Family Casework and Counseling: A Functional Approach [Reprint 2016 ed.] 9781512807714

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UNIVERSITY OF PENNSYLVANIA SCHOOL OF SOCIAL WORK

SOCIAL WORK PROCESS SERIES

FAMILY CASEWORK AND COUNSELING A FUNCTIONAL APPROACH

Previous

Publications

JOURNAL OF SOCIAL WORK PROCESS Volume I

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

of

Print)

Volume II

METHOD AND SKILL IN PUBLIC ASSISTANCE (Out

of

Print)

Volume III

SOCIAL CASE WORK WITH CHILDREN (Out

of Print)

SOCIAL WORK PROCESS SERIES

TRAINING FOR SKILL IN SOCIAL CASE WORK Edited, by

VIRGINIA P. ROBINSON

A FUNCTIONAL APPROACH TO FAMILY CASE WORK Edited

by

JESSIE TAFT (Out of Print)

UNIVERSITY OF PENNSYLVANIA SCHOOL OF SOCIAL WORK

FAMILY CASEWORK AND COUNSELING A FUNCTIONAL APPROACH Edited by JESSIE TAFT

UNIVERSITY OF PENNSYLVANIA PRESS Philadelphia 1948

Copyright 1948 UNIVERSITY OF PENNSYLVANIA PRESS

Manufactured in the United States of America • London Geoffrey Cumberlege Oxford University Press

CONTENTS INTRODUCTION

ix

Jessie Tap, Editor PART I. A Functional Approach to Family Casework INTRODUCTION T O PART I

3

Jessie Taft S O M E P R O B L E M A T I C ASPECTS O F FUNCTION IN T H E F A M I L Y AGENCY AS REVEALED IN T W O CASES

18

Rosa Wessel T H E USE O F F E E IN T H E CASEWORK PROCESS IN A F A M I L Y AGENCY

68

Frances T. Levinson T H E SPECIFIC NATURE O F F A M I L Y CASEWORK

82

M. Robert Gomberg THE

RELATION

OF

CASEWORK

HELP

TO

PERSONALITY

CHANGE

119

Grace Marcus A DISCUSSION O F T W O CASE RECORDS ILLUSTRATING PERSONALITY CHANGE

133

Virginia P. Robinson The L e e Case: Else Jockel

Ι3β

The Marks Case: Ruth Fizdale

150

ν

vi

CONTENTS PART I I .

Counseling in a Family Agency T H E F A M I L Y AGENCY IN T H E P O S T W A R PERIOD

183

MARGUERITE MUNTO COUNSELING AS A SERVICE O F THE F A M I L Y AGENCY

191

M. ROBERT GOMBERG T H E GOLD CASE, A M A R I T A L P R O B L E M

219

M. ROBERT GOMBERG DISCUSSION

262

JESSIE TAFT T H E F O X CASE, A P R O B L E M IN R E F E R R A L

273

JESSIE TAP CASE RECORD:

CONCLUSION

Jessie Taft

CELIA BRODY

301

CONTRIBUTORS · Jessie Taft, Professor of Social Casework, University of Pennsylvania School of Social Work Rosa Wessel, Associate Professor of Social Casework, University of Pennsylvania School of Social Work Frances T. Levinson, Assistant Executive Director, Jewish Family Service, New York M. Robert Gomberg, Assistant Executive Director, Jewish Family Service, New York Grace Marcus, Professpr of Social Casework, University of Pittsburgh School of Applied Social Sciences Virginia P. Robinson, Vice-Dean; Professor of Social Casework, University of Pennsylvania School of Social Work Else Jockel, Case Supervisor, The Family Society, Wilmington, Del. Ruth Fizdale, Associate Chief of Social Work In Charge of Training, Veterans Administration, Washington, D. C. Marguerite Munro, District Secretary, Family Service Department, Brooklyn Bureau of Social Service, Brooklyn, New York Celia Brody, Associate District Supervisor, Jewish Family Service, New York * The contributors are listed according to their current positions.

INTRODUCTION Jessie Taft I N ORDER to bring together into one book an account of the development of functional casework in the private family agency as it has come to the attention of the Pennsylvania School of Social Work through its field-work agencies, its supervisors, and its advanced students, we have included in this volume all but the dated articles from A Functional Approach to Family Case Work, published by the University of Pennsylvania Press in 1944 and now out of print, and the articles from Part I of our 1946 pamphlet, Counseling and Protective Service as Family Case Work. To this material has been added another counseling record with introduction and discussion by the editor. The editor's introduction to the 1944 book has been retained because it describes the problem of relating a functional viewpoint to family agency casework as such and anticipates even greater difficulty in meeting the test of so-called "pure" counseling, a form of helping that is deprived of the customary support provided by tangible services, such as relief. In the first half of the pamphlet, Counseling and Protective Service as Family Case Work, published only two years later and appearing in this volume as Part II, there followed a straightforward attempt to meet the challenge of the counseling service which in this brief interval had emerged as an increasingly important community need. In the first paper in Part II of the present volume, Miss Munro expresses the conviction and clarification achieved by her agency during this two-year postwar period regarding its peculiar responsibility for helping as a family agency. Dr. Gomberg, whose earlier paper, "The Specific Nature of Family Casework," attacks the problem of functional definition directly and answers it satisfactorily up to the point of "pure" counseling, follows through in Part II of this book with a paper on the place of counseling in a family agency and a complete case record which shows his own way of working with a marital problem and demonstrates the ix

FAMILY CASEWORK AND COUNSELING experimental use of policies and procedures set up by his agency to implement a functional approach to counseling as a legitimate family casework service, not just a psychotherapy which might better be handled by a psychiatrist or by a worker under psychiatric supervision. The question which the reader must answer for himself is whether the counseling case, as it is found in a social agency, can be truly differentiated by that very fact—that is, by the fact that it has come to a social agency with a specific name and purpose and is met by a social worker as a representative of that agency—or whether the counseling case merely gives the social worker his opportunity to play therapist and should be rightfully a case for the psychiatrist or the psychiatric clinic, if facilities were available. In other words, is casework help in the counseling case merely a stopgap, an inferior kind of helping for those who know or can afford no better, or is it a legitimate social service, for which a social agency, through its workers, can take full responsibility without disguise or apology and without psychiatric supervision? The Gold case or the case of Miss Black, as carried by Dr. Gomberg, may arouse question as to the readiness of the average trained worker to undertake a process that might well be called psychotherapy. Concerning the Fox case which has been added to the previously published material there can be no doubt. However fine the skill, however therapeutic the results, there is nothing in the handling of this situation that a mature, well-trained, able caseworker with a defined agency function under her should not be expected to do. Perhaps referral has not been considered a sufficiently important service to require a genuine counseling process, yet the Fox case to my mind is a perfect illustration of family agency counseling and of functional casework. The degree of skill and therapeutic effectiveness in any helping situation will always be determined to a great extent by the experience and qualifications of the individual practitioner, but whether "pure counseling" in its varied forms will be allocated in the future to casework or to psychiatric auspices depends, in my opinion, largely on the courage and conviction with which the family agency defines its responsibility and sets up reliable policies with supporting structures for the use of its workers.

Part I A FUNCTIONAL APPROACH TO FAMILY CASEWORK

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

THIS

The first volume of the Journal of Social Work Process in 1937, entitled The Relation of Function to Process in Social Casework, had brought out clearly what the functional approach could mean in the practice of casework with children. At that time, the material on which we were learning about the importance of agency function as a much needed source of control in casework method was drawn chiefly from the work of the child-placement agencies of Philadelphia. The deepening comprehension of three major child-placement agencies in our community regarding the nature of their service as one long, sustained process of establishing and maintaining the functional relationships on which a child's placement depends, provided a rich stream of case material on which to learn and to teach. We had also drawn heavily upon the evidence of process as presented in the practice of the Philadelphia * Refers to the original volume ( 1944), reprinted here. 3

4

FAMILY CASEWORK AND COUNSELING

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

INTRODUCTION

5

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

6

FAMILY CASEWORK AND COUNSELING

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

INTRODUCTION

7

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

8

FAMILY CASEWORK AND COUNSELING

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

INTRODUCTION

9

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

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FAMILY CASEWORK AND COUNSELING

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

INTRODUCTION

11

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

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FAMILY CASEWORK AND COUNSELING

as insoluble the undeniable problem of family agencies today, without an effort to locate a specific function and a casework method, even in this area of so-called "counseling." As long as there is some tangible service which the client seeks and the agency offers, however slight it may be as compared to the psychological help he receives in obtaining it, the worker seems to be freed, equally with the client, to engage in a genuine helping process. While there is no doubting the personality change effected in every case presented in this volume, it is also clear that neither worker nor client departed in any instance from authentic casework practice. This is determined, it seems to me, by the pervasive presence of agency, as a background, which holds both worker and client in a larger reality. However, without actual reliance on the focus provided by some concrete service, through which agency is expressed, it is difficult for them to gear their relationship to a social casework medium. It tends to approximate the commonsense-friendly or the professional-therapeutic. The functionally trained worker becomes uneasy in either situation, as it soon deprives him of the role which he can carry with skill and leaves him as unsure as the client, whose fear is enhanced by any attempt to internalize his problem but whose projection of it upon others gives no practical possibility for solution. In Mrs. Wessel's paper, which discusses, with the understanding of an old family caseworker, the complicated problems arising from the ever-changing encroachment of new agencies upon the family-agency preserves, the Alberts case shows how surely and effectively a young student can sustain her helping role, when she uses not merely herself but her agency, and its responsibility to the supporting community, in order to condition the client's request for temporary financial aid while he is qualifying for a job. That this reliance on agency can become an escape from helping and is frequently so utilized by beginning students and unqualified workers, no one will deny. The fact remains, however, that, without it, psychological sensitivity and genuine feeling for what the client experiences in taking help lose their dynamic, which, as Miss Marcus has demonstarted in her paper in this volume, on "The Relation of Casework Help to Personality Change," lies in the possibility of a new and creative relation to reality limits, as

