the worker and the mother had agreed on a date for the children's return, in order to avoid her procrastination after the wedding, Mrs. P. promised not to reveal this date to the children until a month before they were to be reunited with her. It was believed that she would hold to this plan after the worker pointed out to her how Edward would badger her to advance the given date. The mother was also supported in her need to have the first few months of her marriage to herself and her husband alone in order to consolidate the relationship. The five-month interval decided upon was used to work out more of the children's feelings about the divorce, the placement, and the mother's remarriage. This was facilitated by the visits of the mother and stepfather to the children which brought out the children's reactions to him, and to their mother for marrying him. Finally, they began to accept the prospect of enjoying their second father. He gave to them what children need to have from a father, that which they did not get from their own father and which they could not get from their mother. All of this was explained to the children as their responses in these visits were noted. The mother's request to have Edward visit first, without Nancy, was fraught with implications not desirable in view of Edward's pattern of needing to control the entire situation. She was therefore helped to understand that the first visit of the children to the home now occupied by the stepfather and herself, and where the children were to live also, was to be planned so that both children would be there together. This was the family situation at the time both children were placed, namely, that both were sharing

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the mother. That they would have to cope with the reality of sharing her now with this husband, as they did formerly with their father, made it imperative that the stepfather be there also on their arrival. This situation of sharing was made favorable by creating good feelings in the children toward the stepfather from the earlier contacts they had had with him. Subsequent visits to the parents were planned so that each child could have a turn at visiting alone, Edward going first, and thus each child had the parents to himself to recreate the one-to-one relationship with them. The parents can be further supported at first in undertaking the new responsibilities for the child's care when the worker discusses reality planning for the child which this move involves. Some of these activities in themselves bring forth feelings in the parent with which the worker can help. The child's school transfer must be obtained from his former school, which either the worker or the foster mother can do. But the own parent must enroll the child in the school of his neighborhood, where questions will be raised which will distress both the parent and the child. They will be less troubled in this situation if desensitized by thorough discussion with the worker in advance as to how to explain to the school authorities the very sensitive subject of the different name of the guardian, for example, that of the foster parents, on the transfer slip. If the parent has been living in the same neighborhood for some time before the child joins him, the child will be pained in explaining to the playmates he makes there why he was not living with his parents before. It might be well to point out to the parent that his story to the playmates' parents should match that which her child tells to their children. It will be helpful for the child and his parents if their shame and guilt about the placement can be alleviated enough for them to be able to give a superficial version of the reality which caused the placement. An unfortunate reality situation carries less feeling of degradation than does failure to be an adequate parent and or an adequate child who does not need to be placed. An example of this brief sort of explanation in the case, for instance, of the absence of a father,

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for whatever reason, might be that because the parents were separated, the mother had to work to support the children, and therefore could not take care of them at home. Other needs and behavior of the child also have to be explained to the parents resuming his care—as, the need for the medical follow-up of a continuing condition, what care that condition may require at home, and the child's habits in regard to food, hygiene, and sleeping. The mother may or may not follow the regimes her child has been under, but at least she will know what he is doing as he practices them. If she permits this without interference, it will help the child's transition to her own methods of care to be made more easily. Information about the child's social activities may be shared with the parents and their reactions handled if they are antagonized by this. The parents' resentments might be stirred up if they are told about the child's music or art lessons, which they may not be able to afford financially or may be too jealous to allow him to have. Or, they might not even understand the need of his having these. The parents probably would be less threatened by information regarding the child's scout activities, church and Sunday school attendance, and the like, given for their orientation to enable them to make future plans in regard to these. T h e child's behavior, habits, and emotional disturbances, and how they manifest themselves, should be discussed with the parents for their enlightenment, and advice and guidance offered for their better handling of the child in the light of the disturbances. The parents can be counseled to expect that, after the glamor of the reunion is worn off, the child will test them out to see how much he can get away with, especially when he attempts to retaliate for past and present disappointments he has had in his parents. Care should be taken not to accuse the parents indirectly through explanations of the child's behavior which make it referable to their former handling, including placement, as the parent's guilt and angry defense may then interfere with their efforts to handle their child. If such accusations are unavoidably implied, the worker must repair the effect this has by reassuring the parent in his guilt. T h e parent also may later use this information about the child's behavior in the foster home in scolding him for disciplinary pur-

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poses or in his wrath at the child when he proves too much for him. The child who has had an attachment to the worker will become bitter if the parent quotes the worker in this destructive fashion, and he may feel that he cannot trust any grownup. To offset this possible reaction, it behooves the worker to tell the child at the end of the period of preparation for his homecoming, that he has told the parent certain things about him to help the parent understand him better and thus be able to help him in his unhappiness which is what makes him act so as to get into trouble. The worker clearly defines to both parent and child the purpose in this sharing of the child's problems with the parents as being for the child's welfare. In some instances, the worker should even spell out to the child what he has said to the parents about him. Further practical preparation consists of telling the child that there will be rules and limitations at home from his parents. During placement the child glamorizes his parents to the extent of eliminating memories of prohibitions and deprivations from them as if such had never existed prior to the separation. When the foster parent would find it necessary to discipline the child, he would take refuge in the fantasy that his parent would never do such a thing to him. A rude awakening for the child in this area can increase his difficult behavior. It may even be desirable when telling him that his parents also have rules—since rules are necessary as one means of keeping us safe—that the parents will make mistakes about the rules at times, but that nevertheless they have the right to make the rules. Hope and comfort is stored away with him to tide him over these future gaps in the parents' handling by reminding him that the parents love him even when they make mistakes; it is just that they do not realize their mistakes in time to avoid them. As stated earlier, the worker's continuing help to both the child and the parent from the beginning of the child's return home is indicated, provided the parent is receptive to this. If not, the parent may permit an occasional contact by the worker with the child on a social basis, which should be used for support and tapering off of the relationship, if it has been a meaningful one to the child, as well as for the fun such a visit affords. When it appears that

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the parent will not permit even this much contact with the child after his return home, or if such contact will not be feasible for reality reasons, then the tapering off of the relationship should be done before placement is terminated. If this be the situation the worker might yet send a few cards or notes to the child in his home to avoid a too sharp break, provided both the parents' and the child's attitude toward the worker invites this. Sometimes, however, even such contact is not possible, as, for instance, when it is known that the child will incur much displeasure from his parents on this account because they are hostile to the agency and the worker. When this is not the case, efforts should be made to impress the family with the need of the child to visit his old haunts, if possible, after a period at home has made him begin to feel settled there. The child needs to return to the scene of his former living to pick up the parts of his feelings he has left behind in his ties and experiences there. In this way he may be able to unite these parts within himself, to feel his identity more complete, and to be enriched from the ties he had during placement if these were nourishing. The writer has described many of the foregoing steps in the process of reintegrating a family in the report of a case published in the American Journal of Orthopsychiatry * TERMINATION

BY T H E CHILD'S COMING O F AGE

Termination of placement can happen naturally by the child's coming of age. This normal aspect of growth into maturity can occur fairly happily, but there is a distorted version of it in instances where midadolescents, starting at about fourteen or fifteen, return to their parents without planning for it with the agency. Parents' Distorted Use of Their Child's Coming of Age. The children who return to their families on their own initiative have considered placement to be exile from their families, even though the parents had been unable to take care of them and had requested their placement. The longing of the children to return to their parents, who ofttimes are very deteriorated socially or will even be cruel to the children, has continued to exist. Either the children have not been brought into a therapeutic relationship to help them face and understand their parents' shortcomings, or, often, such

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work with the children is resisted by them unless they are quite young when placed. They have managed to live with their thoughts about their parents' inability to rear them by erecting many rationalizations to excuse the parents and defenses to bear their own frustrations. Even when the child realizes as he grows older that the parent is either mentally ill or otherwise incapacitated, he will make a vow to rescue the parent, or to do for the parent what he wished the parent had done for him. Underneath this, the child is still longing for the parents to give to him, and hence he cannot be free of the intensely strong ties he has to them. In returning to his parents' home, the child secretly hopes to get what he previously missed from them, even though consciously he knows this cannot happen. Knowing this, what the child will do instead is to take care of his parents, in a manner of making restitution to them out of his guilt over his deep hatred toward them for failing him so badly. The parents, in turn, will accept and even demand the children's return to the home, as they see the children now as assets rather than responsibilities. The children are now past the age when they require physical care in their rearing, and in fact, they now can do the housework and the shopping, as well as care for themselves personally. Supervision of their social life is not considered necessary as long as they avoid trouble which would burden the parents. More, they may already be earning after school, and soon will be working full-time, which is what the parents are hoping for, as this will give them better support in their old age than public subsidy or the meager earnings they have been able to eke out could. The case illustration of Paula in the chapter "Work with Children after Placement," shows how a child was rescued from this strong neurotic attachment to the own family which makes the children victims, if not financial, then emotional, of their parents' exploitation. The rescue work must begin long before the child is apt to return to his family in this fashion, otherwise it is seldom effectively successful. Gradual Weaning by the Agency. In happier circumstances, as when the child lives with his own family throughout his lifetime, preparation for social independence and self-support is a gradual process. The child is weaned while still being given to by the

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parents. The older adolescent under normal conditions achieves the status of maturity by gradually assuming more and more responsibilities. The placed child, on the other hand, when he reaches adolescence, is not likely to have as much incentive to take on responsibility, because he has been given less dependency gratification emotionally and often materially than has the child growing up in his own family. Yet he is often expected to take on this responsibility sooner than most adolescents. Rather, the weaning process with him should be as gradual as is consistent with both the agency's budget and the child's needs. Since agencies vary in the extent to which their budgets can permit this gradual weaning —the budgets of some are quite inadequate—whatever the situation is, it should be realistically shared with the youth. Such a course followed in families who are financially limited is considered a sound mental hygiene approach to helping the adolescent develop a sense of sharing responsibility. In either the family or the agency situation, the adolescent can be told that those in charge would like to give him more, and would do so, were that possible, but that what is being given is all the budget can afford. This will help the youth to feel that he is not being deprived and, further, that his is a place of importance in the situation since its components have been confided in him. Differences exist in the needs of placed children in this respect as in others. An immature eighteen-year-old child, extremely fearful of independence because of great unmet dependency needs and because of his loneliness due to the fact that he has no ties on which to lean, should have a longer period of weaning, with more financial as well as emotional support from the agency. On the other hand, another child who has rallied all the meager resources within himself to become outwardly adequate by earning, making his way with friends, and the remnants of his family, even though achieving this by acting on compulsive defenses, should be allowed and even encouraged to maintain his independence in this way. His sense of power in this freedom and his ability to give to himself from his earnings many things he enjoys are compensations for his endeavors to become self-supporting. It is definitely inadvisable to make this child's situation easier for him beyond supporting his

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own efforts. For to do anything for him which he can do for himself will undermine his compulsive defenses so that he will be left helplessly floundering in his underlying weakness. Out of the latter he would present problems, such as stubbornly refusing to assume even minor responsibility in his angry demanding that the world make up to him what he was deprived of as a child. Since this cannot be achieved as fully as he wishes by any means, since what he is crying for is gratification of his actual old emotional deprivation, an impasse will occur. Should the child's defenses be weakened, the resulting situation will require a firm stand by the parentfigure in the worker to help the child rally his old defenses for managing. Further help should be given only after the child makes some efforts in that direction, the latter should be the condition on which such help is given. There is the child, also, who taking incentive from meaningful ties to a foster family, a worker, or a relative, or some combination of these, will enter into the next phase of growth by going either to work or to college, as do children growing out of their own homes. With this placed child it is the meaningful relationships which will have nourished his healthy growth. Whatever the course of their coming of age, providing it is a reasonably healthy one, the children's efforts in that direction should be stimulated and supported. The actuality of working, earning money, and planning the use of it, even if only for their own personal needs at first, is an ego-strengthening experience for all children regardless of their life circumstances. All along the way, the planning of the earnings should be done together with the child, taking into account his expressions as to needs as far as is feasible, encouraging him to learn the nature of his expenses and their costs, granting his needs as generously as possible while at the same time guiding and restricting his expenditures as indicated. Explanations should be given the child for the various steps so that the entire process becomes an educational experience in which he participates in managing his affairs. Learning to take care of his own needs, even in a small measure at first, is a step toward social maturity. At first this is usually done by getting small odd jobs. These are normally assumed at the beginning of high school,

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but may be taken earlier or later, depending on the particular child's maturation in this area. The expenditure of these first earnings for the child's own gratification is valid to give him an incentive to work in order to obtain gratification, rather than to find it through play alone, or in further dependency, or through other methods, such as the excitement of delinquency. Thus, the child's first small earnings should be used to augment his recreational allowance. When the child's earnings increase and become larger than the allowance given him plus the amount of earnings he was originally allowed to keep, the agency's allowance should be eliminated so that the child takes care of his recreation altogether. The amount needed for a boy's recreational allowance will be greater, if he is dating, than for a girl's, since the boys' spending money has to pay for the recreation of his date. The next step in planning with the child as his earnings increase is to make provision to augment the regular clothing budget allowed by the agency. No allowance ever seems large enough for an adolescent's clothing needs, especially if the adolescent is a girl who is now or soon hopes to be dating. When part-time earnings surpass those needed to cover both a satisfying recreational allowance and an enlarged clothing budget, then the agency should also withdraw the amount it gives for clothing. Subsequently, the child may earn even more, especially during summer vacations from school, when his wages may be equivalent to those of an adult. These earnings should be budgeted to cover carfare and luncheons during the child's employment, his clothing and recreation, and some savings if the job is only a temporary one for the summer. The savings will supplement the smaller part-time earnings the child will have when full-time employment ceases at the opening of school. Some of the savings can be planned in advance to afford certain special needs, such as the extra-large expenditure required for a winter coat or suit or the additional expenses incurred by clothes, celebrations, class pictures, and class books, and so forth, occurring at graduation from high school or college. If it is known that the child will return after the summer to a part-time job with substantial earnings after school hours,