INTRODUCTION

13

represented by agency requirements, limits as real for the worker as for the client. In Mrs. Wessel's second case, the Fletcher family, we have a perfect illustration of helping which is almost purely psychological even in its content—nothing but a series of interviews held to a limit in time by the reality of furlough and held to the function of the Red Cross Family Service by the interstate involvement and the soldier's feeling of claim on this agency. True, there is some financial assistance, and a use of hospital for the wife and institutional shelter for a child, but the worker's helpfulness lies primarily in her ability to focus the soldier's conflict around an effort to clarify his own attitudes and to hold him to the necessity of coming to a meaningful decision regarding the next step. That this decision is no final solution is clear, but it is also clear to me that the work of this young student contains the very essence of family casework helping, a process that would have been impossible for this worker or this man outside of the family service sustained by the Red Cross function and without the limits inherent in the reality problem of the soldier. To say that the man's fundamental marital conflict is untouched is beside the point and may or may not be true. All a social worker can know is that the worker has used himself and his agency in the interest of community and client to the limit of his skill, in order to help the client to effect some releasing change in his own situation. There is no need to question the validity of the help unless the problem continues to be reflected in an attempt to use agency irresponsibly. How deep casework help may prove to be, if measured by results in the client's adjustment, is brought out impressively not only in the Alberts' improved marital relation but in the Marks and Lee cases, which Miss Robinson compares. It is evident that "depth" is dependent less on the particular helping medium than on the dynamic granted to helper and agency through the vital significance of the conflict brought to them by the client's election at a point of crisis, without which even the therapist is impotent. It is only the skilled caseworker who can use the client's projection of his problem on agency, conscious or unconscious though it be, to the limit of its potentiality for helping. Miss Jockel took full advantage of Miss Lee's unequivocal acceptance of agency as the

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FAMILY CASEWORK AND COUNSELING

sign and symbol of a new life for herself, while Miss Fizdale with equal sureness helped Mr. Marks to throw off the agency that had come to symbolize his own immaturity and failure. What could one ask more of any helping than that an individual should find it possible to live again or to begin to live for the first time? Yet in these two cases, there is no shadow of doubt that the setting which made help available was the social agency, and that both workers, skillful as they were in meeting the psychological problem, depended for their surety in helping upon their awareness of agency support and agency sanction. Despite the clarity achieved in these papers just referred to, the core of the conflict which absorbs the family agency at this moment has not yet been touched by them nor by the functional method. Indications of this core and of efforts to come to grips with it are to be found in the papers by Miss Levinson and Mr. Gomberg, both responsible and experienced leaders in family agencies. From Miss Levinson's important and penetrating analysis of the effect of fee on client and worker, we are justified, it seems to me, in concluding that when a family agency finds its case load decreasing because financial help has ceased to be the prevalent need, and because the increasing demand for counseling service is hard for workers to sustain without the customary relief structure, there will eventuate naturally a movement toward the payment of a fee by the client, not only because he should pay for agency time if he can, but because it adds an element of structure and procedure which helps to reëstablish the lost control. Although it may embarrass the worker at first, it ends by giving her, as well as the client, a greater security. While to some this reversal of family agency tradition may seem to break down the last barrier between therapy and casework, in my opinion it actually serves as a truly differentiating factor. It undoubtedly makes the worker's assumption of professional ability more conspicuous, both to herself and to administration, thus increasing individual responsibility, but at the same time it removes from her all personal share in setting the basic condition of service—in this case, the fee. The client knows that he pays agency, not the worker; that he must take the worker appointed by agency and may not choose for himself; and that the fee scale set up by the agency is one that the worker has no power to change. Thus, through the establish-

INTRODUCTION

15

ment of a consultation center, one family agency at least has injected itself firmly into the structure of the counseling service on a casework basis, as far as this service is offered to those who can pay. The problem that remains to be solved presents itself as twofold. First, how can agency make itself felt in the "counseling" cases where there is no fee to carry its presence and no tangible service, with requirements and procedure against which the client can test himself? Must such cases, which today form the bulk of applications in some agencies, become the graveyard of the family case load, because individual workers lack the skill and training to carry such cases personally and hence lose more cases than they keep? Or do we give up family casework as such and insist upon some form of psychoanalytic or psychiatric training and supervision, which wül use the agency merely as a center for nonmedical practitioners, working on their own responsibility or under the protection of the psychiatrist in charge—a form of socialized psychiatry for those who cannot reach the psychiatrist? That the latter alternative is one the community has a right to choose, provided the profession of psychiatry agrees, I would not dispute, but the problem we are facing here cannot be solved by this form of escape. If there is any reality in this process we call casework helping, as such, and differentiated from therapy, we have to find its place and its functional determination in the family field. In my opinion there is one other source of control which is comparable to fee but which, because its importance has never been realized in social work, has been left to the judgment of individual workers. That source of control is time, and the possibility of sustaining the individual worker through formulated agency policy regarding the time it gives, where there is no other clear practical or realistic limit in the situation. The family agency has learned to take responsibility for the effect of money given to the client, not only upon him but upon his family. As yet no family agency to my knowledge has ever tried to consider its responsibility for the effect of time upon the client and his relationships, as well as upon the helping process itself. Nor has any family agency held itself accountable for the value of limited or unlimited time consumed in contacts except, perhaps, to the extent of limiting the individual interview in advance, through the necessity of the ap-

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pointaient calendar. The utilization of the time structure when other practical content fails is outstandingly illustrated in Mr. Gomberg's case material, but not every caseworker can be expected to carry personal responsibility for time so skillfully and surely. The actual value to agency of the worker's time will soon become evident where fee service is involved, and once its meaning for helping is understood there, the social agency will have discovered another way of taking from the worker a burden that only the therapist should be asked to carry, that is, the personal responsibility of setting the date for ending contacts.3 The Pennsylvania School has long since learned the value for the student of the impersonal predetermined time limit as given in the conventional quarter or semester. If the social agency can decide arbitrarily or by some objective standard to parcel out time, just as it decides on a fee scale, it will have taken a long step toward keeping a consultation service well within the area and capacity of social work. There remains the second, and in my opinion the fundamental, aspect of this central problem of family casework, which provides the challenge that Mr. Gomberg meets squarely. Is there anything definitive about the purpose of the family agency, apart from specific policies and procedures, which can be so stated that it actually limits or determines for an individual worker the direction, extent, and boundary of his work with a client, no matter what particular service is requested? Mr. Gomberg believes that there is and has succeeded in describing an operating principle acceptable to his own agency, which would bring all services under the direction and control of a dynamic yet definitive concept activating the general purpose which all family agencies acknowledge. Perhaps the family agency will have to face the necessity of eliminating something, of finding some boundary beyond which it will refuse to go, if it wishes to retain a specific identity; but unless that boundary is admitted and its definitive, determining quality embodied in a general statement of function, such as Mr. Gomberg has found, which affects because it permeates its every procedure, the family agency, in its struggle to hold every "outpost" may lose a unique opportunity to develop the very service 8 Jessie Taft, The Dynamics of Therapy in a Controlled Relationship ( New York: The Macmillan Co., 1933), Part I, "The Time Element in Therapy."

INTRODUCTION

17

that its name implies in a world that has never been more in need of help for the family. In this volume, the casework department of the Pennsylvania School has put together evidence, which has come to it through the last five years, of the applicability of the functional approach to the family field. On the basis of the results for casework helping in situations where the agency purpose and policy give sanction to the service, we believe that we are justified in our expectation that the problematic area of "counseling" will yet be clarified and either eliminated or restored to authentic casework status within a function peculiar to the family agency.