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based on the experience of the previous year and because the summer employer promises that for the fall, the surplus from the fulltime earnings during the summer should yield a token contribution toward the board bill, rather than be placed entirely in savings. That some amount of savings should be budgeted is indicated for most children, and especially for those in placement, because these will give them self-pride and a sense of security. In advance of the time the child may decide to spend this money, he should be told that discussion of plans for the expenditures to be made with it are to be held with the worker. Such a plan provides for the child's learning to manage his large sums of money with the guidance of an interested adult who understands him, rather than letting him learn the hard way—in other words, learning to manage after he has already spent the money unwisely on the basis of his impulse or whim. With a child's second summer of generous, full-time earnings, a larger, more realistic contribution toward his board bill should be planned, after he has taken care of the other items already mentioned. As with any first experience a child has with full-time earnings, whether the job is for the summer only or is the beginning of one on which the child will eventually become self-supporting, the first two to four paychecks should be left to the child in full, to be used as "mad money," or savings, or both. He should be made to feel free to do with them whatever he wishes, as this may be the only time in his life that the child will have a chance for such a satisfying experience with money. After this the necessity for self-support will set in. It is well to keep in mind, when placing a child in a new foster home or in a residential club as he is approaching the age when he will soon be self-supporting, that such living arrangements should be located where the board and rent rate will fall within the range which this child's earning potential will permit him to pay. Thus he will be able to continue to live in the same place after he begins to be self-supporting, instead of having to move at that time, as the latter would create difficulties in the weaning. He can better manage one step at a time in the experience of working, and in the assumption of financial responsibility. The security of

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familiar living arrangements is an aid to this. It is even easier for him when he can make his own financial arrangements for the board and room rate with the foster family who have reared him, if he prefers to make his home with them after termination of the agency's responsibility. Often the boy or girl who remains in such a situation marries from the foster home and enjoys the sharing of celebrations and the devotion from the foster family on this occasion as if with an own family. Pictures of "grandchildren" will probably be displayed later in these foster homes, attesting to the meaningful tie with the foster family. Although the steps in budgeting the child's earnings have been outlined specifically here, they need not be followed rigidly. As in all work with human lives, there are individual needs which require an alteration of regular plans to serve the particular individual best. Individual alteration, however, has to be handled with care, for it may permit the projection of the child's many other subjective needs, and the worker's as well, into the realm of money. In this way the child will lose one of his most valuable tools for growth at this stage, if he is permitted to turn to the use of money to meet his neurotic needs. Also, he loses a chance for help with the other needs which he is expressing neurotically. The subject of money has many connotations to as many people, and it is fraught with much emotion owing to the specific meaning it carries to the particular person, as well as to the fact that we live in a money culture. Just as the variations can provide for the above errors, so too, they can provide excellent tools for constructive work in certain personality situations. For example, an especially deprived adolescent girl, who knew her mother and sister were prostitutes, worked part-time during high school, and was allowed more than the usual augmented amount for clothing so that she might adorn herself from a superfluous stock of costume jewelry and give to herself in other material ways with the worker's approval. In this way she was doubly given to, since the worker's approval of these expenditures along with the expenditures themselves, which were somewhat excessive, placed a value on her femininity. This was to help her feel, together with verbal reassurance, that she need not throw her femininity away as did her mother and sister, out

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of their deep feeling of feminine inferiority and masochism. Following graduation, this girl obtained full-time office work and after her allowance of two weeks' pay to splurge with was steadily self-supporting at this job. Another instance of varying the planning of expenditures of earnings for personality growth and security took place with a sixteen-year-old girl, with latent schizophrenia defended by compulsions, one of which was the saving of string, papers, and useless junk to a rather extreme degree. Since she felt herself a very valueless person and lacked even a nominal amount of inner security, she depended strongly on these material possessions for security. Since the psychotic core of her illness could not be worked through to correct her use of money in its service, the money was applied dynamically as a treatment tool. She was encouraged to assemble valuable property while she was helped to feel she deserved it. One such item was a portable radio, another was a portable typewriter, the latter at a cost of a hundred dollars. Since she had been in eight foster homes in eleven years, and did not know where she would be living after graduation, the items she chose, as if they were extensions of herself, were also portable. These expenditures were allowed instead of requiring any board payment out of the substantial earnings she received from a fulltime summer job, the first one she had held. She did pay toward her board, however, when she had full-time work the next summer. When the Agency Remains a Parent-Figure. After the child becomes self-supporting, it does not necessarily mean that his contact with the agency is terminated. The agency worker may remain actively engaged in supporting the child emotionally and also in counseling him about practical matters. The child may bring for discussion the problems which occur in his jobs, his questions about dates and courtship and marriage, his wish for advice on how to deal with a parent whose problems fall on the child's life. Especially when the child has been immersed in working through underlying conflicts and has had a meaningful relationship with the worker in this process, does the contact not end. It may well be that the child, once feeling himself emancipated, does not wish further contact with the agency, which reminds him of the tragedy in his life. Yet even as he is not pursued, he should

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be left with the feeling that the worker and the agency will always have a friendly interest in whatever happens to him. Such an ending was reported by this writer in a case of latent schizophrenia, 5 even though there had been a meaningful relationship with the worker (this type of ending is known to happen especially in the treatment of psychotics 6 ). Two years after this termination, and after Anna had become self-supporting and then married, she sent an announcement from another city of the birth of her son to the worker's home address. In the next year, she gave this worker's name for work references at two banks where she applied for employment. Since these children are often lone individuals who have no kin or none on whom they can fall back, it may help them to know they can come back to the agency, even if the worker is no longer there, if they find themselves in an extremity and desperately in need of help. Just as all adults need to have such a resource for unexpected crises or for periods of depletion in young adulthood, for which they usually turn to close relatives, so the foster child who does not have this resource, needs to feel that the agency stands ready to help him. This can mean a few irregular small grants of money to tide him over, or if more money and other help is needed, the agency will refer him to the proper resource in the community for this. If the help is not forthcoming from the other agency, the placement agency should stand by him, as does a family, until the help needed is found. Some children like to return to resume brief contact with the staff at the agency whom they know, out of their anonymity in the military service, from which they are on furlough, or to show their success and well-being. This is a way they have of rounding out their experience with the placement agency. Those children who come from institutions sometimes return to see a favorite person still there, or to show their tie in an impersonal manner. Not only may they give a supply of baseball bats or bicycles, but they may show a greater devotion when they, for example, spend their free Saturdays in building cabinets for a playroom there. If this is still giving to themselves, and if it symbolically meets their need, then it serves a highly beneficial purpose at the same time, and is indicative of a constructive mode of life.

NOTES

1 : DIAGNOSIS AT INTAKE

1. Bowlby, Maternal Care and Mental Health, pp. 11-12, 2 4 - 2 5 . 2. An illustration of the need for the referring agency to confer first with the placement agency to avoid hardship to the family is given in a paper by Kline, "Differential Diagnosis in Planning Placements for Children," in National Conference of Social Work, 1952, Selected Papers in Casework, pp. 129-33. 3. Bowlby, Maternal Care and Mental Health; Kanner, "Early Infantile Autism," Journal of Pediatrics, Vol. XXV, July, 1944; Spitz, "Hospitalism," in The Psychoanalytic Study of the Child, Vol. I ( 1 9 4 5 ) ; Spitz and Wolf, "Anaclitic Depression," in The Psychoanalytic Study of the Child, Vol. II ( 1 9 4 7 ) . 4. Rail, "The Casework Process . . . in the Child's Own Home," in Child Welfare League of America, Inc., Working with the Child and His Parents, pp. 1 - 9 passim. 5. Anna Freud, "Safeguarding the Emotional Health of Our Children," Child Welfare, X X X I V (March, 1955), 1 - 4 passim. 2:

AN ATTEMPT AT CLASSIFICATION OF

PARENTS

1. Weiss, Principles of Psychodynamics, pp. 19-25 passim, 36—44 passim. 2. Beck, "Protective Casework Revitalized," Child Welfare, XXXIV (Nov., 1955), 2. 3. Beck, "Protective Casework Revitalized, Part II," Child Welfare, XXXIV (Dec., 1955), 16-17. 4. Glickman, "The Planned Return of a Child to Own Family," American Journal of Orthopsychiatry, XXIII (Oct., 1953), 834-47; Overton, "Aggressive Casework," Reaching the Unreached, pp. 54 ff. 5. Beck, "Protective Casework Revitalized, Part II," Child Welfare, XXXIV, (Dec., 1955), 17, 19.

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FACILITIES

6. Overton, "Aggressive Casework," Reaching the Unreached, pp. 51-61 passim. 7. This case has appeared in slightly variant form in Glickman, "Treatment . . . after Placement," in Child Welfare League of America, Inc., Working with the Child and His Parents, pp. 11-12. 8. Mahler, "On Child Psychosis and Schizophrenia," in The Psychoanalytic Study of the Child, VII (1952), 286-88 fï. 9. Kanner, "Problems of Nosology and Psychodynamics of Early Infantile Autism," American Journal of Orthopsychiatry, X I X (July, 1949), 420-26. 10. Kanner, "Early Infantile Autism," Journal of Pediatrics, X X V (Sept., 1944), 211-17. 11. Mahler, "On Child Psychosis and Schizophrenia," in The Psychoanalytic Study of the Child, VII ( 1 9 5 2 ) , 288-89. 12. This case has appeared in slightly variant form in Glickman, "Treatment . . . after Placement," in Child Welfare League of America, Inc., Working with the Child and His Parents, p. 12. 13. Ibid. p. 13. 14. Kline, "Differential Diagnosis in Planning Placements for Children," in National Conference of Social Work, 1952, Selected Papers in Casework, pp. 131-34. 15. Rail, "The Casework Process . . . in the Child's Own Home," in Child Welfare League of America, Inc., Working with the Child and His Parents, pp. 2 - 3 . 16. This case has appeared in slightly variant form in Glickman, "Treatment . . . after Placement," in Child Welfare League of America, Inc., Working with the Child and His Parents, pp. 14-15. 3:

TYPES OF PLACEMENT

FACILITIES

1. Dettelbach, Criteria for Agency Referral of a Child to a Residential Treatment Center, in "Symposium, 1954, The Role of Residential Treatment for Children," American Journal of Orthopsychiatry, XXV (Oct., 1955), 670-72 ff. 2. Greenwood, The Role of Psychotherapy in Residential Treatment, in "Symposium, 1954, The Role of Residential Treatment for Children," American Journal of Orthopsychiatry, XXV (Oct., 1955), C97-98. 3. Bowlby, Maternal Care and Mental Health, pp. 67-68, 70. 4. Bowen and Gross, "Services for Children in Independent Boarding Homes," Child Welfare, XXXIV (Dec., 1955), 9 - 1 3 passim. 5. Lander, When Does an Agency Refer a Child to a Residential Treatment Center? in "Symposium, 1954, The Role of Residential

NOTES: PREPLACEMENT

WORK

421

Treatment for Children," American Journal of Orthopsychiatry, XXV, (Oct., 1955), 677-78. 6. Bettelheim, Love Is Not Enough and Truants from Life; Gerchenson, The Improvement-Deterioration of Children in Residential Treatment Units. 7. Mayer, Introduction to "Symposium, 1954, The Role of Residential Treatment for Children," American Journal of Orthopsychiatry, XXV (Oct., 1955), 667. 8. In the Jewish Children's Bureau of Chicago. 9. Reid and Hagan, Residential Treatment of Emotionally Disturbed Children, a Descriptive Study. 10. A unique setting which is neither hospital nor social agency and which functions like this is the Sonia Shankman Orthogenic School in Chicago. See Bettelheim, Love Is Not Enough. 11. Bettelheim, Love Is Not Enough, pp. 17-21. 12. Bettelheim, Truants from Life, pp. 141-43. 13. As, for example, at Topeka State Hospital, Kansas. 14. Bettelheim, Love Is Not Enough, pp. 83-375 passim; Greenwood, The Role of Psychotherapy in Residential Treatment, in "Symposium, 1954, The Role of Residential Treatment for Children," American Journal of Orthopsychiatry, XXV (Oct., 1955), 693. 15. Aichhorn, Wayward Youth, pp. 138-42. 16. Greenwood, The Role of Psychotherapy in Residential Treatment, in "Symposium, 1954, The Role of Residential Treatment for Children," American Journal of Orthopsychiatry, XXV (Oct., 1955), 696. 17. Konopka, The Role of the Group in Residential Treatment, in "Symposium, 1954, The Role of Residential Treatment for Children," American Journal of Orthopsychiatry, XXV (Oct., 1955), 683-84. 18. Ibid., p. 683. 19. Aichhorn, Wayward Youth, pp. 117-42. 20. Greenwood, The Role of Psychotherapy in Residential Treatment, in "Symposium, 1954, The Role of Residential Treatment for Children," American Journal of Orthopsychiatry, XXV (Oct., 1955), 697. 21. Konopka, The Role of the Group in Residential Treatment, in "Symposium, 1954, The Role of Residential Treatment for Children," American Journal of Orthopsychiatry, XXV (Oct., 1955), 681. 4:

PREPLACEMENT WORK WITH

FAMILIES

1. Glickman, "The Planned Return of a Child to Own Family," American Journal of Orthopsychiatry, XXIII (Oct., 1953), 834-38. 2. Flesch, Treatment Considerations in the Reassignment of Clients.

422

NOTES: CHILDREN

AFTER

PLACEMENT

3. Glickman, "The Planned Return of a Child to Own Family," American Journal of Orthopsychiatry, XXIII (Oct., 1953), 838^44. 4. Richman, "Trends in Child Care," Jewish Social Service Quarterly, XXIX (Dec., 1952), 179-80. 5. Glickman, "Ego Treatment Causing Structural Change in Personality," American Journal of Orthopsychiatry, XXV (Jan., 1955), 189. 6. Bowlby, Maternal Care and Mental Health, p. 131. 7. Anna Freud and Burlingham, Infants without Families, pp. 1321; Spitz, "Hospitalism," in The Psychoanalytic Study of the Child, I (1945), 53-55 ff. 8. Spitz and Wolf, "Anaclitic Depression," in The Psychoanalytic Study of the Child, II (1946), 313-42 passim. 9. Anna Freud and Burlingham, Infants without Families, pp. 7 7 82. 10. Bowlby, Maternal Care and Mental Health, pp. 132-34. 11. Bettelheim, Truants from Life, pp. 143—46. 12. Dukette and Gerard, "Techniques for Preventing Separation Trauma in Child Placement," American Journal of Orthopsychiatry, XXIV (Jan., 1954), 111-27. 13. Burnstein and Bruce, Hartford Develops a Program of Subsidized Foster Homes, pp. 62 ff. 14. Sigmund Freud, "Mourning and Melancholia," in Collected Papers, IV, 152-80 passim. 5:

WORK WITH FOSTER

FAMILIES

1. Gerard, "Psychogenic Tic in Ego Development," in The Psychoanalytic Study of the Child, II (1946), 138-39 ff. 2. Kline, "Differential Diagnosis in Planning Placements for Children," in National Conference of Social Work, 1952, Selected Papers in Casework, pp. 136-37. 3. Charnley, The Art of Child Placement, pp. 167-74. 4. Feldman, "The Teaching Aspect of Casework Supervision," Social Casework, XXXI (April, 1950), 160. 5. Littner, "The Natural Parents," in Shapiro, ed., A Study of Adoption Practice, Vol. II: Selected Scientific Papers, pp. 24-25. 6. Johnson, "Sanctions for Superego Lacunae of Adolescents," in Eissler, ed., Searchlights on Delinquency, pp. 225—29. 7. Alexander and French, Psychoanalytic Therapy, pp. 66-70. 8. Sigmund Freud, "Mourning and Melancholia," in Collected Papers, IV, 152-80 passim. 6:

WORK WITH CHILDREN AFTER

PLACEMENT

1. Flesch, Treatment Considerations in the Reassignment of Clients. Z- Glickman, "Ego Treatment Causing Structural Change in Per-

NOTES: FAMILIES

AFTER

PLACEMENT

423

sonality," American Journal of Orthopsychiatry, XXV (Jan., 1955), 177. 3. This has been illustrated in a case report previously presented by this writer in ibid., pp. 177-78. 4. Glickman, "Treatment . . . after Placement," in Child Welfare League of America, Inc., Working with the Child and His Parents, pp. 16-19. 5. Ibid., pp. 17-19. 6. Anna Freud, Introduction to the Technic of Child Analysis, pp. 49-55. 7. Redl, Children Who Hate and Controls from Within. 8. Johnson and Kohlsaat, "Some Suggestions for Practice in Infant Adoptions," Social Casework, XXXV (March, 1954), 91-94. 9. Littner, "The Natural Parents," in Shapiro, ed., A Study of Adoption Practice, Vol. II: Selected Scientific Papers, p. 22; Young, Out of Wedlock, pp. 66-67, 68-72, 76-77. 10. Gerard and Overstreet, "Technical Modification in the Treatment of a Schizoid Boy within a Treatment Institution," American Journal of Orthopsychiatry, XXIII (Jan., 1953), 171-85; Glickman, "Ego Treatment Causing Structural Change in Personality," American Journal of Orthopsychiatry, XXV (Jan., 1955), 171-93. 11. Glickman, "The Planned Return of a Child to Own Family," American Journal of Orthopsychiatry, XXIII (Oct., 1953), 834-47; and "Ego Treatment Causing Structural Change in Personality," American Journal of Orthopsychiatry, XXV (Jan., 1955), 171-93. 12. Jewish Board of Guardians (New York), Primary Behavior Disorder in Children, pp. 9-59; Johnson, "Sanctions for Superego Lacunae of Adolescents," in Eissler, ed., Searchlights on Delinquency, pp. 225-44. 7:

WORK WITH FAMILIES AFTER

PLACEMENT

1. Glickman, "Ego Treatment Causing Structural Change in Personality," American Journal of Orthopsychiatry, XXV (Jan., 1955), p. 182. 2. Alexander and French, Psychoanalytic Therapy, pp. 66-70. 3. Glickman, "Treatment . . . after Placement," in Child Welfare League of America, Inc., Working with the Child and His Parents, pp. 16, 19-20. 4. Federn, Ego Psychology and the Psychoses, pp. 6 ff. 5. Weiss, Ego Strengths and Ego Weaknesses. 6. Weiss, Principles of Psychodynamics, pp. 16-17, 141—42 ff. 7. Ibid., pp. 30-31 ff. 8. Federn, Ego Psychology and the Psychoses, pp. 288-89 ff. 9. Glickman, "Ego Treatment Causing Structural Change in Per-

424

NOTES: TERMINATION

OF

PLACEMENT

sonality," American Journal of Orthopsychiatry, X X V (Jan., 1955), 171-72, 178-81. 10. Glickman, "The Planned Return of a Child to Own Family," American Journal of Orthopsychiatry, X X I I I (Oct., 1953), 834-35, 837-38. 11. Kanner, "Problems of Nosology and Psychodynamics of Early Infantile Autism," American Journal of Orthopsychiatry, X I X (July, 1949), 420-26. 12. Federn, Ego Psychology and the Psychoses, pp. 167, 171 ff. ; Glickman, Discussion of Sherrill, "Therapy with Mothers of Children Having Emotional Difficulties," Journal of Psychiatric Social Work, X I X (Spring, 1950), 140-41. 13. Glickman, "The Planned Return of a Child to Own Family," American Journal of Orthopsychiatry, X X I I I (Oct., 1953), 838. 14. Ibid., pp. 834-39. 8: TERMINATION OF PLACEMENT

1. Glickman, "The Planned Return of a Child to Own Family," American Journal of Orthopsychiatry, X X I I I (Oct., 1953), 834-44 passim. 2. Ibid., pp. 842—44. 3. Ibid., pp. 838—42. 4. Ibid., pp. 843—44. 5. Glickman, "Ego Treatment Causing Structural Change in Personality," American Journal of Orthopsychiatry, X X V (Jan., 1955), 189. 6. Federn, Ego Psychology and the Psychoses, pp. 119-20, 124.

BIBLIOGRAPHY

Aichhorn, August. Wayward Youth. New York, Viking, 1935. Alexander, Franz and Thomas M. French. Psychoanalytic Therapy. New York, Ronald, 1946. Beck, Bertram M. "Protective Casework Revitalized," Child Welfare, Vol. XXXIV, No. 9, November, 1955. "Protective Casework Revitalized, Part II," Child Welfare, Vol. XXXIV, No. 10, December, 1955. Bettelheim, Bruno. Love Is Not Enough. Glencoe, Illinois, Free Press, 1950. Truants from Life. Glencoe, Illinois, Free Press, 1955. Bowen, Ruth, and Zoa Gross. "Services for Children in Independent Boarding Homes," Child Welfare, Vol. XXXIV, No. 10, December, 1955. Bowlby, John. Maternal Care and Mental Health. Geneva, World Health Organization, 1952. Burnstein, Margaret J., and Viva E. Bruce. "Hartford Develops a Program of Subsidized Foster Homes," Public Welfare (American Public Welfare Association, Chicago), April, 1953. Charnley, Jean. The Art of Child Placement. Minneapolis, University of Minnesota Press, 1955. Child Welfare League of America, Inc., see Glickman, Esther, and Rail, Mary E. Dettelbach, Miriam H. Criteria for Agency Referral of a Child to a Residential Treatment Center, in "Symposium, 1954, The Role of Residential Treatment for Children," American Journal of Orthopsychiatry, Vol. XXV, No. 4, October, 1955. Dukette, Rita, and Margaret W. Gerard. "Techniques for Preventing Separation Trauma in Child Placement." American Journal of Orthopsychiatry, Vol. XXIV, No. 1, January, 1954. Federn, Paul. Ego Psychology and the Psychoses, edited and with an Introduction by Edoardo Weiss. New York, Basic Books, 1952.

426

BIBLIOGRAPHY

Feldman, Yonata. "The Teaching Aspect of Casework Supervision," Social Casework, Vol. XXXI, No. 4, April, 1950. Flesch, Regina. Treatment Considerations in the Reassignment of Clients. New York, Family Service Association of America, 1947. French, Thomas M. The Integration of Behavior. Vol. I. Chicago, University of Chicago Press, 1952. Freud, Anna. Introduction to the Technic of Child Analysis. Nervous and Mental Disease Monograph Series, No. 48. New York and Washington, 1928. "Safeguarding the Emotional Health of Our Children: An Inquiry into the Concept of the Rejecting Mother," Child Welfare, Vol. XXXIV, No. 3, March 1955. Reprinted by Child Welfare League of America, Inc., New York, 1955. Freud, Anna, and Dorothy Burlingham. Infants Without Families. New York, International Universities Press, 1944. Freud, Sigmund. "Mourning and Melancholia," in Collected Papers. Vol. IV. London, Hogarth, 1934. Gerard, Margaret M. "Psychogenic Tic in Ego Development," in The Psychoanalytic Study of the Child. Vol. II, 1946. New York, International Universities Press, 1947. Gerard, Margaret M., and Helen Mary Overstreet. "Technical Modification in the Treatment of a Schizoid Boy within a Treatment Institution," American Journal of Orthopsychiatry, Vol. XXIII, No. 1, January, 1953. Gerchenson, Charles P. The Improvement-Deterioration of Children in Residential Treatment Units: A Summary Report. Unpublished paper, Jewish Children's Bureau of Chicago, November, 1953. Glickman, Esther. Discussion of Helen H. Sherrill, "Therapy with Mothers of Children Having Emotional Difficulties," Journal of Psychiatric Social Work, Vol. XIX, No. 4, Spring, 1950. "Ego Treatment Causing Structural Change in Personality." American Journal of Orthopsychiatry, Vol. XXV, No. 1, January, 1955. "The Planned Return of a Child to Own Family," American Journal of Orthopsychiatry, Vol. XXIII, No. 4, October, 1953. "Treatment of the Child and His Family after Placement," Social Service Review, Vol. XXVIII, No. 3, September, 1954. Reprinted in Child Welfare League of America, Inc., Working with the Child and His Parents, New York, December, 1954. Greenwood, Edward D. The Role of Psychotherapy in Residential Treatment, in "Symposium, 1954, The Role of Residential Treatment for Children," American Journal of Orthopsychiatry, Vol. XXV, No. 4, October, 1955.