SOME PROBLEMATIC ASPECTS OF FUNCTION IN THE FAMILY AGENCY AS REVEALED IN TWO CASES Rosa Wessel THE family agency, which has weathered many social and economic crises in its comparatively brief existence, is today meeting on many sides, from social workers as well as from lay groups in the community, the sharpest challenges with which it has yet been confronted. Serious though the problems of survival are, it is unnecessarily pessimistic for family caseworkers to fear that the private family agency may be a casualty of the war. Out of my own early experience in family casework, and from more recent experience in teaching and advising students who are receiving their field-work training in family agencies, I have developed increasing conviction about the unique contribution which the private family agency has made in the past and the contribution it can continue to make, in service and method, now and in the future. This conviction impels me to try to find some answer to the insistent question: Has the family agency a valid basis for asking continued support? Does it serve a legitimate purpose in our society? In other words, has it a function? The immediate interest underlying this paper springs directly from an experience in teaching a course, called "The Moving Focus of Social Work Today in Services to Families," in the 1943 Summer Institute of the Pennsylvania School of Social Work. There were some fifty students enrolled in this course, all experienced social caseworkers who were holding positions of supervisory and executive responsibility. Most of them were either working in family agencies at the time or had had some experience in family casework. Among them were graduates of thirteen schools of social work, and they came from twenty-two states. The Institute covered only ten days in actual time; but working as intensively as this brief time necessitated, with students who brought 18

PROBLEMATIC ASPECTS OF FUNCTION

19

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

20

FAMILY CASEWORK AND COUNSELING

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

1

The Alberts family consists of Mr. and Mrs. Alberts, both in their middle thirties, and their two children, Selma, eight, and Jimmy, four. Mr. Alberts, a sheet-metal worker by trade, had always been able to support the family on his earnings, which averaged about fifty dollars weekly. Two years ago he suffered a severe heart attack, developed diabetes, and was hospitalized for a short period of time. He then returned to sheet-metal work. About ten months ago he again collapsed and since that time has been unemployed. The family exhausted all of its resources, pawned various possessions, and even borrowed sums of money which they were unable to repay. Finally, in September 1942, they had to apply to the public relief agency for assistance and Mr. Alberts returned to the hospital. He was discharged about two months later. There followed a frantic search for work, each time ending either in a collapse or a job refusal because of his precarious condition. Mr. Alberts was referred to the private family agency by the hospital, which he had also tried to enlist in his search for work. He was told that we might find him a job and help him secure glasses which he badly needed. When Mr. Alberts came to the agency he presented these two requests, and was given an appointment for January 14, 1943. He did not keep it but arrived later in the day, explaining that it had been necessary for him to see the 1 Excerpt from thesis, "The Use of a Specific Family Agency Service to Effect a New Balance in a Deteriorating Family Relationship," Marcia Leader, Pennsylvania School of Social Work, June 1943. Mrs. Leader is now Senior Psychiatric Social Worker, Menninger Foundation, Topeka, Kansas.

PROBLEMATIC ASPECTS OF FUNCTION

21

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

22

FAMILY CASEWORK AND COUNSELING

is an ADC 2 grant, and of course I would know that it was impossible to keep a family and run a house on that amount. She had thought of working herself or even taking in foster children again, but Mr. Alberts was simply too nervous to stand anything like that. They feel terrible about having to come to the agency for help. I said I did know about their difficult circumstances and Mr. Alberts' illness. I had come to see what they wanted to do and whether or not the agency could be of help to them. Mrs. Alberts, pointing to her husband, said, "You'd never know it to look at him, but that man is really half dead." Mr. Alberts looked very annoyed and smiled with forced effort. Mrs. Alberts continued with an account of his illness dating back two years, and ended by saying what a horrible experience his having gone to the agency office to make application had been. I knew this must have been difficult. I asked Mr. Alberts what they had in mind to do now. Moving nervously to the edge of his chair, he stated with considerable firmness that he wanted a job. That had been his purpose in coming to the agency. He did not want "charity." I explained that we did not find jobs for people, although I could refer him to the Employment and Vocational Bureau, a Federation agency, if this was consistent with medical recommendations. Mrs. Alberts broke in to say that he was not ready for work now. It was foolish for him to think of it, although they were very hard up. I commented that it might be possible for the agency to give them financial help for a limited time, until Mr. Alberts was ready for employment if they were interested in this kind of assistance and if Mr. Alberts were ready to carry out the prescribed treatment. Mr. Alberts bitterly replied that he would not think of it. All his life he had worked and earned a good living. He was not going to take "charity" now. I replied that it had been pretty tough, after having had a good trade and supported his family for so long, to find himself in this spot. He nodded and said, "You bet." Mrs. Alberts made several attempts to smooth things over, repeating that he should not be ashamed about asking for help now. Mr. Alberts angrily shooed the children into the kitchen. With mounting rage he turned to his wife, repeating that he did not want "charity," then asked me again if I could refer him to a job. I stated again briefly the conditions under which this would be possible. At this, Mr. Alberts burst forth with a withering blast. If he listened to the doctors he would stay home for the rest of his life. They were all crazy; he would not listen to any of them. I said I knew that it was no fun sitting home month after month, and added that no one could make Mr. Alberts do what he himself was against doing. His anger was evident as he turned to me saying, "How would you feel if you had to sit here all day and see them [refer2

Aid to Dependent Children. Department of Public Assistance.

PROBLEMATIC ASPECTS O F FUNCTION

23

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

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

PROBLEMATIC ASPECTS OF FUNCTION

25

1-27-43 Mrs. Alberts arrived at the office on time for her appointment. She was neatly dressed and spoke quietly, at times a little uncertain and faltering. This was in marked contrast to her compelling manner in the previous interview. I commented on her having come in such bad weather, but Mrs. Alberts quickly assured me that it was all right. She wanted to talk about several things. In fact, Mr. Alberts was eager to come with her but she would not think of it because it was cold and snowing out. It was difficult for her to get into the business of the interview, although she immediately showed me the verification of income and expenses she had brought. With profuse tears, she expressed how badly she felt about their having to ask for help after all these years of independence. She even had to borrow money from a neighbor to come here today. Mrs. Alberts seemed very much weighed down with concern over Mr. Alberts' health and their uncertain future. Things wouldn't be so bad if he weren't so moody. She nearly goes out of her mind watching him mope around the house. Sometimes he just sits and cries for hours on end. In response to my expressed appreciation of how these difficulties affected her, Mrs. Alberts was able to state that she had also come to ask for help for herself. She wanted to do whatever she could to help the family get back on its feet, but she needed special medical care for her obesity. This involved considerable extra expense which they could not meet with their present income from the Department of Public Assistance. It was difficult for her to ask for specific help and she expressed uncertainty about beginning treatment. Because of all the difficulty with Mr. Alberts, she could think only of him and the children. She sighed and said she didn't count. I remarked that she could certainly feel that way about herself, but I thought she was as much of a person as the others and perhaps she did have a right to want something for herself. Mrs. Alberts was then able to state her determination to go ahead with medical treatment, and outlined her plans to contact the doctor for an examination. She realized the difficulties she might encounter in treatment, but seemed eager to carry it out with the assurance of help from the agency. I said that on the basis of the physician's findings we could both consider the recommendations, and perhaps she would then be better able to decide whether she wanted to go ahead with them. We then computed the family budget, Mrs. Alberts taking quite an active part in this. I explained when they could receive their allowance and the conditions on which its continuation depended. I said that it would still be necessary for Mr. Alberts and me to settle more definitely, if we could, the basis of our continuing to work together before the

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

PROBLEMATIC ASPECTS OF FUNCTION

27

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

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FAMILY CASEWORK AND COUNSELING

depend on whether he wanted to work along with the agency on the basis of the doctor's recommendations, or try to manage on his own. Although we seemed to have finished, Mr. Alberts made no move to go. I asked if there was something else he wanted to talk about, for we still had some time. Mr. Alberts self-consciously replied that it was funny, but he had not planned to talk about so many things today, or even tell me about the job. He wasn't sure what I would say about it, and was a little scared too. I remarked that this was natural. He quickly added that he wasn't nearly so scared as when he had first come. I said I could see why it was so for him; he had no way of knowing what getting this help would be like until we had talked these things over. Perhaps after he had thought this over and talked with Dr. D. he might decide that he did not want to continue with it. Mr. Alberts said that he really didn't know, but he was glad he had told me anyway. He repeated his promise to call me this afternoon.

I did not hear from Mr. Alberts that afternoon, but on 2 - 4 - 4 3 I received a call from Mrs. Alberts. She began by telling me that Mr. Alberts had secured a statement from Dr. D., who felt that he could take the job in a month if he carefully restricted his activity. When I commented that I had been expecting to hear from Mr. Alberts himself about this, Mrs. Alberts quickly added that he had gone to the hospital clinic today for an eye examination and was lying down because it had tired him out. She assured me that he would get in touch with me. She also wanted to talk about herself. She had gone to the doctor, who prescribed a special diet and an abdominal support. She planned to discuss the latter with her DPA visitor to see if she could secure the appliance through the Public Assistance medical program. If not, could we help her? I thought this would be possible. She would let me know how she made out. Mrs. Alberts ended the conversation by saying that things were beginning to go a lot better at home and acknowledged the receipt of their first check. Mr. Alberts called me on the following day. He had been to see Dr. D. and was eager to talk over his recommendations with me. Because the doctor had been ill, he had not been able to see Mr. Alberts the day of our last appointment. He referred also to his eye examination and requested an appointment. One was set for 2-8-43.