BIBLIOGRAPHY

427

Jewish Board of Guardians, Staff Members of (New York). Primary Behavior Disorder in Children: Two Case Studies. New York, Family Service Association of America, 1945. Johnson, Adelaide M. "Sanctions for Superego Lacunae of Adolescents," in K. R. Eissler, editor, Searchlights on Delinquency. New York, International Universities Press, 1949. Johnson, Adelaide M., and Barbara Kohlsaat. "Some Suggestions for Practice in Infant Adoptions," Social Casework, Vol. XXXV, No. 3, March, 1954. Kanner, Leo. "Early Infantile Autism," Journal of Pediatrics, Vol. XXV, No. 1, September, 1944. "Problems of Nosology and Psychodynamics of Early Infantile Autism," American Journal of Orthopsychiatry, Vol. XIX, No. 3, July, 1949. Kline, Draza. "Differential Diagnosis in Planning Placements for Children," in National Conference of Social Work (Chicago, 1952), Selected Papers in Casework. Raleigh, North Carolina, Health, 1953. Kline, Draza, and Helen Mary Overstreet. "Maintaining Foster Homes through Casework Skills," Social Service Review (University of Chicago), Vol. XXII, No. 3, September, 1948. Konopka, Gisela. The Role of the Group in Residential Treatment, in "Symposium, 1954, The Role of Residential Treatment for Children," American Journal of Orthopsychiatry, Vol. XXV, No. 4, October, 1955. Lander, Joseph. When Does an Agency Refer a Child to a Residential Treatment Center? in "Symposium, 1954, The Role of Residential Treatment for Children," American Journal of Orthopsychiatry, Vol. XXV, No. 4, October, 1955. Littner, Ner. "The Natural Parents," in Michael Shapiro, ed., A Study of Adoption Practice, Vol. II: Selected Scientific Papers Presented at the National Conference on Adoption January 1955. New York, Child Welfare League of America, Inc., 1956. Mahler, Margaret Schoenberger. "On Child Psychosis and Schizophrenia: Autistic and Symbiotic Infantile Psychoses," in The Psychoanalytic Study of the Child. Vol. VII, 1952. New York, International Universities Press, 1952. Mayer, Morris F. Introduction to "Symposium, 1954, The Role of Residential Treatment for Children," American Journal of Orthopsychiatry, Vol. XXV, No. 4, October, 1955. Overton, Alice. "Aggressive Casework," Reaching the Unreached. New York, New York City Youth Board, 1952. Rail, Mary E. "The Casework Process in Working with the Child

428

BIBLIOGRAPHY

and the Family in the Child's Own Home," Social Service Review, Vol. XXVIII, No. 3, September, 1954. Reprinted in Child Welfare League of America, Inc., Working with the Child and His Parents, New York, December, 1954. Redl, Fritz. Children Who Hate. Glencoe, Illinois, Free Press, 1951. Controls from Within. Glencoe, Illinois, Free Press, 1952. Reid, Joseph H., and Helen R. Hagan. Residential Treatment of Emotionally Disturbed Children: A Descriptive Study, New York, Child Welfare League of America, Inc., 1952. Richman, Leon H. "Trends in Child Care," Jewish Social Service Quarterly, Vol. XXIX, No. 2, December, 1952. Sherrill, Helen H. "Therapy with Mothers of Children Having Emotional Difficulties," Journal of Psychiatric Social Work, Vol. XIX, No. 4, Spring, 1950. Spitz, René A. "Hospitalism: An Inquiry into the Genesis of Psychiatric Conditions in Early Childhood," in The Psychoanalytic Study of the Child. Vol. I. New York, International Universities Press, 1945. Spitz, René Α., and Κ. M. Wolf. "Anaclitic Depression: An Inquiry into the Genesis of Psychiatric Conditions in Early Childhood," in The Psychoanalytic Study of the Child. Vol. II, 1946. New York, International Universities Press, 1947. Weiss, Edoardo. Ego Strengths and Ego Weaknesses. Chicago. Unpublished. Principles of Psychodynamics. New York, Grune, 1950. Young, Leontine. Out of Wedlock. New York, McGraw, 1954.

INDEX

Acceptance, by child, of controls, 90 f.; of child for himself, 194, 208; of child's family, by worker, 246 f., 332 f.; of child's hostility, 122 f., 126, 296; of reality situation re parents, 297 ff.; verbalized, of hostility, 293; see also Reassurance Accident, death by, 261 Achievement, strength through, 343 Acting out, 85; in adolescence, 181, 216 f., 264; and anxiety, 249 f.; as child's response to placement, 211; as defense, 91; effect of, in group living, 95; of emotional disturbances, 78; of impulses, 354; by parent toward child, 98; self-punitive devices for, 284; understanding of child's problem gained through, 87 Action, choice of, see Choice of action Activity, discussion with child in terms of his, 256 f.; familiar, continuance in new environment, 148 f. Adjustment, parental, three major areas of, 12 f.; of child at school and play, 255; see also Integration Adolescence, destructiveness in, 264; disturbances of, and foster family, 195 Adolescent, acting out, 181, 216 f., 264; club residence for, 80, 415 f.; disturbed, treatment in hospital setting, 85; ego strength through working, earning, planning, 413 f.; sharing of family responsibility, 412; support to, on return to family, 410 ff.

Adoption, by foster family, 241; indications for, 344 f.; parental refusal to relinquish child for, 376 ff.; preparation for, in neutral group living, 96 Adoptive home, 68 f. Adults, child's relationships with, in therapeutic program, 86 f.; immature, 310 ff., 320, 365 (see also Immaturity; Maturity) Age, as factor in matching child and foster family, 194 f.; and termination of placement, 410 ff. Agencies, variations in philosophy and policy, 99 ff. Agency, placement, see Placement agency "Agency-made psychopath," 66 Agency-owned foster home, 73 Agency-owned group home, example of treatment in, 281-327; see also Group homes Agency treatment centers, as community resources for individual, 93; and hospitals, differences between, 92 f.; see also Residential treatment centers Aggregate institutions, 74-76; see also Dependency, care Aggression: oral, 36; permissivity of, 272; treatment of, in controlled environment, 91; see also Anger; Hostility; Rage Alcoholics, 346 Ambivalence, parental, 162; explanation to child of, 400 f.; re placement, 18 f., 54; re return of child, 389, 402 f. Ambivalence of child, 120; re return to family, 297 ff., 310 f., 318 ff.,

430 Ambivalence of child (Continued) 398 {.; toward foster home, 356 Anger, expression of, 293, 397 f.; fear and guilt over, 363 ff.; focus of treatment, 285 ff. ; repression of, 365; resistance to discussion of, 317; verbalization of, 293, 296 ff., 368; of worker toward parents for damage to child, 334 f., 352; see also Hostility; Rage Anxiety, in character structure, 63; of child re return to family, 398 f.; diminution of, 90; of foster mother, 213; individual and group, 95; parental, agency's role in, 9 f.; re pregnancy, 230, 232; and rage, 142 f.; underlying cause of acting out, 249 f.; see also Fear Attitudes: objective, and acceptance of foster child, 221 ff., 241 f.; parental, inaccessible to change, 357 — subjective, of foster family, 204 f.; of worker, 16-19, 195-200, 249 f., 334 f. Authority, over child, division of, 234 f.; consistent, 273 f.; of court, see Court, Court action; firmness tempered with warmth, 247; of parent-figure, 234 f.; see also Discipline; Restrictions Autism, causes of, 35, 141; development of, in child, 30 ff.; need for excessive mothering, 188; placement problem, 31 ff., 344; and relation to reality, 77 Baby, see Infant Behavior, bizarre, 35 f.; conforming, 158, 192, 208, 264, 284, 328; criminal, of parents, 26 f., 269 f.; destructive, 283; deviations in, and mistaken theories of placement, 70; regulation of, by ego energy, 341; unconscious motivation of, 27 Behavior, disturbed: discussion of, with foster family, 206 ff.; effect of group pressure on, 94 f.; foster father's role in overcoming, 190 f.; motivation of, 14; objective attitude toward, 221 ff.; and professional foster home care, 71 f.; supportive discussion of, with child,

INDEX 139 f.; after visits to relatives, 386 Behavior disorders, causes of, 155 f.; as problem of placement, 88; in the school situation, 88 f. Birth, explanation of, to young girl, 303 ff.; see also Childbirth Boarder, older boy as, 190 f. Boarding home, 71 Boys, agency allowance to, 414 f.; control of mother, 405 ff.; girl's attitude toward, 322, 326 f.; jealousy of brothers, 292; mother's use of, to fulfill dependency needs, 174 f.; need of father-figure, 155; older, and suitable foster family, 190 f. Budgeting, adolescent training in, 414 ff. Care, of child, after restoration of family, 407; custodial, 77; family vs. institutional, 99 f.; personal, of child, 251; physical, neglect of, 281 ff., 297; temporary, of emergency cases, 96 Caseworker, dynamic relationship with parent and child, 110-15; transfer to, f r o m intake worker, 105-9; see also Worker; Workerchild relationship; Worker-parent relationship Casework relationship, development of, 245-59; see also Worker-child relationship; Worker-parent relationship Character structure, of child of narcissistic parents, 49; compulsions in, 63; damage to, f r o m lack of mothering, 142 f.; and ego energy, 338 ff.; of family, diagnosis of, 12 ff.; location of disturbance in, 24 f.; management of, through ultimatum, 357 f.; of members of foster family, 171 ff.; mixture of components of, 63; modifications and compensations, 194; narcissistic, 42 (see also Narcissism); of parents, 18 f., 23-100; of parents, and placement goals, 344 f.; of parents, and termination of placement, 391 ff.; and resolution of hostility, 390; working within dynamics of, 219-24 Charnley, Jean, 181

INDEX Child, abandonment of, preplacement work with parent to avoid, 103 ff. ; acceptance of, for himself, 194, 208; adjustment at school and play, 255; aid to, in differentiation from parent, 279; areas of life adjustment, 13; behavior deviations, 53 (see also Behavior, disturbed); conflict of loyalties (q.v.), 240 f.; confusion re "real" and foster mother, 376 ff.; contacts with parents and relatives, 371-87 (see also under Visits); continuance of familiar activities in new environment, 148 f.; danger to, from psychotic or criminal parents, 26 f.; and death of parent, 260 f.; death wishes re sibling, 383; defenses for sibling rivalry, 382 f. (see also under Defenses); description of, to foster family, 206 f.; developmental history of, 13 f.; and division of authority, 234 f.; emergency placement, 147 ff.; as emotional crutch to mother, 31; exhibitionistic, 42 f., 192; explanation to playmates re return to family, 407; explanations to, see Explanations; fear of, and refusal of contacts with, parent, 377 f.; first meeting with worker, 115 ff. (see also Worker-child relationship); foster home care, 16 f. (see also Foster home; Foster family); fun with housemother, 301; fun with mother, 292; fun with parents, 256; healthy growth, 194 ff. (see also Growth); hostility toward mother, 126, 230 f., 286, 351; hostility toward parents, 250, 396 f.; hostility toward worker, 121 ff.; identification with wishes and attitudes of, 120; importance to, of decision for placement, v, 4; inferiority feelings of, and rejection, 209 f.; interpretation of death of parent as rejection, 260; knowledge re, 155-61; lack of understanding of separation from parent, v, 380 f.; longing to return home, 285 ff., 290 ff., 394, 410 f.; love of fun, 301, 358; manipulation of foster family, 263 ff.; memory of mother's homicidal attack

431 on, 378; mental health of, 14; misconceptions re foster home, 103 ff., 126 f.; misconceptions of sex, 302 ff.; moving to foster home, 136 ff.; need for mothering, 139 ff.; needs of, 155 (see also Needs); only, in foster family, 182 f.; parental bar to development of, as separate entity, 29 ff.; parental concern for welfare of, 55, 58; and parental quarrels, 45, 157 ff.; parent's sexually delinquent behavior and, 275 ff.; payment for support of, 19 f., 50, 5 1 , 7 2 ff., 393, 412 ff.; placement based on needs of, 65 ff., 107; preparation for return to family, 127 f., 395-410; preparation for separation from mother, 33, 115-29; reactions to placement, 15, 120 ff.; reactions when needs are not met, 155 f.; readiness for placement, 144; realistic attitude toward neurotic parent, 372 ff., 391, 411; and recognition of selfworth, 42 ff.; relinquishment of family tie, 270 f., 299 ff., 350 ff.; relinquishment of foster family tie, 395 ff.; sharing of mother, 404 ff., 406 f.; sharing of parental love, 383 f.; and social opinion of peers, 94; suitability of foster home to, 168 f., 192; supervision of life situation, 251 f.; timing of information to, of return to family, 397 ff.; as toy for parent's gratification, 42 ff.; training to assume responsibility, 183 f.; treatment of personality damage before placement, 252-54; treatment of separation trauma, vi, 253, 32831; types unacceptable to foster families, 67 f.; worker's acceptance of family, 246 f., 332 f.; worker's relationship with, 233 f. (see also Worker-child relationship) — conforming: behavior as defense, 158, 208, 264, 284; suitable foster home for, 192; and treatment for separation trauma, 328 — disturbed: barriers to constructive use of placement, 244; behavior disorders, 8, 87 ff., 112; contact with parents, 372 ff.; explanation

432 Child, disturbed (Continued) of, to parents, 408 f.; and foster mother, 221 fit., 237 f.; improvement in, 91 f., 388 f.; incapacity for object relationships, 84; institutional care of, 74 f.; internalization of réactions, 87 f.; learning process, 88 f.; need for and acceptance of controls, 90 f., 192; replacements, 282 ff.; residential treatment centers, 80-94; response to placement, 210 f.; and social opinion of peers, 94; termination of placement, 394 f.; treatment for, 10, 81 ff., 328 — older: as asset to parents, 411; payment for chores in foster home, 183 f. — psychotic: and the foster home, 141 ff.; need for warmth of love, 247; specialized hospitals for, 77; treatment of, 84, 88 f., 257 f.; worker and, 196 f. — withdrawn: placement of, 78; treatment setting for, 83 f., 88 f. — young, explanation to, of father's imprisonment, 271 f.; in institutional setting, 140 ff.; and knowledge of parent's psychotic behavior, 268; memories of death, 397; need for personalized attention, 140 f.; play technique in preparation for foster home, 130 ff. Childbirth, mother's death in, 261 ff.; see also Birth Child guidance, 253 ff., 329 Choice of action, as dynamic support, 337, 339, 354 f., 357 Classification, psychosocial, of parents, 23-100 Clinic, psychiatric, treatment of parent by, 361 f. Clothing, budget for, 414 Comic books, child's resort to, as evasion in treatment sessions, 288, 293, 298 f. Community, agencies, role in placement, 5; facilities for child care, 67; foster family and, 168; protective work with youth, 27; resources, 101 Companionship, as motivation of foster mother, 182 f.

INDEX Compulsions, in character structure, 63; and defenses, 412 f., 417 Conflicts, internal, and breakdown of neurotic balance, 360 f.; of loyalties, see Loyalties, conflict of; in maturation process, 328; resolution through parent-child relationship, 402 f.; revival of, on return of child to family, 402 f.; uncovering of, 360 — parental: agency's supportive help in, 51 ff.; and ambivalence re placement, 54; effect on foster family, 162 — personal: direct treatment of, 224 f.; and group living, 95 f.; indirect approach to, 223; internalization of, 277 f.; partialized areas of, 222, 224 f., 226-33, 362 ff.; uncovering of, 227 ff.; of worker re child, 335 Contractual foster home, 72 f. Control, of child, see Discipline; Restrictions; of foster mother by child, 264; of mother, by child, 363 ff., 405 f. Controlling and directing, as motivation of foster mother, 181 Correspondence, preplacement, between worker and child, 137 f. Cottage plan, in institutional facilities, 74 Counseling, of foster family, 211 f.; at onset of placement, 235 f.; of parents, 18ff. (see also Workerparent relationship) Court, and agency guardianship of child, 395; contempt charge against parents, 20 f.; intervention when child fears parent, 377; placement ordered by, and intake study, 4; referral of parents to, 20; removal of child from sexually delinquent parents, 275 ff., 336 f.; and replacement after restoration of family, 390 f.; role of, in placement, 20 ff., 118 f. Court action, for child's protection, 28 f.; necessity for because of character structure of parents, 26 f., 392 f.; parental reaction to placement by, 105 f.; as treatment measure for parents, 391 f.; work-

INDEX er's help to parent in regard to, 110 f. Court order, in case of sexual delinquency, 336 f.; explanation to child of placement through, 291 f.; placement through, 118 f., 201 f., 323 f. Creation, explanation of death in terms of, 261 Crime of parent, and child's behavior, 26 f., 269 f.; explanation of, to child, 273 Criminal, treatment at point of defense, 349 Crisis, disruption of parental functioning by, 50 ff., 359 f. Curiosity, of child, re relatives, 387; re siblings, after placement, 384 Custody, legal, of child of divorced parents, 21 f.

433 tions for, 74-76; longing for, of child, 65; of mother on child, 34 f., 373 ff.; of older boy on father-figure, 190 f. Dependency gratification, of child through control of mother, 405 f.; early, and refusal to assume responsibility, 413; of foster mother and child, 215-18; mother's need for, 62; need for, 180 Dependency needs, of foster mother, 203 ff.; frustration of, 363 ff.; gratification of, through child, 174 f., 365 ff.; and relinquishment of family tie, 320 f.; transference f r o m mother to mother-figures, 312 f.

Day foster care, 51 Death, of brother, 317 f.; child's memories of, 387; explanation of, to child, 259 f.; of mother in childbirth, 261 ff.; of parent, 260 f.; wishes, of child re sibling, 383 Defenses, acting out as form of, 78 (see also Acting o u t ) ; child's clinging to, 254; compulsive, 412 f., 417; conforming behavior, 158, 208, 264, 412 f., 417; emotional, of the child, 121 f.; money as, 219-21; need of, 290; of parental adequacy, 352; parental hostility to foster family as, 159 f.; psychological, types of, 63; psychotic behavior as, 347; rebuilding of, 359 f.; refusal of gift as, 288; secrecy and manipulation as, 264; for sibling rivalry, 382 f.; unresponsiveness as, 144 f.; vocabulary and pseudomature manner as, 124 ff.; weakening of, 226; worker's respect for, 245 f. Delinquency, development of patterns of, 46 ff., 65 f.; scientific approach to, 50; sexual, in mother, 336 f.; and specialized institutions, 76

Depression, of child re return to family, 398; chronic, 112, 281 ff.; and emotional deprivation, 34; as feature of character structure, 63; psychological diagnosis of, 25 Deprivation, early, compensations for, 330 f., 350; effect of, in later life, 214 f., 220 f., 364 ff.; emotional, effect of, 34 f., 42, 48 Desertion, explanation of, to child, 275; and feelings of inferiority, 263 f. Diagnosis, as basis for choice of placement facility, 101; of child's placement needs, 65 ff.; through description of typical day in child's life, 14; and elimination of replacement, 96; evaluation of material, 16 f.; of family character structure, 12 ff.; of necessity for placement, 3-22; of parent and child and their relationship, 12 ff.; psychosocial, of parents, 23-100; and work with foster family, 153 f. Discipline, child's need of, 90 f., 192; child's need for understanding of, 409; fantasies of child, 409; positive, 343; see also Restrictions Disturbances, behavioral, see Behavior, disturbed; emotional, see Emotional disturbances; psychological, quantity and location of, 23 ff.

Delusions, parental, explanation to child of, 267 Dependency, care, aggregate institu-

Divorce, 369 f.; child's attitude toward parents', 324 ff.; explanation of, to child, 274; father's arrange-

434 Divorce (Continued) ments for contacts between child and relatives, 385 f.; legal custody of child, 21 f.; and parental visits to placed child, 160 Drowning, attempted suicide by, 314 ff. Dukette, Rita, and Margaret W. Gerard, 146 Dynamics, psychological, classification according to, 26-63 Dynamic support, see Support, dynamic Earnings, budgeting of, 414 ff.; of child, as asset to parents, 411; for chores in foster home, 183 f. Eating, fussincss re, 156

Economic situation, of family, 19 f., 51; as foster parent's motivation, 179 ff. Ego, defects in boundaries of, 341 ff.; growth, 90; resources, 48 f.; weak, deficient in libido energy, 338 ff.; see also Libido; Superego — strength: derived from motherfigure, 364; support and encouragement of, 360; through working and planned spending, 413 f. — structure: effect on, of parental sexuality, 276; weak, of parents, 335 f. Ego defect, 63; in the disturbed child, 88 f.; and incapacity for positive relationships, 348; in parents, 2629, 345-47; and placement, 344 f. Ego energy, comparative adequacy of, 358 ff.; concepts of, 338 ff.; and emotional economy, 358 ff.; lack of, 352; and libido, 340 — depletion of, 53, 342; through child's sexual overstimulation, 276; example, 60-63; from external crises, 359 Ego states, 338-39 Emotional disturbance, of child, 10 (see also Child, disturbed); environment during treatment for, 82 ff.; and institutional care of children, 74 f.; parental, 18 f.; reluctance to relinquish, 89 f. Emotional economy, 23-25; assets and liabilities in, 63; effect of in-

INDEX creasing demands upon, 43 f.; and ego energy, 358 ff.; of foster family, 170-77; inability to invest in others, 67 f.; of mother of autistic child, 29-41; and personality resources, 50 f.; see also Energy, emotional Emotions, destructive, 409; ventilation of, 211 f., 257 f. Employment, of older adolescents, 414 f. "Empty nest," as motivation of foster mother, 181 f. Energy, emotional, adequacy of, and role of parent, 23 ff.; depletion of, 53, 62, 115, 335; and investment in others, 67 f., 144; of mother of autistic child, 29 ff. Environment, therapeutic use of, 86 ff., 329; in residential treatment center, 90 ff.; treatment of disturbed child limited by nature of, 82 f. Equilibrium, see Mental health equilibrium; Neurotic equilibrium Evaluation, of diagnostic material, 16 f.; of effect on child, of placement, 390 f.; and emergency placement, 150; of foster family by worker, 197 ff.; of parental potential for restoration of family, 389; of reality situation, 52 Examples, breakdown of neurotic equilibrium, 50-63, 358 ff.; child's reactions to mother's death from childbirth, 263-65; direct treatment of conflicts in foster mother, 227-32; divorced father's arrangement for contacts between child and relatives, 385 f.; dynamic supportive work with foster family, 215-18; effect of meaningful relationship with worker after termination of placement, 418; effect of no preplacement work with mother, 104 f.; ego-defective parents, 28 f.; ego strengths and weaknesses derived from early experiences, 339 f.; expenditures of savings for personality growth and security, 416; face saving through choice of action, 355; foster mother's constructive sublimation of

INDEX neurotic needs, 185-88; foster mother's gratification of her own needs in foster child, 171 f.; girl having neurotic tie with mother, a, suffering chronic psychotic depression, 280-327; gratification of defensive needs for money, 21921; mother's dependency needs gratified by young son, 174 f.; mother who maintains mental health equilibrium through child, 36 f.; narcissistic parents, 44-50; parental wishes and expectations, 10-12; parent with weak ego structure, 336 f.; personality growth through achievement, 343 f.; placement disturbed by mother's neurotic tie to child, 372-75; preparation of young child for return to family, 116 f., 122 ff., 404 f.; preservation of family through casework with parents, 38-41; psychotic mother prevented from seeing child, 378; realistic and specific knowledge of child, 157 ff.; of remedial treatment and change in personality, 363-71; restoration of family after mother's remarriage, 405 ff.; understanding foster mother through her social history, 172 f.; workerchild relationship as bridge over separation f r o m family, 130 ff.; worker's neutral role and handling of child's hostility, 122 f.; work with young child re father's imprisonment, 271 f. Excrement, eating of, 35 Exhibitionism in child, and matching foster family, 192; as cover for inferiority, 42 f. Experiences, emotional, positive and negative, 338 ff.; painful, repression of, 256 Explanation, of agency role in placement, 122 f.; of ambivalence, to child, 400 f.; of birth, to young girl, 303 ff.; of child's needs, to parent, 408; of death, to child, 259 f.; of desertion, to child, 275; of disturbed child, to parents, 408 f.; of emergency placement, to child, 150 f.; of father's imprisonment,

435 to young child, 271 f.; of illegitimacy, to child, 279 f.; of mental illness, 266 f., 287, 292, 310 ff.; of murder, to child, 266 f., 269 f.; of nature of parent-child relationship, to foster family, 161 f.; of parental delusions, to child, 267; of parent's criminal behavior to child, 273; of parent's sexual delinquency, to child, 278; of pathological facts of life, to child, timing of, 268 f.; of pregnancy, to young girl, 303 ff.; of return to family, by child, 407; of sexual intercourse, to young girl, 302 ff.; of suicide, to child, 265 ff.; in terms of child's understanding, 267 f. Face saving, and false pride, 354 f.; and narcissistic character structure, 392 f. Family, acceptance of, by worker, 246 f., 332 f.; casework to avoid broken home, 17, 38 f.; change of situation, and return of child, 394 f., 404 f.; child's acceptance of reality situation re, 297 ff.; diagnosis of character structure of, 12 ff.; disrupted by tragedy, and emergency placement, 50 ff., 146 ff.; effect on child of dissolution of, v, 64; financial aid to, 20, 50, 51, 72 ff., 412 ff.; financial situation, 19 f.; importance of intake study to, 3 ff.; importance of ties, 387; integrative capacity of, 24, 27, 29, 53 f., 359, 371 f.; integrative capacity of neurotic tie to mother, 281-327; interrelationships, 24 f., 161 f.; jealousy of preferred child, 383; knowledge of, 159-61; positive and negative values, 56, 358 f.; preparation of, for return of child, 395-410; preservation of, 38-41; question of child's return to, 127 f.; religious preference, 7, 11, 189; relinquishment of tie to, 254 f., 312 f., 317, 332 ff., 381; restoration of, after placement, 53 (see also Restoration of family); role of, 64-66; semblance of unity, 49; shared experiences,

436 Family (Continued)

384; social situation, 8; source of personality development, 99 f.; visits to, 284, 294 f., 300; worker's acceptance of, 246 f. Family agency, referral of parent to, for therapy, 361 f.; role of, 333 Family casework, indications for, 54; service, 51 Fantasies of child, re his destructive emotions, 257 ff.; re discipline, 409; re family, 399 f.; of responsibility for mother's death, 262 f.; re return to family, 386 ff., 411; re violent death, 266 ff. Father, alcoholic, 29; of autistic child, 31, 35; dependency conflicts, 55; identification with, 172 f.; imprisoned, 272 f.; ineffectual, 281 ff., 296 ff.; influence on girl's attitude toward boys, 322 ff.; as integrative factor in family, 38-41; and placement problem, 11 f.; psychotic attachment of daughter to, 36 f.; sentenced for murder, 269 f. Federn, Paul, 338 Feeble-mindedness, 77 Feeding problem, 156 Financial support, see Support, financial Foster family, age and sex of own children as consideration in placement, 194 f.; attitude toward the natural family, 176 f.; attitudes toward role and care of foster child, 164 f.; caretaking activities, 242; child's first contact with, 129-39; child's manipulation of, 263 ff.; and child's ties with natural family, 209 f.; child's visits to, after termination of placement, 410; diagnostic information as guide in work with, 153 f.; disruptive effect of parental visits, 372 ff., 378 ff., 390; example of use limited to specific child, 186 ff.; explanation to, of parent-child relationship, 161 f.; explanation to, of specific nature of foster child care, 165 ff.; foster child as replacement for deceased baby, 186 ff.; friendliness with child's