PROBLEMATIC ASPECTS OF FUNCTION

29

2 - 8 ^ 3 Mr. Alberts was in the office promptly for his appointment. With considerable animation he remarked that things were going along fine. I thought that a lot had happened since we last talked, and wondered where he wanted to begin. Immediately he mentioned the eye examination. He needed glasses very badly in order to continue with his job training. We worked out the necessary arrangements for securing the glasses. Mr. Alberts felt that this would be a big help to him, and with much directness expressed his appreciation. With evident satisfaction, he said that not only had he been examined by Dr. D., but he had also managed to talk over his job with the doctor at the hospital where he goes for monthly check-ups. Both indicated that the job was within the limits of his ability. I asked where he thought he and I stood now in terms of our working together. Mr. Alberts proudly commented that from all indications he would be through his learning period in about ten days. He was learning much faster than he'd anticipated and was really in a hurry to get this thing over with. I did know how much he wanted to get back to being on his own, but wondered why he felt he had to hurry so. Mr. Alberts replied with a grin, "If you want to know the truth, I would like to get rid of the help from you." I recognized that we were both interested in his eventually becoming independent, but I had some question if this was really the way to achieve it. Mr. Alberts did not refer to the doctor's restrictions, but pridefully pointed out what a wonderful "break" he was getting in this job, and he simply had to make the most of it. He painted a very bright picture of future possibilities. While recognizing these, I commented that I was concerned with what he was doing right now and how we were going to work together from this point on. Mr. Alberts guessed he did get overenthusiastic, but everything was at stake now and he simply had to make a go of it himself. I said it seemed hard for him to think that he could not do the whole thing immediately and all by himself. He returned to discussing Dr. D.'s statement, and as though arguing with himself, but finally stated that he was ready to abide by it. I added, "But how about the restrictions?" Mr. Alberts then admitted that he had put in several extra hours in an attempt to learn faster. He just had to start earning money for the sake of his wife and kids. They were the ones who were really suffering. I thought that he had done some suffering himself. He admitted this with a nod. Maybe it would be too much for him to comply with the doctor's recommendations. He tensely repeated that he was going to do whatever Dr. D. told him. I commented that it might not be easy, for already he found himself working extra hours and hurrying the

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

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

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

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

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

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much better things were for him now. I thought he had been able to come through a lot, and it hadn't all been easy for him. He quickly remarked, "Yes, especially the taking part." Mr. Alberts began to say something about his taking the money for the suit and how it would feel to show up on the job decently dressed. Some of the men had already made remarks about his shabby clothing. His face suddenly turned red and he sat staring hard at the floor. Slowly Mr. Alberts' eyes filled with tears. At first he tried to hide them by glancing around the room. Finally he gave way and sobbed quietly for several moments. After some time he softly commented, "I'm acting just like a big baby now." I said that was all right. I added that it was probably what he wouldn't let himself do before. Mr. Alberts didn't seem to be in any hurry to dry his eyes. He continued crying. Finally, after another lapse of silence he wiped his eyes, smiled, and said that he was "okay" now. He made several halting attempts to start a sentence, but couldn't seem to get beyond the word "thanks." The color returned to his face as he stumbled over words, finally commenting that he couldn't say much. I knew what he felt and guessed that he didn't have to put it into words. Mr. Alberts then asked if we might figure out how much longer he would be needing the allowance and we computed his additional expense. He couldn't quite figure out exactly when he would get paid, but thought it would be some time around the end of the month. He would let me know. He did not seem at all anxious to leave but continued talking eagerly with me about his future with the railroad, about his plans for fixing up the house, and buying some new clothes for his wife. They were ready to go ahead with plans for securing another foster child. I had to remind Mr. Alberts that our time had already passed. He assured me that I would be hearing from him by the end of the month and we agreed to let things stand that way. I wished him luck in his new job. Mr. Alberts shook hands firmly, accepted this warmly, and added, "I want to thank you." 3-31—43 Mr. Alberts phoned to tell me that he had received his first pay check of $88.47 for fifteen days work. He sounded quite elated about this and asked for an appointment to "wind things up." I suggested that perhaps he would want to make this our last time and he agreed. We settled for a definite time on 4-2-43. 4-2-A3 Mr. Alberts in by appointment. He looked a little tired, but nevertheless seemed in good spirits. He was wearing his new suit and shoes and appeared to be very much at ease. Immediately he showed me the stub of his pay check, carefully pointing to the place where the amount of his earnings was recorded. I guessed he was proud of that. He nodded, and I added that he certainly had a right to be. We talked

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

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the end of the week I would know they were not interested in further help. If so, then today would be our last time. At this Mr. Alberts became quite serious and shifted the conversation more directly to himself. He began by talking about his illness. He had been so disgusted with everything that he didn't know which way to tum. He said, "Everything was running through my head until I thought I would go crazy. First I was thinking maybe Sally should go to work, but the more I thought about it the sicker I got. How could she work? I didn't waint her to. Her job is home with the kids." He then began thinking seriously about going out of town—perhaps his chances of getting work would be better somewhere else. I said that that would have been a kind of running away, wouldn't it? He leaned over the desk and almost whispered that it was true, at one point he had figured on deserting the family. The way he saw it, Sally and the children would be better off that way. They didn't need him around. Not working, he wasn't much good to them. There were always agencies to take care of a mother and children. He then emphasized the struggle he had had in coming to the agency. "I didn't want to sink that low." I knew it had seemed like the end, but how did he feel about it now? Mr. Alberts replied that he had nearly "hit the ceiling" upon receiving their first check. I knew that what he was feeling at the time did not make it possible for him to take the agency's help, and recalled my questioning whether we could accomplish anything together. Mr. Alberts smiled in recollection and said he had the same question. "You did the most wonderful thing possible for a man." He added that a man doesn't want relief all his life. He wants a chance to work and support his famly. He was afraid that he'd lose that chance if he took help from the agency. I thought that he had been afraid, too, of facing something in himself that might make him lose that chance. Mr. Alberts said he knew what I meant, his not wanting to believe that he was really a sick man and couldn't do the same kind of job that he had done before. He spoke of this with quite a feeling of accomplishment. His attitude toward the agency got into the discussion again. I guessed he could see now that we did have faith in a man's wanting to work for himself and his family. It was on that basis that the agency's services were available. He smiled and said, "Well, you sure done a wonderful job." I commented that we had done only part of the job, Mr. Alberts had something important to do with it too. He beamed. Nothing was said for several moments. There was evident sincerity in all that he had just said. Our time was nearly up. I asked Mr. Alberts if he was ready to say good-by now or would he like another time to decide? Smiling, he re-

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plied, "Oh, I'm not saying 'good-by,' I'm saying 'so long' now." I agreed that it could be "so long," for I did want Mr. Alberts to know that he could return at a future date if he again felt the agency might be of service to him. He thanked me. He rose to go, saying that he would talk the matter of the belt over with his wife and if they wanted to discuss further the possibility of using the agency's help with this she would get in touch with me. I acknowledged the possibility that they might prefer to end right away. After a moment's hesitation he finally walked toward the door, and as he turned around offering to shake hands with me, there were tears in his eyes. He did say, "So long," and I wished him lots of luck. DISCUSSION

It is scarcely possible to discuss the problematic aspects of the function of the family agency as they appear in the Alberts case without examining first the more general question of why there has been greater resistance to the concept of function among family agencies than among the more specialized fields, such as child placement and medical casework. Since the family agency was the parent stem of all casework, traditions have become settled upon it which are difficult alike for the lay and professional groups in social work to question or move. One of these traditions, which tends to impede the professional development of the family agency, is the tradition of the total and generic. Family agencies, originally created for the specific purpose of the practical handling of problems of poverty and dependency, have developed steadily by adding new, varied, and more professionally sophisticated services. As their awareness of the multiplicity of problems of family life developed, they widened the area of their interest in, and responsibility for, problems of family adjustment. For years they were the apex of all professional social work, and no social worker, whether practicing with individuals or groups, felt her training adequate unless she had had some experience in family casework. It is understandable that family caseworkers now experience greater difficulty than workers in other areas of social casework in defining a specific focus for their activity. In their resistance to the concept of functional limitation, there is a natural fear that this narrowing of their scope of operation may mean a diminishing of the family agency's effectiveness, as well as a lessening of its importance. The Alberts case portrays a family agency operating with a de-

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fined function that has in it no assumption of total coverage, either in analysis of problem or in service. It has limited itself to meeting only certain kinds of need and only under certain conditions. It has committed itself to work directly with a client's direct request, at the point of engagement with the problem he presents. To appreciate the full professional dignity of such limited help giving within a family-care agency, requires a knowledge of the pervasiveness of the help-taking, help-receiving experience. In its simplest terms, in the Alberts case, a man with a cardiac condition is referred to a family-care agency by the social service department of a hospital for a job and for help in securing glasses. He is accepted for this specific help. He brings his own focus. He has decided at what point he can bear to put out the effort it costs to live. Around his focus of job revolves almost every individual and family problem one could enumerate—his position as head of his household, as husband, as father, as provider. His whole future is at stake. In the truest terms, physical as well as psychological, it is a matter of life and death; the kind of job he takes can shorten or lengthen his days. The practical request he makes has the permissive quality of his own sanction of the referral made by the hospital social service department. It is evidence of his real involvement in an experience of powerful importance in a critical moment in his life. To take help around this point of finding a job cannot fail to affect every aspect of balance and imbalance in his life. If this is rightly understood, the caseworker cannot ask for a spot of greater strategic value. She can only be humble before such awesome responsibility, and be grateful that the social agency in its definition of function, as an expression of the contributing community's intentions toward its clients, has protected both her and her client from the full potential of the impact of their powerful personal feelings as they work together on this seemingly simple, specific request—a job and a pair of glasses. The reader will see how frequently she is required to use her function, to maintain for him a balance between his impulse to stay and work responsibly with a help-giving source, his impulse to take only as little as he can bear at the moment and then to run away in shame and fear. Some family caseworkers have a tendency to ascribe to function a rigor and an inflexibility which are neither necessary nor desirable in good casework practice. Traditionally the givers, whether of funds or of understanding, they are fearful that a de-