INDEX relatives, 317, 324, 386; importance of knowledge of, 152; initial response to foster child, 206 ff.; interpersonal relationships, 94, 177 f.; life situation, 167-71; matching child with, 189-95; motivations, 166, 171 ff.; negative and positive values, 170 f., 189 ff.; objective attitude toward foster child, 221 ff., 241 f.; with only child, 182; preparation of, for emergency placement, 150; preparation of child for separation from, 395 ff.; preplacement meetings with child, 209 f.; reaction to nature of parent-child relationship, 161 f.; reappearance of natural parents, 376 f.; reasons for replacement, 139 f.; rejection of application, 166; relationship with natural family, 238 ff.; relationship with worker, 200-205; responsibility, 251; standing in the community, 168; strength of ties with, 385; strict, orderly, 192; study of, 198; tensions in, 237; and termination of placement, 395 ff.; testing-out period with foster child, 207 f.; wishes and expectations re foster child, 164 ff.; work with, 152-242 Foster father, aid to foster daughter in resolution of oedipal conflict, 218; dominant, older boy's transferral of identification to, 190 f.; placement work with, 212; role of, with young boy, 155 Foster home, agency-owned, 73; ambivalence of child toward, 356; atmosphere, 169; availability of, 169 f.; behavior disturbances as bar to, 112; child's introduction to, 134 f.; contractual, 72 f.; contraindications for placement in, 78; description of, to child and parent, 127 f., 129, 143; disturbances of, by parents, 159 f., 355 ff.; in dwindling supply, 100 f.; education f o r living in, 144 f.; free, permanent, 68; hazards for child in, 16 f.; indoctrination in regime of, 145; moving into, 136 ff.; for older adolescent, 415 f.; over-all super-

437

INDEX vision of child in, 233-42; physical condition, 168; placement based on diagnostic appraisal, 65; play technique in preparation for, 132 f.; private, 69 ff.; professional, 71 f.; and the psychotic child, 141 ff.; replacement from, 139 f.; selection of, 69 ff.; study of, 16389; subsidized, contractual, and agency-owned, 72 ff.; value of worker's visits to, 252 Foster mother, adjustment of own children, 174 f.; ambition for professional knowledge, 185 f., 203; child as replacement for dead son, 219-21, 228 ff.; direct treatment of conflicts in, 227-32; disclosure of background experiences, 222 ff.; dominating, 203; emotional needs, 179; explanation to child of status of natural parents, 376 f.; foster child as threat to adequacy of, 177; inconsistent behavior, 212 f.; investment of self, 214 f.; motivation, 182 f., 184, 219-21, 228; need of mothering, 215-18; personality, 153; positive and negative values, 176; preference for foster child, 177 f.; rivalry with worker, over child, 234; social history of, as aid to self-understanding, 172 f.; test of, in capacity to give mothering, 179 f.; as threat to own mother, 358; wish for larger family, 184 Foster parents, caretaking activities, 236; counseling on child's deviant behavior, 155; explanation to child of reasons for placement, 255; inservice training, 98; life experiences of, as basis for guidance, 212; motivations, 178-89; periods of crisis, and function of worker, 210; preparation for receiving child, 136; professional, 79; response to worker's counseling, 211 f.; rivalry with parents over child, 161; training in special skills, 76 f.; subjective attitudes, 204 f.; value of knowledge of social history, 172 ff. Freud, Anna, 16 Frustration, without compensation, 338 ff.; and rage, 266 f.; release

of, through permissible tiveness, 257

destruc-

Games, competitive, therapy through, 293; see also Play Gerard, Margaret W., 146 Gifts, f r o m family to placed child, 240; promises of, to child, 374; refusal of, as defense for aggression, 288 Girl, agency allowance to, 414 f.; attitude toward boys, 322, 326 f.; case of neurotic tie with psychotic depression, 280-327; effect on behavior of, of father's crime and imprisonment, 269 f.; jealousy of brothers, 292; predelinquent, and personality growth through achievement, 343 f.; resolution of oedipal conflict through foster father, 218; use of money in growth of personality, 416 f. Giving, constructive, 179 f., 214 f.; at point of need, 393 Goals, of placement, 344 f. Grandmother, companionship with, 340; psychotic, boy's visit to, 386 Gratification, dynamic, and replenishment of ego energy, 342 f.; libidinal, and ego strengths, 338 ff.; misdirected source of, 262; in terms of need rather than neurotic demand, 113 f.; through talented child, 192; see also Dependency gratification; Self-gratification Grief, guilt as neurotic element in, 229 f. G r o u p care, facilities for, 74 Group homes, 78-80; indications for placement in, 282; see also Agency-owned group home Group living, benefits in, 94; influence of, on parents, 96 f. Group setting, sharing of parentfigures, 144 Growth, healthy, of child, 194 ff.; toward independence, and relinquishment of family tie, 182 f.; toward maturity, 328; and meaningful relationships, 413; need for self-realization, 54 f.; of personality, 64, 416 f.

438 Guilt feelings, over anger, 317, 363 ff., 398; beneficial release of, 108; over conflict of loyalties, 78, 312; of foster mother, 178, 213; over hostility toward mother, 286 ff. (see also Hostility); interpretation of universal nature of, 257; as neurotic element in grief, 229 f.; parental, 18 f., 53 f., 57 f., 97, 108, 109, 396 f.; parental quarrels and, 157 ff.; over placement, 53 f., 57 f., 366 f., 396 f.; rationalization of, 97; reduction of, through reassurance, 172; restitution for, 318 ff., 411; self-punishment for, 298 f.; and sexuality, 276, 308 f.; verbalization of, 297 f.; of worker, 119 f., 197 ff.

Hagan, Helen R., 80 Handicap, physical, and professional foster home care, 71 f.; and specialized institutions, 76 f. Handling, see Therapy; Treatment Hardships, childhood, effect of, 364; see also Deprivation Health, flight into, 314 History, diagnostic, see Diagnosis; intake study Home, child's criticism of, 281-327 passim; treatment of autistic child in, 32 ff.; see also Family; Father; Mother; Parents Homemakers, emergency, 147 Homemaking services, 50 Hospitalization, explanation of, to child, 315 f.; of mother, child's idea of, as desertion, 287 Hospitals, and agency centers, differences between, 92 f.; locked ward, 85 f.; psychiatric residents, 93; residential treatment facilities, 80-82; specialized, for care of children, 77; types of settings for treating disturbed children, 81 ff. Hostility, expression of, 35 f., 120 f., 285 f., 360; and feeding problem, 156; to mother, 33, 126, 294 f.; to mother-figure, 289 ff.; and overprotection, 383; toward parents, 250, 396 f.; toward worker, 121 ff.; reduction of, 124 f.; and relin-

INDEX quishment of tie to mother, 351; see also Anger; Rage Housemother, conflict in loyalty to, 289; fun with, 301; hostility toward, 294 f.; therapeutic role of, 286 ff.; see also Foster mother Houseparents, child's relationships with, 86 f.; in group homes, 79; professional, and emergency cases, 96; relations with parents, 98; in social agency setting, 81 Housework, mother's attitude toward, 339 f. Hysteria, manifestations resembling psychotic episode, 85 Identification, and feelings of inferiority. 263 f. — of child: with father, 172 f.; with mother, 320 f.; with parent-figure, 235; with parent's love for sibling, 382 f.; with teachers, and capacity to learn, 186 — of foster mother, with placed child, 171 f. — of worker: with child, 196 f., 233 f., 248 ff.; with child and parent, 119 f.; with child's love for mother, 284; with foster parent, 237 Illegitimacy, explanation of, to child, 279 f. Illness, and death, 261 Immaturity, in adults, 310 ff., 343; and arrested development of personality, 42, 343; and dependency needs, 365; of parents, 336 Impulses, containment of, 342 f., 352, 354; destructive, internalization of, 91; and integration, 341; vs. judgment, 340 f. Incest taboo, as factor in placement, 195 Income, extra, as motivation of foster family, 179 ff. Independence, growth toward, 412 f.; through renunciation of parents, 182 f. Individual, most important areas of current life situation, 174 Infant, development of relationships through personalized care, 140 f.; maternal warmth of stronger effect

INDEX than psychotic behavior, 281-327; needs of, 155 "Infantile neurosis," 171 Inferiority, feelings of: boasting as cloak for, 48; caused by rejection, 209 f.; cloaked by exhibitionism, 42 f.; hidden, 352; identification and, 263 f.; and illegitimacy, 280 Information, spontaneous, from the parent, 7 f.; see also Explanation In-service training, of workers, in child guidance, 253 f.; of foster parents, 98 Insight, into neurotic needs, 185; into unconscious needs, 196 "Insight, sickness," 89 Institution, child's relationships to personnel, 143; closed, 85 f.; controlled environment of, 81 ff.; facilities, 74-80; i m p e r s o n a t e d care, 140 f.; and parents' undesirable behavior, 98; replacement from, 140-45; specialized, 76 f. Intake, agency policies, 66 ff.; parents' participation in, 17; process, methods of, 3 ff. Intake study, content of, 6-8; development of casework relationship during, 245; diagnostic history, 359 f.; diagnostic picture, 380 (see also Diagnosis); evaluation of parental potential for restoration of family, 389; example of parental wishes and expectations, 10-12; purpose and extent of, 3-5; questions answered by, 5-13; use of, in preplacement work, 107 ff.; value of, 71 Intake worker, aid to parent in reaching decision for placement, 6; contact with child, 15 ff.; relationship with parent, 3 f.; transfer of parent to caseworker, 105 ff.; see also Worker Integration, of child's emotions re separation from and return to family, 396 ff.; and impulses, 341; of old and new ties, 341, 410; of relationships, 381, 386 Intelligence, matching child and foster family on basis of, 192; see also Learning

439 Intercourse, sexual, explanation of, to young girl, 302 ff. Interests, sublimative or social, 12 f. Interpersonal relationships, see under Relationships Interpretation, of parent's attitude and behavior, 258; of play material, 256 ff.; see also Explanation Interviews, treatment, see Treatment interviews Investment, of child's dependency longings, 65 f.; of self, 214 f., 225; of self, and emotional economy, 67 f., 144 Jealousy, of brothers, 292; of mother, 295; of sibling still with parents, 383; see also Sibling rivalry Juvenile courts, 27 f. Kline, Draza, 53, 177 Learning, capacity for, and identification with teachers, 186; disturbed child's block against, 88 f. Libido, 338; and ego energy, 340 License, state, for foster homes, 69 Life situation, of child, over-all supervision of, 251 ff.; current, 160 f.; of foster family, 167-71; important areas of, 174 Loss, of other ties in child's return to family, 399 f.; of valuables, as self-punishment, 298 f. Love, parental, sharing of, 383 f.; psychotic child's need for warmth of, 188, 247; see also Mothering; Warmth Loyalties, of child to parents, 94 — conflict of, 241 f., 288 ff., 295, 390; guilt over, 78, 312; and relinquishment of family tie, 299 Marriage, desire for preservation of, 55; use of children to maintain, 39-41; see also Divorce; Remarriage Masochism, 29, 365; in mother's sacrifice, 58 Masturbation, 302 f., 305 f. Matching of child to foster family, 189-95; general examples of,

440 Matching to foster family (Cont.) 191 ff.; and religious preference, 11 f., 189 Maturity, criteria of, 195 f.; dependency tie as barrier to, 320; emotional, attainment of, 365 ff. Memories, repression and revival of, 397 Menstruation, 307 f. Mental health, of child, 14; see also Mental hygiene concepts Mental health equilibrium, breakdown of, 358 ff.; parental maintenance of, through emotional dependency on child, 29-42, 349-51; recovery of, and return of child, 394 Mental hygiene concepts, approach to the assumption of responsibility, 412; in the care of children, 76 f., 155 f.; dynamic support of weak ego structure, 336 ff. Mental illness, explanation of, to child, 266 f., 287, 292, 310 ff.; misconceptions of, 232; of mother, as cause for placement, 28 f. Money, as defensive need, 219-21; learning management of, 413 f.; see also Earnings; income, extra Mother, acceptance of child's hostility, 126; adoptive, domineering, 364 ff.; autistic child's expression of hostility toward, 33; child's fun with, 292; child's hostility toward, 126, 230 f., 286, 351; cold, aloof, 30 f., 344, 349 f.; dependent on child for emotional satisfaction, 34 f., 373 ff.; dominated by child, 363 ff., 405 f.; dominating, 175; example of no preplacement work with, 104 f.; feeding on child, 341 f., 344; feelings of guilt, 18 f., 53 f., 57 f.; masochistic sacrifice, 58, 363 ff.; mental illness as cause for placement, 28 f.; narcissistic, see Narcissism; neglect of physical care of children, 281 ff., 297; preservation of family despite alcoholic husband, 29; prostitution, 275, 346 f.; psychotic, level of treatment, 345 ff.; psychotic attachment to own father, 36 f.; sharing by siblings, 406 f.; symbi-