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fined function requires such specificity that it operates relentlessly at the intake desk to exclude all but the manifestly eligible for whom there are no other community resources. The Alberts case demonstrates quite the contrary, that an agency's clarity about its distinctive purpose in the community need not result in such uncompromising harshness to the client. Indeed, the criticism which this agency is likely to find itself facing is not that it refused, but that it accepted a case and too easily. Rigid functional lines can be drawn to question the necessity for a family agency in this case, and the agency must be able, in reply, to relate its activity to its avowed purpose. In "Problems of the Private Family Agency in War Time," Elizabeth H. Dexter, speaking as the case supervisor of a large metropolitan private family agency, has given one alternate statement of function for family casework which has a peculiar aptness for the Alberts' situation: "counseling and relief service available for limited periods to persons who have a problem that threatens the integrity and adequate functioning of the family, and who wish assistance in improving their situation." 3 This may not be acceptable to all family agencies, but it corresponds closely to that of the Jewish Welfare Society. Why, then, must the family agency justify its acceptance of the case? The question is precipitated by the fact of referral. Mr. Alberts did not come to the family agency; he was sent by a hospital social service department. Since a job, which he needs and wants so desperately, was not directly available through the family agency but through the Vocational Placement Bureau, another constituent of the Federation of Jewish Agencies, why should not the hospital social worker have made the referral directly to the Bureau? Particularly, since it becomes increasingly clear that the crux of Mr. Alberts' trouble lies not in the need of a job but rather in his attitude toward his own illness, it does seem that the case need never have been referred to a family agency. It is quite conceivable that some perceptive medical social workers might have recognized this as a problem of a patient's nonacceptance of his handicap, falling well within their own casework function. I have known medical caseworkers who could have handled this with consummate skill. And yet, in referring the case, the medical social 3

A Functional Approach to Family Case Work, p. 22.

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worker may have understood the true extent of the precariousness of this man's whole situation, and have felt the desirability of offering the client the possibility of the services of a family agency as a community resource. The decision to go or not to go was always within his own control. To say that the family agency here merely supplemented, for lack of skill and resources available in the hospital, ignores the factor of the man's painfully hesitant but unremitting approach to a place already known to him as a help-giving source for the handling of family problems. The function of a family agency is seldom more desired and feared by a client, and seldom more applicable, than in the case of Mr. Alberts. His statement of focus as "job," has in it, broadly conceived, a permissive range of interest. It is only if one conceives of "job" from the point of view of "pin-point" focus, that the referral seems entirely inept. The case has a further complication, however, which is more difficult to reconcile in terms of function: The Alberts were already receiving Aid to Dependent Children from the public assistance agency. Why need they have been referred to a private family agency? Whatever their problem, was it not within the function of the public agency to provide some possibility of solution? Is aid in securing a job and glasses not equally obtainable through public resources? The private agency seems caught in a dilemma here. If these services are provided by the public agency, then we may charge the private agency, in accepting the case, with duplication of services, with no distinctive purpose of its own. If these services ¡are not available through the public agency, the private agency may again be charged with "supplementation of defects in the skill and facilities of another agency."4 For it seems a reasonable expectation that a public agency, which is granting aid to a family because of the father's breakdown in health, should include in its services to this family such help as will enable the father to take over as much of its support as is consistent with his returning strength. This goes well beyond the usual original purpose of the public aid program, which was the determination of eligibility and the maintenance of certain kinds and classes of disadvantaged citizens. In Pennsylvania, however, in the last few years, since unemployment has receded, we have had a decided shift toward a broader and more generous interpretation of the purpose of our 'Ibid.

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public assistance program. This resulted at the last session of the legislature, in an amendment to our original public assistance law, declaring it to be the legislative intent, . . . that the purpose of the act is to promote the welfare and happiness of all the people of the Commonwealth by providing public assistance to all of its needy and distressed, that assistance shall be administered promptly and humanely with due regard for the preservation of family life, . . . and that assistance shall be administered in such a way and manner as to encourage self-respect, self-dependency and the desire to be a good citizen and useful to society.5 In its generosity, this statement of intent is the very epitome of the undefined, and in its comprehensiveness it appears to do away with the necessity for the private agency where the public agency is active. An earlier amendment, the so-called Rehabilitation Act, passed in 1941, has even more specific relation to this case. This legislation was the result of the community's genuine interest in having recipients of public aid helped to "go off relief." According to the law it is the duty of the public assistance agency "to promote the rehabilitation of persons receiving assistance. . . 6 The law lends itself to widely divergent interpretations, according to the various local county boards' understanding of the meaning of rehabilitation. It is not surprising that the law is conceived of largely in practical terms, and results in many cases only in the provision of a brace, a truss, a set of dentures, or an increase of budget for supplementary diet. What the public agency has not generally undertaken as its own responsibility is the considered, purposeful handling of the process that is involved in both terminals of its work with people, the coming into and the going out of relief. This is not a criticism of our local public agency; it is a statement of fact that has a more general application. A public agency may, by the very category of assistance granted, precipitate new problems and intensify the existing problems within the family group. As proof of a family's eligibility for Aid to Dependent Children when the father is living, the man must have himself declared unemployable. This is an indignity which 5 Excerpt from Legislative Act Number 1071, Pennsylvania State Legislature, 1943. β Excerpt from Legislative Act Number 181, Pennsylvania State Legislature, 1941.

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can scarcely be borne my many fathers, for whom earning ability is the mark of their manhood and the tangible confirmation that they are carrying their rightful role in our dominant family pattern. To Mr. Alberts, proof of his unemployability placed the seal on a doom which he had been trying to escape for several years. The deterioration of the family relationships was inevitable as he struggled alone with his guilt for the dependency of his wife and children. In accepting the Alberts family for relief, the public agency had set in motion a new phase in this family's experience, but it had not conceived of its responsibility as extending to the handling of the movement it had thus stirred up. Mr. Alberts' relation to public relief is such that he must ignore it as something in which his wife and children are involved, but not he. He has received public assistance but he has not been part of it. "There are always agencies to take care of mothers and children," he says later. He has been a client of the agency for four or five months, but he has had so little real connection with it that it does not even occur to him to explore its resources for his present need when he accepts the referral to the Jewish Welfare Society. Nor, we should add, does it occur to the medical social worker to refer him back to the public agency for the special services she believes he now needs. If the public agency has these services at its disposal, she has not been made aware of it. The knowledge of Mr. Alberts' physical readiness for a sedentary job after just "two more months of nourishing food" is information easily obtained from his physician by the private agency's worker in pursuance of her function in this case. But it would have been equally available to any worker of the public agency, had that agency conceived of its function as extending to include the process as well as the act of the client's giving up of relief. Here lies the difference between mere movement and process. The former is random; the latter involves a series of steps leading toward a culmination. The former can spill out explosively in all directions; the latter is held to form and pattern either by its own necessity or by the introduction of structure and focus from without. Caseworkers do often precipitate a process involuntarily and, unaware, live through it with the client to a successful eventration. Often the client is his own precipitator, as unaware as we. We may be thankful that a considerable number of our clients often use nat-

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urally and constructively such attendant circumstances as time and season and place, which to the caseworker may seem unimportant and even irrelevant, to hold the experience of taking help to one of direction and goal for themselves. When, however, a caseworker can carry consciously her share in precipitating and sustaining a process through each successive step to its ending, she is operating with full professional responsibility. I have known few public agencies which take this kind of responsibility, and in these few notable instances, the public agency, interested in developing its staff for more sensitive performance, has usually set up a special district or project for experimentation and demonstration purposes. But I believe that we can identify here a difference in concept of job between agencies, rather than a difference merely in levels of skill. It is for this reason that it seems to me the Jewish Welfare Society can accept for help a man who is trying to "get off relief," without being charged with duplication of service or supplementation of inadequate skill. In these days of easy availability of jobs, I have known public relief clients who, after long periods of relief taking, have responded to the dynamic impact of a new visitor's relation to them, by flinging themselves off relief with a sudden reassertion of the impulse for self-responsible living. Their plans are not always well considered, and are sometimes actually harmful to themselves and others. Before the visitor returns for her regularly scheduled visit, the damage may already be done. Indeed, there may be no return visit; for if a client notifies the public agency to remove his name from the rolls because he is now employed and able to support his family adequately, few public agencies would question his act or feel that they had been negligent of responsibility in not doing so. The private agency's response to Mr. Alberts' finding his own job illustrates this difference in the concept of function of the two agencies. Referred to the private agency for help in obtaining a job, he is offered the supplementary relief necessary to get himself into good condition to hold employment. In the first interview he himself limits the length of time he will accept this help to two months, but by the time he returns for his second interview ten days later, he has already found his own job and has reduced his original request for help by one-half, from two months to one. Any worker, and particularly a young student, might have been

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forgiven a natural human reaction of gratification at the rapidity of this movement and therefore an easy yielding to his altered request, especially since it asks so much less of the agency. Mr. Alberts himself is surprised at her refusal to accept his activity on these terms. "I should think you would be glad to get rid of me, he says. But such gratification is really a layman's typical reaction, which ignores the powerful negative factors in this behavior: the desperation of this man's fear of his future, his unwillingness to take help on the terms it is offered, and the denial of his predicament. Because she accepts her agency's functional requirement that its services be related to a feasible plan for becoming independent, even though she appreciates what it meant to him to have secured work so quickly, she is able to say "no" to what may seem to some readers a laudable and reasonable request. Although I have characterized the reaction above as that of the layman, it is frequently encountered among even the most experienced caseworkers, expressed as resistance to the resolute role the worker must play when she sets requirements for a client to meet as a condition of receiving help. Here it centers upon the worker's requirement that Mr. Alberts present evidence that his physician knew of this job, approved of it, and felt that his physical strength was commensurate with its demands, before help could continue. In identification with the client's weakness, some caseworkers faced with this responsibility would be inclined to say that the client's burden is already too great—how can they require more of him? Because they do not understand the process in which they are participating, setting conditions seems like a forcing of their own will upon the other, a form of "conditional relief," for which they feel so personally responsible that they mistrust it. Anyone who follows the history of relief-giving, from charity to social security over the last few centuries, becomes acutely aware that our current resistance to conditional grants grows out of that history.7 In reaction against age-old repressive attitudes and measures toward people in need, we have grown so accustomed to speaking of relief as a right, that we seem to have forgotten that a right is something to which one has a just claim and that responsibilities accompany it. Nevertheless, in public relief social 7 Karl de Schweinitz, England's Road to Social Security ( University of Pennsylvania Press, 1943).