INDEX otic relationship with child, 30 ff., 281, 349-51; unconscious projection onto daughter, of desire f o r own baby, 217 f.; wish to return to, 285 ff., 290 ff., 394, 410 f. Mother-figure, direct expression of hostility to, 289 ff.; ego strengths derived from, 364; meaningful relationship with, 374; supplementary, for autistic child, 32; transference of anger to, 284 f., 293 f.; transference of dependency to, 312 f. Mothering, autistic child's need of, 188; capacity to give, as test of foster mother, 179 f.; child's need for, 139 ff., 142 f.; foster mother's need of, 215-18; value of, to child deprived of warm relationship, 350 Motivation, of child for contacts with siblings, 383; of foster parents, 177-89, 198 ff.; neurotically based, 225; for restoration of family, 389 — for placement, 7 f., 389 f.; behavior disturbance of child, 14; illness of mother, 11 ; individualization of, 25; to preserve marriage, 55 Murder, explanation of, to child, 266 f., 269 f. Narcissism, 63, 318; cause of, 45; in children, 67 f., 143; of psychotic parent, 318 Narcissistic parents, 41-50; child as source of gratification to, 162; dynamic handling of, 351-58; request for placement, 45 ff.; and return of child, 345, 392 f.; treatment level, 357 f. Natural parents, see Parents Needs, compatible, of child and foster family, 194, 198 f.; dependency, see Dependency needs; individual, gratification of, 202 ff.; knowledge of, in matching child and foster family, 189 ff.; parental, children as fulfillment of, 352 ff.; parental, understanding of, 110 f.; of parents vs. those of child, 42 ff., 59; for self-realization, 54 f.; so-

INDEX cially unacceptable or destructive, 202 f.; unconscious, 195 f. — neurotic, constructive sublimation of, 185-88; and use of m o n e y as gratification, 416 Neglect, of h o m e and children, 281 ff., 297 N e i g h b o r h o o d , of foster home, 168; poor, as reason for placement, 290, 296 "Neurosis, infantile," 171 N e u r o t i c bases of investment of self, 225 Neurotic equilibrium, breakdown of, 50-63, 358 ff.; in parent-child relationship, 363 ff. Neurotic parent, d y n a m i c handling of, 368-71 N e w York City, 27 N u r s e r y school, 51 Object relationships, disturbed child's incapacity f o r , 84 Obesity, foster family's handling of, in foster child, 192 f. Oedipal conflict, 218, 368 f. Overprotection, a n d underlying hostility, 383 Parent-child relationship, adequacy of, 18 f.; child's understanding of, 245; classification according to psychological dynamics, 26-63; diagnosis of, l l f f . ; explanation of, t o foster family, 161 f.; in foster family, 179; neurotic equilibrium of, 50 ff., 62, 363 ff.; positive and negative values in, 16 f., 22 ff., 27; preponderance of assets in, 59; resolution of conflicts through, 402 f.; rivalry in, 47; supportive, in preplacement work, 102 ff.; symbiotic tie, 30, 281, 349-51; therapeutic t r e a t m e n t of, 281 ff.; working t h r o u g h , in treatment of parent, 361 Parent-figure, authority of, 234 f.; handling of child's neurotic demands, 273; personal care of child, 251; worker in role of, 243 ff., 247 ff. Parenthood, adequacy for, 24 f., 41 ff.; foster mother's adequacy

441 for, 179 f.; inadequacy for, 102, 110 f., 342, 345 f., 352 f., 390; motivation for, 359 Parents, attitude t o w a r d agency, 282, 290, 296, 355 f., 390; attitude toward residential treatment center, 97 f.; child's dependency longings invested in, 65 f.; contacts with child a f t e r placement, 37281; criminal, treatment of, at point of defense, 349; criminal behavior, 26 f., 269 f., 273; current life situation, 160 f.; deprivations as child, 111 (see also Deprivation, e a r l y ) ; disruptive visits to foster family, 372 ff., 379 f., 390; distorted use of child's c o m i n g of age, 410 f.; divorced, see Divorce; ego-defective, 26-29, 345-47; expectations and wishes concerning help f r o m agency, 7-12; explanation to, of child's needs, 408; explanation to child of criminal behavior of, 273; first meeting with foster family, 135 f.; foster h o m e as threat to, 96 f., 145, 159 f.; guilt over placement, 53 f., 57 f., 366 f., 396; history of personal background, 13 ff.; i m m a t u r e , 336; information withheld f r o m , of child's whereabouts, 377 f.; motivation f o r placement, 7 f., 11, 25, 55, 389 f.; narcissistic, 41-50, 162, 318, 345, 351-58, 392 f.; necessity f o r work with, 99 f.; need f o r selfrealization, 54 f.; neurotic, 36871; participation in actual moving of child into placement facility, 136-37; participation in intake process, 17; participation in preparing child f o r placement, 11529; potential f o r restoration of family, 389; preparation f o r separation f r o m child, 4 f., 19 ff. (see also Separation; Separation t r a u m a ) ; preplacement work with, 102-51; projection of p r o b l e m s o n t o children, 54, 97; psychiatric treatment, 361 f.; psychosocial classification of, 23-100; psychotic, 267, 318, 347; and p u r p o s e of placement, 15 f.; reaction to reality of placement, 108 f.; readi-

442 Parents ( C o n t i n u e d ) ness for separation f r o m child, 20 ff-, 105; reappearance of, 216 f., 242, 380; renunciation of, in child's growth toward independence, 182 f.; sexually delinquent, 275 ff.; spontaneous information from, 7 f., 11 f.; termination of placement at request of, 394 f.; threat to child, of placement, 15; transfer from intake worker to caseworker, 105-9; understanding of needs of, 110 f.; visits with child, 239 f., 372 (see also under Visits); wish for child's contact with relatives, 385 f.; withdrawal f r o m placement request, 19 f.; work with, after placement, 332 ff.; and worker, 334 (see also Worker-parent relationship); worker's acceptance of, in presence of child, 333; worker's role with, 238 ff. (see also Workerparent relationship); see also Father; Mother Partialized area, direct treatment in, 363 ff.; uncovering of, 222, 224 f., 226-33 Participation, parental, in actual moving of child into placement facility, 136-37; in intake process, 17; in preparing the child for placement, 115-29 Past, child's resistance to exploration of, 254; helping child to avoid repression of, 149; revival of realistic memories of, in preparation for return to family, 397; transference of feelings from, into current experiences, 336 Pathology, location of, 23-25 Peers, social opinion of, as constructive force, 94 Permissiveness see Acceptance Personality, arrested development of, 42; basic, change in, 360 f., development through healthy family life, 64; dynamics of, 23 ff.; immature areas of, 343; reaction formations in, 258 ff.; resources, and emotional economy, 50 f.; use of money for growth in, 416 f.; see also Character structure

INDEX Phobias, release of, 143 "Pity for the orphan," 262 f. Placement, age of child at, 345, 350; agency requirements re, 7; avoidance of, ν, 24; background of recommendation for, 5 ff.; caused by parent's criminal act, 271 f.; child's rationalization of reasons for, 290, 296 f.; contraindications for, 59; disturbed by parents, 372 ff., 379 f., 389 ff.; effect of protracted delay in, 128 f.; evaluation of harm or help to child, 390 f.; explanation to child of reason for, 147 ff., 246, 255, 259-81; goals of, 344 ff.; independent of agency activity, 69-71 ; and level of treatment, 345 f.; matching child, foster family, and natural family, 189-95; narcissistic parents' request for, 45 ff.; parental guilt over, 53, 57 f., 366 f., 396; parental motivation for, 8, 55, 160; parental reaction to delay in, 109; parental readiness for, 109 f.; problem of autistic child, 31 ff.; reasons for, 147 ff., 246, 255, 25981, 288 f.; and the referring source, 6; responsibility for, 118 f.; transfer from intake worker to caseworker, 105-9; work with child after placement, 243-331; work with foster family, 210-32; work with parents after placement, 332 ff. — emergency, 146-50 — indefinite, indications for, 346 — involuntary: parent's sexual activities as cause of, 275 ff., 336 f.; see also Court action — permanent: and contacts between parent and child, 376 ff.; and contacts with relatives, 387; indications for, 344 f.; reality factors, 128; and sibling contacts, 384 f. — temporary, 51 ff.; causes of, 345; and the child's questions re his return home, 127 f.; contacts between parents and children, 381; contacts with relatives, 386 f.; indications for, 359 — voluntary, 291; parental hesitation over, 108 f.; parents' legal

INDEX rights in, 5 f.; preplacement work to avoid parental abandonment of plan, 103 ff.; reasons for, 3 f. (see also under Placement) Placement agency, appeal to court for authority, 391 f.; blamed by child for family situation, 296; blamed by mother and child for placement, 282, 290, 355 ff.; child guidance work, 253 ff.; child's understanding of role of, 390; contact with child in adoptive home, 68; continuing interest in child after termination of placement, 417 f.; development of relationships in setting of, 86 ff.; dynamic and supportive work, vi, 212-18; explanation to child of role in placement, 122 f.; financial aid after termination of placement, 412 ff.; foster homes owned by, 73; and foster mother, 227-32; function in deep personal problems of parent, 361; gradual weaning of child from, 411-17; and group homes, 79 (see also Group homes); group homes of, for emergency cases, 96; intake policies, 66 ff.; office as setting for family contacts, 372 ff., 379 f.; private, requirements, 7; public, requirements, 7; recommendation for court action, 21 f.; responsibility for contacts between siblings, 384; role of, 3 ff., 27, 333; 372 ff., 390 f.; roster of emergency homemakers, 147; scope of service, 7, 9-12; service to professional foster parent, 72; supervisor, 196, 201 ff.; supportive aid to foster family, 165 f.; termination of placement, 388-94; therapy for parent, 362 f. (see also Therapy; Treatment); timing of revelation to parent of service and method, 8 f.; treatment centers, see Agency treatment centers; Residential treatment centers; types of aid to prevent family breakdown, 51 ff. Placement facilities, factors in choice of, 99 f.; and preplacement, 129; role in treatment of child and parents, 98 f.; selection from, to

443 meet needs of specific child, 66 ff.; types o f , 64-101 Placement worker, see Caseworker; Worker Play, aggressive, 298, as therapy, 272, 285, 287, 293; worker's use of, with child, 256 f. Play activities, arrangements for, in foster home, 169 Play technique, in preplacement work, 116 f., 132 ff. Pleasure-loving parent, 351; see also Self-gratification Positive and negative values, in family, 56, 358 f.; in foster family, 170 ff., 176, 189 ff.; in parentchild relationship, 16 f., 22 f., 27, 59 (see also Parenthood); in relationships, 382 f. Pregnancy, anxiety re, 230, 232; explanation of, to young girl, 303 ff. Preplacement work, 3 f.; with child, 115-29; by correspondence between worker and child, 137 f.; with families, 102-51; with foster family, 205-10; with psychotic child, 141 f.; purposes of, 102-5; steps in the process, 107 f.; substitutes for, in emergency placements, 146-51; transfer of parent from intake worker to caseworker, 105-9 Presenting problem, nature of, 6-8 Pride, narcissistic, appeal to, 353 f. Problems, underlying, treatment of, 362 f. Problem situations, presentation of, to foster parents, 176 Projection, of child's hostility onto worker, 121 f.; of parental problems onto children, 54, 97 Promises, unrealistic, to child, 373; of worker to child for support on return to his family, 399 Property, valuable, accumulation of as dynamic tool, 417 Prostitution, 275, 346 f. Protection, of child f r o m disturbing parental visits, 372 ff.; of child and family, 27, 391 Psychiatrist, in hospitals and agency centers, 92 f.; treatment of parent by, 361 f.

444 "Psychopath, agency-made," 66 Psychosomatic disorders, treatment in hospital setting, 84 f. Psychotherapy, depth of treatment, 93; extramural, 67; in hospital setting, 85; for psychotic child, 84 Public funds, for child's support, 20, 50 Punishment, self-, loss of valuables as, 298 f. Quarrels, adult, effect of, on child, 157 ff., 322, 386 Questioning, by child, see Explanations; technique of, to elicit background history of parent, 13 ff. Rage, acting out on transference level, 390; destructive, 257 f.; example of fear and guilt re, 269 f.; reduction of, through repetitious reassurance, 142; repression of, 284; see also Anger; Hostility Rationalization, child's, of reasons for placement, 290, 296 ff. Reaction-formations, in child's personality, 258 ff. Reality, development of relationship to, 140 f.; and ego weakness, 340; reaching out toward, of autistic child, 32; testing of, 87, 92 Reality situation, amelioration of, and return of child, 388 f.; child's acceptance of, re parents, 297 ff.; evaluation of, 52; faced by child, 295 f.; neglect of, 249 f.; and placement, 4 f.; and transference feelings, 204 f.; see also Life situation Reassurance, through interpretation of fear and guilt, 257; and reduction of guilt, 172; through universalization, 256 ff. Receiving home, 96 Redl, Fritz, 277 Referral, to another agency for treatment of parent, 56 f.; of parent for psychiatric treatment, 361 f.; from placement agency to another, 12 Referral source, prior discussion with, 6

INDEX Reid, Joseph H „ and Helen R. Hagan, 80 Rejection, of child, 16, 24; of child by foster family, 209 f.; child's feeling of, in replacement, 139 f.; death of parent interpreted as, 260 f.; feeling of, after mother's remarriage, 355 f.; of illegitimate child, 280; by mother, 367 f. Relationships, conflicting, 288 (see also Loyalties, conflict o f ) ; development of, in agency setting, 86 ff.; in group home, 301; positive, incapacity of ego-defective parents for, 348; positive and negatives in, 382 f.; social, 174; synthesis of, 381, 386; of worker with child, see Worker-child relationship; of worker with parent, see Worker-parent relationship — interpersonal, 174; avoidance of, 94 f.; inability to form, 67 f.; interpreted by child as hurtful, 264; lack of, in large child-care institutions, 76; libidinal, 12 f.; prognosis for children unable to form, 77; wish for, 145 — meaningful: barriers to, 372; and healthy growth, 413; and institutional setting, 140 f.; rejected, as self-protective device, 144 f. — multiple: of child, and return to family, 399 f.; child's transference of feelings in, 386; and separation of case responsibility, 154 Relatives, contacts with child, 371 ff.; relationship with, 385-87; visits of parent and child to, 385 f. Religion, and explanation of death to child, 260 f. Religious preferences, and placement, 7, 11 f., 189 Remarriage, and continuation of placement, 355 ff.; and parental visits to child, 160; plans for the child's future, 370 f.; return of child to family, 394, 405 ff. Replacement, avoidance of, 65; and child's disillusionment re return to family, 400; child's fear of, 131; easing the separation trauma, 146; from foster family, 200, 224 f., 232; indications for, 390; prepara-