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workers have learned to work comfortably with conditions of eligibility, wherever the conditions are not capriciously or arbitrarily set, wherever they grow administratively out of a community's desire not to deprive people of their rights but to make certain that only those who have a just claim exercise those rights. It is the "plus" contribution of the skillful caseworker's performance in administering eligibility for assistance that helps make this exercise of a right an experience of deep psychological value for the client. In a private agency the eligibility for help rests not only upon proof of a particular kind of need but, in addition, upon the client's readiness to use the help "toward a constructive purpose." The agency interprets this purpose as including both the client's personal welfare and the community's, as well. If, out of pity for Mr. Alberts, this worker had committed the agency to becoming a partner in his reckless plan, neither he nor the community would have been well served and the worker's act would have been not only professionally remiss but socially reprehensible. For the exercise of a right, as each of us can testify, carries with it an inescapable obligation of proper use of the benefits thereby obtained, and there is no more grievous penalty for misuse or default of such opportunity than one's own sense of guilt. What I mean to say is that Mr. Alberts is entitled to supplementary help from the Jewish community of Philadelphia, but if he takes it he must be willing to make a social accounting of it. This he cannot do if in desperation he uses the agency's money and its services to seize and hold a job through a false presentation of his fitness for it. I do not need to belabor this point, for it is obvious as one reads the case that it is this kind of behavior which has led to his several previous breakdowns, piling failure on failure, and thus compounding his anxiety. Part of the help he needs from this agency is a strength which he may use to protect himself from his own violent impulses and the inevitable guilt reactions. The personal and professional strength of this caseworker is implicit in her every act, but the strength the client uses to work on his problem derives explicitly from his encounter with the conditions set up for the worker by the agency. If the agency, believing that one of Mr. Alberts' rights is the right even to refuse its help on the terms it is offered, stands firm on its requirements, then in struggling with his own confused intentions in relation to those

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requirements, he will be able to find his more balanced purpose toward himself and his family. When his decision is finally made, he will know that he is not caught or committed by any will but his own. It is very important for this man, whose most vital organ has betrayed him, to come to the realization that he can still be master of his own fate, that this is a right not conceded to him grudgingly by a social agency, nor to be fought for against opposition, but admittedly his. He could have no more poignant realization of this truth than that which he obtains from the worker's response to his threat of suicide—her simple acceptance that it lies within his power to destroy his own life. Again, when Mr. Alberts returns the following week, on February 8,1943, the worker is required to project a steadying factor into the situation, to put process into what is now haphazard activity. With independence so near at hand he is making a mad dash for it, revealing thereby fear and denial still operative. His compulsion to overwork, pressing time beyond endurance, is evidence of his unwillingness to handle his situation with regard to his actual strength, which does not altogether promise well for his future. Again the worker holds him to the "constructive purpose" which is the only condition of their engagement. This involves his real acceptance of his limited physical strength, the necessity to yield to nature, rather than to override it in an exaggerated accession of strength which he would not long be able to sustain. This is what I mean by a worker's use of process, this deliberate, painstaking accompanying of the client step by step, holding the experience to a focus which gives it form, pattern, and meaning. I have discussed this point at some length in order to make it clear that in our present generally accepted division of responsibility between public and private agencies, family caseworking agencies can legitimately have a function which involves a supplementary service to public assistance clients. If ever rehabilitation is interpreted by public agencies in its deepest psychological significance, we shall have a new departure in public assistance which will require of its administrators a new kind of selection of qualified workers and a responsibility for the development of a new and more professional level of skill in casework. If this should happen in any community, the private agency would then find it necessary to retire from such activity, for there would then be

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truly a duplication of effort and services. I do not believe that this day will be hastened by the refusal of private agencies to give such service now, for, whatever social workers may hope to the contrary, this difference in function is rooted deeply in the community's conception of a difference, which it desires to have exist and is willing to support, between public and private services, the difference best expressed in the terms "public welfare and private social work." I have spoken earlier of the reluctance on the part of family agencies to work with the giving of a single direct service rather than a more comprehensive approach. Nowhere is there better testimony of this worker's acceptance of a limited function than in her handling of the deteriorating relationship between husband and wife. Of all the many problems within the family at the time of referral, this was one of the most critical. Mr. Alberts was later to tell the worker that he had even contemplated desertion as the way out. Are we then to explain the remarkably improved relations between husband and wife as merely coincidental with or a byproduct of her activity? The worker herself in her thesis gives the clearest possible answer to this question, and I shall quote a few sentences from it: As Mr. and Mrs. Alberts each used this agency service to achieve for themselves a redefinition of their separate roles, so they have used it to come together on a new basis. Mrs. Alberts' pride in her husband's accomplishments, her willingness to be a junior partner in his job venture, are all convincing indications of this. Mr. Alberts is now "the real boss"—which is the way both of them want it to be. Although Mrs. Alberts puts all of the change on Mr. Alberts, her contribution to it has been a significant one, involving real courage and strength on her part. The reorganization which both Mr. and Mrs. Alberts were able to develop in striving to recreate the balance of their original roles derived its impetus and direction from our focus on the specific and limited agency service they were using. Had I attempted to meet or even handle every problem they presented in their intensely personal relationship and for which they did not ask help, there would have been very little need for them to develop and test their own strengths in effecting a new balance. My willingness to provide this agency service as a social service, with each in turn as the center of interest, at the same time aware of the dy-

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namics of the family constellation, gave each something they could use to rebalance their personal relationship by themselves. 8

Here is a fundamental belief in the strength of the individual to "move mountains" in his own behalf. If a worker has this faith in human beings, she will not dissipate her energy or her agency's resources in doing for people what they can do with so much greater gain for themselves. She will be willing to trust the client to use her specific function with whatever psychological meaning it has for himself, if together they can agree on its applicability to the specific problem he chooses to define and present for help. The culmination of a process of help-taking is usually seen best in the ending phase of an experience. Here there is likely to be unmistakable evidence of whether the client has merely bowed more or less politely to external circumstances, keeping his internal organization intact and tightly locked against any real help, against the demand or opportunity for any new use of himself, or whether the client has truly participated by doing and by undergoing an experience that has made possible a new alignment and discovery of his own powers. The proof of Mr. Alberts' genuine readiness to leave the agency is not in his almost incredibly improved physical condition, nor in the family's financial stability, but in the new yielding to life. In his final interview, in reviewing with the worker all the agony of having had to come to terms with a damaged heart, he has abdicated from the negative position of power and strength which he had protected so fiercely against admission of human frailty. The real culmination of the process is in his willingness to say "So long" rather than a final "Good-by," for this is an acceptance, without excessive fear or false pride, of the possibility of recurrent illness and consequent recurrent need. This must have been rich reward for a young worker whose adherence to her functional responsibility in this case had so often required of her, even while she was deeply touched by the client's plight, an austerity that could well be mistaken for ruthlessness. Although he has still a remnant of fear at giving up the supporting strength of the agency and must, therefore, play with the idea of obtaining help a little longer, he has in fact already made 8

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

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his declaration of freedom. With his own first earnings he has made an extravagant purchase of clothing for his wife, spending on this "free willing gift" an amount equal to the cost of the surgical appliance for which he is now asking help and which he declares to be essential to her well-being! This is in essence his own emancipation. Once more and for the last time during this contact the worker places before him the functional limits of the agency. His request is one which the agency can consider, but only in the light of the family's new budget. In a calm and practical consideration of the meaning of continuing to take some form of help from the agency, Mr. Alberts' momentary impulse away from complete independence is spent, and the urgent desire to handle his own affairs reasserts itself. He has learned to take help but he can also give it up. The family agency need not be apologetic for its activity in this case. It is proof that the private agency plays a unique part in the life of the community, and that its uniqueness is not alone in the service offered but in the devotion to the development of professional method and process. «

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It may surprise some readers that the Fletcher case, the second case I am presenting, is not set in a so-called family agency but in the Home Service Department of the local chapter of the American Red Cross. In the case I have just discussed, the family agency was required to justify its own activity against possible criticism from competing interests. In considering the case which follows, the family agency may well play another role—that of the protagonist who makes the charge of invasion of its province. I have selected a case which illustrates the newly developing family services of Home Service, in order to discuss the criticism prevalent among family caseworkers of encroachment upon their established area of operation—indeed, in order to demonstrate the inevitability of this development. In this case, technically a Red Cross responsibility because of nonresidence and an urgent time limit, a kind of service traditionally administered by family agencies is handled by the Home Service worker with a degree of skill comparable to that of the skillful family caseworker. In her two student years in Home Service, in the period of its phenomenal

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expansion, this worker has not, to be sure, had the benefit of a clearly defined function to work with; but she has learned to value the kind of help inherent in a professional definition of service, and she is willing to take responsibility in large measure for setting that definition in each case. This is no easy task in an agency publicized as "The Greatest Mother in the World." TI IE FLETCHER CASE

9

Early in December 1942 we received a letter from Mr. Fletcher, a seaman stationed at X, a distant naval base, asking if we could locate his wife and child. Aside from three names she might possibly be using, there was nothing to go on. About a week later a call from one of the local hospitals told us that a patient, a Mrs. Fletcher, wanted to talk to Red Cross. Mrs. Fletcher had been admitted following a miscarriage. She said she had come here from California in the fall and gave a hotel address on admission. It was the same family. I saw Mrs. Fletcher in the hospital on 12-9-42. She wanted to discuss care for Tommy, fifteen months, and asked our help in locating her husband. Her older child, a girl of three, was with her parents in California. She was an attractive-looking young woman, twenty-one years old, quite self-possessed. When I returned to the hospital on Friday, 12-11-42, I found Mr. Fletcher there. He was a tall, pleasantly homely man of twenty-five. He had obtained a furlough in response to the wire I had sent on locating his wife. He wanted to go along with me when I went to get Tommy to take him to the public agency's shelter. After we had picked Tommy up and were getting into the car, he asked if he could talk to me somewhere. Later we went to the office, where he told me he wanted to ask about "having Tommy adopted." We discussed this at some length. In this interview he expressed much concern over his wife's behavior since their separation in September, which had ended in her present hospitalization. This was a hard interview and a hard day for Mr. Fletcher, who stayed with Tommy until he was examined at the clinic and taken to the Shelter. He wanted to come back to the office to discuss plans, and we made an appointment for Monday. 9 Excerpt from thesis, "Offering Professional Help within the Limits of Red Cross Home Service," Roberta Wilson, Pennsylvania School of Social Work, June 1943.

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12-12-42 Mr. Fletcher came to the office early this Saturday morning. He had been talking to his wife and she wanted to go back to X with him. She said she had learned her lesson; and he guessed they could make a go of it. I said he didn't sound very convinced. He shook his head and said with feeling, no, he really wasn't. She insists it would be different, and maybe he should give her another chance. He had tried before and it hadn't worked out. He didn't know why it would work this time. I said, wouldn't it have to be with them both going at it a little differently? How did it seem to her? Just as easy as that, he answered. "We just go to X and begin again as though we were just married." He knew it wasn't as simple as that. I said you couldn't get anywhere by just pretending to forget the past. He said he couldn't forget the past but wondered if in spite of it they could work things out. He spoke with little conviction. I said it would have to be with them acknowledging what had been bad, and still feeling they could go on. He thought they might be able to pull things together. I said that yesterday we had talked mostly about placing Tommy, but at the bottom of that problem was the question of whether he wanted to keep anything together. He said that was the main thing. He just didn't know whether it could be done. She insisted she had learned something. She had had long enough to. I said it wasn't how long but how real the experience. I guessed she might have had a pretty bad time. She'd had a bad time, he said. She had lived all around, and the fellow she came here to meet got married. It wasn't her fault entirely. She had never had any kind of home. When she was young she lived here and there. She never knew where she stood. I said I thought if they were to work it out together she would have to know pretty clearly where she stood in this. He could not do it all. He said he knew he couldn't; she would have to be willing to make it work, too. He wished I could talk to her. He thought perhaps I could see something more in it than he did. I said she had asked us to be in the situation because of placing Tommy and I would want to see her anyway. He was glad of this and thought maybe someone outside "sort of could see more clearly" than he. He talked on, saying she knew right from wrong, for he had spoken with her about this, not about themselves but about people they knew. But she got in with a bunch of girls that ran around, and so she ran around too. He had tried to steer her right. I said he was talking as though he thought of taking care of her as well as of the children. He said it was sort of like that. He wanted to help her, and he guessed he would give her another chance. But it would have to be a pretty clear understanding. He was going to talk to people at the different places she had lived. He looked at me questioningly. I said he might be 'lead-

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ing with his chin." Yes, he knew he was. I said that he might Ieam something pretty painful, mightn't he? He knew he was taking a chance on that, but he thought he'd better know now. Did I think he should? I did think if they were to try to set things up again, he'd want to know what he was dealing with, but I did not know whether he'd get satisfaction this way or not. He said again he knew he might not like it but he guessed he would. He started to go several times, but lingered on. I asked about the wire he had sent home for money and whether he knew that this was a service Red Cross offered, if he needed to take advantage of it. He did not know this was possible. I asked if he had had funds when he left. He laughingly said he had had $28 and spent $25 for his ticket. He admitted he was pretty low. I described the authorization necessary but said we could make him a small loan now, if he wanted. He guessed that would be swell. As he signed the voucher he said it "felt funny" and I asked him, laughingly, if he had never taken a loan before. Never under these circumstances, he said. I said l guessed the whole thing felt pretty odd. Yes, "kind of embarrassing." I said I knew it was a tough situation for him, wondering if he could make anything out of it. I said I remembered that yesterday he had said that with Tommy going into the Shelter, now was the time to place him; and now that the four of them were split up in four different places, perhaps this was an opportunity to reorganize the whole thing on a better basis. He took hold of this and said with more conviction than before, maybe he could; he thought they could. He paused. What did I think? I said I thought he really wanted a chance and was putting a lot into making it work. I did not know much of how she felt. He said she was hard to know. He was going to talk to her again pretty seriously, and he thought they could work this thing out. I asked if he would want to see me again and he reminded me that yesterday we had made an appointment for Monday. 12-14-42 Visited Mrs. Fletcher in the hospital. She was waiting outside the X-ray department in the hall. I asked her if I could talk to her somewhere. She wondered if we could talk here. I said I wanted to talk with her about plans for Tommy and thought we would have to find a place where we could really talk undisturbed. She thought she knew a place, and put her arm in mine as we walked down the hall. We found a little anteroom. I began by telling her a bit about taking Tommy to the Shelter, and said I wanted to discuss further plans with her. She started to tell me her husband wanted her to go back to X with him. I asked her what she wanted to do, and she said she wanted that, too. I told her I was

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interested in discussing this with her because she had asked us to help with plans for Tommy, which really depended on what he and she decided to do. She repeated she thought they'd go to X. I said I knew that they had had trouble before and I wondered how she thought it would work out now. She was willing at first to put the blame on inlaws and just to say it would be all right. I wondered what made her believe so. They had talked it over and would just forget the past. I wondered if this were possible, if this wouldn't be kidding themselves. She seemed to stop and consider this; then said she guessed they couldn't go back, but they could begin again. I wondered if that wouldn't be pretty hard to do. She said she did want to. She had learned something in the last few months. When you were hungry you really knew things. I said I knew she hadn't had an easy time. I remembered she had asked us before about getting back to California. I wondered if going back with him to X would be all easy, either. She guessed they'd have to get used to being together all over again. He was a swell fellow but he had done some things that annoyed her. For example, she told about baking a pie for him and then he wouldn't notice it. And he sometimes didn't show her much affection. She realized now she should have known he was probably just tired, working on the night shift and all. Then once in a while he'd bring her perfume, or admire her hair-do, and she would be so pleased she would just cry. Then she had been pregnant one time after another. He'd always played poker and he began going out nights to play and so she started going out too. But she thought it wouldn't be like that again. I said it was a matter of how much each was willing to put into making it work. She said she was willing to put everything into it. I talked about how it might look like losing some things, in order to have others. She looked at me and said, "I know what you mean." She knew she had been flighty but she had had lots of time to think it over. He'd have to give up some things too, like that poker. She told of his talking this over with her, and he was so mixed up he didn't know what to do. He'd just sit there with his head in his hands. He was a swell fellow, she said again. And he was shy. They always got on together, but she had gotten tired of not getting attention from him. She did leave him finally. Then she described her life with her family and her antagonism to her stepfather. If they went to X they would be away from people "butting in." I thought it wasn't only other people, but something between the two of them. She acknowledged this and said they had talked a lot about it and thought they would try. She wanted to have the children with her. Jane is his pet and Tommy is hers. I wondered if she had thought of taking Tommy if they went