INDEX tion for, 139-45; reasons for, 263; tragedy as cause o f , 252 Repression, of anger a n d fear, 158 f.; of emotions, by child after shock, 147 ff.; of painful experiences, 256; of past, 149; of u n h a p p y memories, 397 Research, goal of, vs. individual therapy, 93 Residence, legal, as f a c t o r in placement, 7 Residential club, f o r older adolescent, 415 f. Residential treatment centers, 80-93; child's reaction to, 89 f.; connected with hospital, 85; connected with social agency, 86-92; continuance of therapy on out-patient basis, 91 f.; group and individual approaches, 94 ff.; parents' attitude toward, 97 f.; physical aspects, 93; psychiatrist in, 92 f.; therapeutic use of controlled environment, 90 ff. Resources, personality, effect of inadequacy of, 50 ff.; see also E g o defect Responsibility, f o r child care, a f t e r restoration of family, 407 f.; family, assumed by adolescent after termination of placement, 412 ff.; of foster family, 251; and multiple relationships, 154; training for assumption of, 183 f.; worker's feeling of, toward child, 196 f. Restitution, and guilt, 318 ff., 411; self-punishment as, 298 f. Restoration of family, 53, 359 ff., 381, 384, 388 f.; attitudes of parents and child re, 411; as goal, 346; gradual steps in, 403 ff.; indications for, 388 f.; process of, 257; and remarriage, 394, 405 ff.; and replacement, 390 f.; and responsibility f o r child care, 407 ff.; timing of i n f o r m a t i o n of, to child, 406 f. Restraint, physical, and destructive emotions, 257 Restrictions, child's need of, 367; value of, to child, 272; see also Control of child; Discipline

445 Right and wrong, standards of, 340 f. Rivalry, of foster m o t h e r with worker, over child, 234; of foster parents with child's parents, 161; in parent-child relationship, 47 R u n n i n g away, handling of problem in controlled e n v i r o n m e n t , 91; t o m o t h e r , 283 R u r a l areas, d y n a m i c child placement work, vii-viii, 137; foster h o m e in, 168

Savings, expenditures of, as aid to personality growth, 416 f.; planning for, with adolescents, 414 f. Schizoid personality, 67 Schizophrenia, latent, 417 f. School, arrangements f o r , p r i o r to child's return to family, 407; behavior problem of disturbed child, 88 f.; foster parents and, 236 School work, difficulty with, 288; improvement in, 292 f.; see also Learning Scientific approach, to child placement, vi; to foster family care, 152-54 Security, derivation of, f r o m institutional controls, 90 f. Self, investment of, in others, 214 f., 225 Self-control, vs. impulses, 354; learning of, 257 f., 270 ff.; restrictions as aid to, 272 ff. Self-defense, reaction of p a r e n t to placement, 346 f. Self-destruction, and sense of guilt, 264 Self-gratification, children as objects of, 352 ff., 392 ff.; goal of narcissistic parents, 42; as motivation of foster mother, 179; pursuit o f , and delinquency, 46 ff. Self-interest, enlightened, and choice of action, 354 f. Self-protection, and rejection of meaningful relationships, 144 f. Self-punishment, 284, 298 f. Self-realization, need for, 54 f. Self-worth, feeling of, 352; necessity to child, 42 ff.; need of psychotic parents for feeling of, 347 f.

446 Separation, explanation of reasons for, 280 f.; from foster family, 395 ff.; preparation of parent and child for, 102-5 Separation trauma, and anger, 296 ff.; child's need of treatment for, vi, 253, 328-31; easing of, vi, 136 f., 146; effect of, after placement, 244, 252 f.; and replacement from foster family, 200; and repression of unhappy memories, 397 Sex, of child, and matching with foster family, 194 f.; girl's interest in, 293 f., 302 f. Sexual conflicts, in motivation of foster mother, 184 f. Sexual delinquency, parental, explanation of, to child, 278 f. Sexuality, child's knowledge of, 275 ff.; sadistic use of, 276 Sharing, of family experiences, 384; of family responsibility, 412; of mother, 404 f., 406 f.; of parental love, 383 f.; of parent-figures, 144 Sibling, birth of, as cause of mother's death, 262, 404 f.; contacts with, 82-87 Sibling rivalry, 194, 382 f.; prevention of intense, 404 f. "Sickness insight," 89 Social activities, of child, 408; gratification through, 314 Social agency, residential treatment centers, 80 ff. Social behavior, and group pressure, 94 f.; therapeutic environment and, 89 Social history of parent, adjustment and compensations revealed through, 172 ff. Social inferiority, feeling of, as result of placement, 332 f. Social Security, for dependent children, 50 Social taboos, and child's suppression of subject of parent's unacceptable behavior, 268 ff.; incest, 195; opinion of peers as, 94; re sexuality, 276 ff. Social work, protective, 27, 372 ff., 391

INDEX Social worker, role of, in residential treatment centers, 92 f.; see also Worker Sonia Shankman Orthogenic School, 421 Specialized institutions, see under Institution States, licensing of foster homes, 69 Stealing, compulsive, 276 f. Stepfather, acquaintance with children before restoration of family, 406 f. Stubbornness, and repression, 158 Subjective attitudes, see Attitudes, subjective Sublimation, constructive, of neurotic needs, 185-88 Subsidized foster home, 72 Substitute family care, 68-74; inacceptability of, to greatly disturbed child, 78 f.; indications for, 67 f. Suffering, accepted as natural lot, 363 ff.; feeling of security gained from, 366 f. Suicide, attempted, by drowning, 314ff.; and depression, 25; explanation of, to child, 265 ff. Superego, 341; gaps in, 343 Supervision, of child's life situation, 251 f.; over-all, of child in placement, 244 f.; over-all, by worker, 248 ff. Supervisor, agency, aid and advice to worker, 196 f.; relationship with worker, 201 ff. Support, dynamic, components of, 213 f.; and level of treatment, 345 f.; to parent and child, 11015; to parent of weak ego structure, 336 f. Support, financial, by agency, 51, 72 ff., 393, 412 ff.; by public funds, 20, 50 Swearing, 285 Symbiosis, 30 ff., 281, 349-51 Symptoms, clinical, 361 Synthesis, see Integration Talk, angry torrent of, 295 f.; effusive, and ego defect, 348 f. Temper, handling of, in older boy, 190 f.; tantrums, 366 Temperament, of foster family suit-

INDEX able for specific type of child, 193 f. Tension, effect on child of, 51; release of, 256 f., 293, 397 f. Termination of placement, by agency plan, 388-94; by the child's coming of age, 410-18; at parent's request, 394 f.; premature, a treatment measure, 389 ff.; preparation of child and family for, 395410; see also Restoration of family Therapist, areas of work, 329 f.; child's relationship with, 89 f., 91 f.; worker's role as, 247 ff. Therapy, dynamic handling of neurotic parent, 368-71; "holding," 379; process of, 288 ff.; progress in, 358; psychiatric, 92 f.; through worker's relationship with mother and child, 373-75; see also Psychotherapy; Treatment Tic, hand waving, 157 ff. Toys, airplanes, 289; retention of, in emergency placement, 149 Tragedy, disruption of parental functioning by, 359 f.; explanation to child re, 150 f., 258 ff.; precipitating cause of emergency placement, 146 ff. Training, in-service, in child guidance, 253 f.; of foster parents, 98 Transference, between agency supervisor and worker, 204 f.; ambivalent, from mother, 319 f.; of anger to mother-figure, 284 f., 293 f.; of child's feelings in multiple relationships, 386; of dependency to mother-figure, 312 f.; of feelings from past, into current experiences, 336; of hostility to worker, 290 f.; positive, of child to worker, 255; to worker, 284, 287; in worker-parent relationship, 335 f. Travel, unaccompanied, child's fear of, 296 Treatment, according to character structure, 345 ff.; of child's separation trauma, vi, 253, 328-31; of disturbed child, in agency setting, 86-93; of disturbed child, in hospital setting, 74 f., 82-86; levels

447 of, 345 f.; of parent-child relationship, 281 ff.; of parents, 56 f., 345 f.; of personality damage to child before placement, 252-54; see also Therapy — direct: of child's underlying problem, 252-58; in partialized areas, 363 ff. Treatment centers, child's situation on discharge from, 100 f.; see also Residential treatment centers Treatment interviews, 86, 89 f.; course of, 284 ff.; frequency of, 366; permissivity of aggression, 272; preparation of child for, 15; resistance to, 317; termination of, interpreted as rejection, 313 Ultimatum, as dynamic handling of narcissistic mother, 357 ff.; and face-saving choice of action, 392 f. Understanding, child's, of parentchild relationship, 245; child's, of role of agency, 390; child's lack of, of separation from parent. 380 f.; diagnostic, of parents, 337-44; of parental needs, l l O f . Universalization, of guilt, 257; of prejudice, 221; for reassurance, 256 ff. Unknown, child's fear of, 103 f., 121, 399 f. Vacations, 294; child's employment in, 414 f. Vander Veer, Adrian, 66 Verbalization, of anger and guilt, 293, 296 ff., 368; of destructive emotions, 256 f.; of hostility, 293 295 ff. Visits by child, to agency after termination of placement, 418; to foster family, 129-39, 410; to parents, 127, 355 ff., 372 ff., 386 f., 400 ff.; with relatives, 371 ff.; with siblings, 382-87 — by parents, 10, 28 f., 239 ff.; in emergency placement, 150; first, to foster home, 380; preparation of child for, 376 f.; reasons for limitation or refusal of, 377 f.; and remarriage, 160; to siblings in placement, 383; soon after place-

448 Visits by parents (Continued) ment, 136 f.; undesirable, 159 f., 372 ff. — by worker, to child, 251 f.; before child's return to family, 406 f.; parents' attitude toward, 409 f. Warmth, needed by cold, aloof mother, 349 f.; parental, effect on child, 358; psychotic child's need of, 247; see also Mothering Weeping, and ego defect, 348; healing through, 149 Withdrawal, of child after placement, 21 f.; from reality, in depression, 25 Worker, acceptance of child's hostility, 121 ff.; acceptance of child's parents, 246 f., 332 f.; anxiety over unresolved conflicts, 335; conflicting roles, 249 f.; counseling by, 18 ff., 239 ff.; demands upon resources of, 329 f.; diagnostic evaluations after emergency placement, 150; dual role, 336, 398 f.; dynamic and supportive role, 212-18, 359; dynamic understanding of behavior, 27; first meeting with child, 116 ff.; giving at point of mother's need, 393; handling of child's ambivalence re return to family, 400 ff.; handling of girl's question about sex, 302 f.; importance of intake study to, 3 ff.; and institutional care of child, 66; interviewing skills and techniques, 175 ff.; mediator between parent and foster home, 135 ff.; multiple relationships, 234; necessity sometimes for more than one, with same child, 249 f.; neutral role, 118, 119 f., 122 f., 205; reactions of child to change of, 245; relationship with parent and child, 103 f.; resentment against parent, 334 f., 352; responsibility and authority of, 202 f.; responsibility for child's total life situation, 330; role with foster parents and nat-

INDEX ural parents, 238 ff.; subjective attitudes, 16-19, 195-200, 334 f.; supervision of child, 233-42, 24558; transference of hostility to, 294 f.; transfer to from intake worker, 105-9; see also Caseworker Worker-child relationship, 116 ff., 233 f.; and autistic child, 33; as bridge over separation, 131 ff.; contacts after placement, 210, 234 ff., 251 f.; correspondence before placement, 137 f.; as cushion in shock of replacement, 252; development of, 245-59; disturbed by parents, 250; in emergency placement, 148-51; neutral attitude, 302; in preparation for child's return, 403 f.; resolution of guilt and anxiety, 398 f.; shaped according to child's needs, 246 f.; support through, after termination of placement, 417 f.; tapering off, 409 f.; therapy through, 245-58, 284 ff. Worker-parent relationship, 238 ff.; contacts, 333 ff.; counseling, 18 ff., 239 ff.; dynamic aid to ego-defective mother, 351; and narcissistic parent, 351-58; and return of child to family, 394 ff.; scientific approach to, 333-37; warm and supportive, 341 f. Worker's relationship with foster family, 120-32, 154, 200-205; and evaluation of foster home, 197 ff.; and foster parent's unconscious motivation, 178 f.; and idealistic vs. realistic view of foster family, 170 f.; identification by worker with foster parent, 237; sense of obligation toward foster family by worker, 198; subjective attitudes in, 195-200 Work life, adult adjustment to, 12 f., 174, 364; preparation f o r in adolescence, 413 f. Youth, example of development of delinquency patterns, 47 ff.; protective work in behalf of, 27