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to X or placing him until they were established. She wanted him with her. He had been her mainstay, the last months. Later they could send for Jane. I said I would be wanting to know what they decided because we would have to arrange about Tommy. She said she would ask her husband to talk to me again. I said he too had told me he would want to do this. We walked back to the wards and again she put her arm through mine and took my hand. She thanked me for coming to talk to her, and thought they could work it out together. She wondered if I could get her some clothes. Eleanore (the girl she had lived with) had disappeared with all her things except a coat. I said we could get something for her. She could send me word if she wanted me to come after they had talked again. 12-14-42 Mr. Fletcher came to the office about a half hour early for his appointment. He had been to the public agency this morning and the worker had said the baby would have to go to either X or California, but she had said that if his wife took him to California, we could ask the Red Cross to meet her there and have someone keep an eye on her. He opened a box of letters he had with him, and wanted me to read them as he handed them to me one after the other. There were letters from her in which she was asking him for a divorce, planning to marry the man with whom she had been going after she left him. Then he gave me one from this man to her, which was very graphic about their affair. I read them as he handed them to me and I had to say he had an awful lot here to take. I wondered if with all this he felt he could possibly go on. He was very solemn as he said he wondered too. He couldn't unless she was sincere in saying she would be different. He looked at me and asked, "Do you know she had a miscarriage?" She had told him Saturday. "That's something else." I said it was one more part of the whole thing, and I knew it was just rotten for him. He said it was, yet he was glad he knew. Now he knew the worst and it was just as well. He asked if I had talked to her, and what she had said. I told him of seeing her this morning and that we had been able to talk quite seriously, alone. Even if I told him what she said, I could not tell how it felt between the two of them. He knew that. He just wondered if he could believe her when she said she wanted to come back. He asked, "Did she tell you she wanted to?" I said she thought they could get together again. I wanted to tell him she was sincere, but I couldn't know. He said, "No, you couldn't tell me that, but I can talk it out here." He said again he thought they could work it out in X. If she were in California he guessed he would have to get the Red Cross or somebody to check up on her. In X he would be there. I said that was

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pretty hard on him to try to build something up with the feeling that he had to check up. He felt it had to work this time or not at all. I said, looking at the letters, that I could feel from all this what an immense amount he had put into finding her and trying to right all this. He acknowledged that that was true, he had tried everything. The thing that worried him was that it was not until she got stuck that she tried to reach him. I thought that was something hard to take. I asked, what did he really want for himself? He really wanted them together. He was fond of kids. That was what married life meant. He talked a little here about both the children. He asked about her transportation. He has a return ticket. I said we could probably arrange for that if they decided to go. He said he believed it would work out for them to do that. We discussed how soon she would be discharged from the hospital. He tipped back his chair and said, "There it all is, in that box. The problem is what to do with the box. If I keep it, shell hold it against me. If I throw it away—." I said they weren't throwing away what was in that box; they were using it in building up something new. "Yes," he said, "That's so. And if there is a new case it would have a box of its own." He tilted back his chair once more and said, rather softly, "I guess 111 have to change a little bit too. I need to show her more affection." And cards—he used to play a lot of poker. He grinned at me and told me about having been in the Army before and learning to play cards there. Then in the Navy he had plenty of chance too. He and I laughed about this a little. When he got up to go he was looking very serious again and lingered a little as he got ready to leave. He said he would call me when he and his wife had talked again and were definite about what they were going to do. The following day Mr. Fletcher phoned me to say he and his wife had decided on going back to X together and when she was ready for discharge he would like to talk to me about her transportation. Within the next four days, however, the doctors revised their opinion and a diagnosis was made of pregnancy of four to four and one half months duration. Mr. Fletcher had kept in touch with me by phone and had come in once or twice. Then on 12-21^12 he came in after phoning for an appointment. 12-21-42 Mr. Fletcher came to the office a half hour early today. His face shows the strain of the last week. He began by saying he was back again. He guessed his plans had come unmade. I said there was certainly something new since he had made his decision. I thought he would want to know that I had talked to the hospital worker since Friday, and she had been able to explain the change in the hospital plans;

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they had decided Mrs. Fletcher was four to four and one half months pregnant. He had had a chance to talk with one of the chief doctors, and that was what they thought, but weren't even sure. He said he didn't think she was pregnant. She hadn't felt life. "She ought to know," he laughed nervously, "she's been that way twice before." I said there had been so much uncertainty in this. "There's another thing," he said, hesitating just a little. "I don't know whether it's my child. It could be; and then again it could not be. I don't know." I said that was a serious thing to wonder about. He repeated, "It could be mine." I said, "But you don't really believe it is." "No," he said earnestly, "I don't really believe it is." I said that was such a hard thing to take. I wondered if he felt he could ever go on. He didn't know. Maybe before, they could have put the past away, but it would be a difficult thing if there was going to be something always to remind them. I said it might be something he could never know about. He didn't think really she would carry this baby. The doctor had said when Tommy was born she probably couldn't go through with another. In a way, that would be for the best. I said, in a way it seemed so, yet he would still need to decide whether he could go on now, knowing this was how it was. He wondered whether the best thing was for her to go to California. The trouble was she couldn't go to her people, or she said she couldn't. She'd talked about getting an apartment, maybe with another girl. Then they'd be back where they started from. He would never be certain whether the children were all right. We had some discussion of how far Red Cross could go in following up the children's welfare if he decided that was the way he wanted it, and he said it might amount to that. I asked how she felt about it now. She still wanted to go to X. It still looked pretty easy to her; they could just go and start over. He didn't want to start again if she only wanted it temporarily, not unless she meant it to be permanent. He couldn't tell how sincere she was. I said no one could tell him that. He had talked to her a lot, but in the hospital it didn't feel as though she were herself and he didn't feel like himself either, with all those people coming over and breaking in. The one time he felt she was speaking sincerely was when they went to a little room by themselves, "where you talked to her." I wondered if she were discharged tomorrow, if his extension would mean they would have a chance to talk when she came out. He had not known the extension was granted. I said I was sorry I had not told him right away, I had presumed he'd received notice direct. I asked if this took a little of the pressure off having to decide right away today. This seemed a real relief and he thought they might be able to decide some-

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thing. Maybe they'd go to a hotel, or they could have a room at the Y. He said he was going to stay over even if it weren't granted. He thought maybe he'd be going back to bread and water for three days, but didn't think they'd be too hard, because they knew why he was here. He was glad to know we actually had it in writing, though. I said he was covered by that. He thought they could talk it over again. He had to see that the children were treated right and he thought if he had them in X he would know. I said that all along it had seemed important to him to know, even though what he knew was pretty painful. He said he had experienced what it was not to know and he didn't like it. I knew what a lot of work he had put into finding out. He thought if she did go to California he might lose track of them again. Another thing she had talked about was just "disappearing" when she left the hospital. He knew that wouldn't settle anything. It would just all come up over again sometime later. I said we were talking of California as meaning letting things go between them. I thought perhaps feeling this way about her present condition he might really think it was too much to cany. Perhaps what he really wanted was to let things go. No, he didn't want to just let things slip away from him. I said for her just to go back to California as before would not settle anything; it would not be an ending, as though there were a divorce. He said that would be different because then he wouldn't be responsible. Now he was legally responsible, he added, even for the new child. I said yes, he really was, and that might seem pretty heavy. Another thing she had thought of was placing this. child if it were bom. He didn't know. It could be his, he said, and he didn't know whether he could take that chance. I said he was asking himself to do one of the hardest possible things and I wondered if he could do this if it were for the children's sake or for hers, unless there was something in it for him that mattered more than the badness in it. He said that one thing that made him feel there was something in it for him was some letters he had found in a suitcase which she had written to him in October but never mailed. He guessed she didn't because he hadn't answered her wire or her letter; but he hadn't known where she was. If it weren't for the letters he wouldn't think she meant what she was saying at all, but they seemed to say there was something with him she really wanted. I said there was something in it he really wanted. What he wanted was for them all to be together. After a pause he said slowly he really didn't know whether he loved her or not any more. He just didn't know. Maybe if things changed it might be different. Things were sure in a mess. I told him I knew they were in a mess, even after all the work he had put into

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them. I wondered if there were any basis on which they could get together. He said slowly, after all they had married. "You married for keeps." He thought it was better to try to save something. H e had to express some doubts; she had only wanted him when she was in trouble and, in spite of what she said about wanting the children with her, she had left Jane and neglected Tommy. But perhaps they could try again in X if she wanted to make it work. I said it would take making. He realized it would be especially hard "maybe the next six months." He would have to go at things a little differently. He talked about playing cards "like I told you before and fellows would drop in and we'd go out for a bottle of beer." "Then," he continued, "we got to going out separately." Of course this time would be harder; there wouldn't be so much money. He had been making $70 a week. He had run the finances and paid the bills and done the marketing. He laughed and said his father had done this for his mother and he just always did, just like his father. I said she wasn't the same person as his mother, though. He thought, now, maybe that had been a mistake. She was jealous of Jane, too, because he paid her so much attention. He thought she needed it, but he would know how to be different about that now. He had gone to the hospital one day and found her making a budget. The figures were all "messed up" but she was making it. I said that seemed like one way of her working on their getting together. He said yes, he guessed it was and it didn't matter so much if the figures were wrong. This seemed to have real meaning for him. I said we had talked about its being different, but I wondered if it could possibly be the same. He said so much had happened, it couldn't be. He knew what he'd done that was wrong and she knew too. At least, she said she did. If he could only be sure. I said I couldn't make him sure. He knew nobody could tell him. He tried to understand from her. I said, "Perhaps she can't tell you in words." Perhaps one way she was different from him was in not being able to deal with this the same way he had to. I could feel how he was trying to think this out to the bottom. He was, because he didn't want to start anything again if it wouldn't work. I said it was a gamble in one way. Even if they started under the best conditions, no one could guarantee how things would work. He took this up and said that was true, even if they had started before when things seemed settled. He knew it would be harder, particularly if there was to be a reminder. But maybe it would be good for her to have a reminder. He was a little stern as he said this. It looked to me as though whatever he decided was with full knowledge of how bad things looked. He thought that was good because if he had to find them out later it would never work. He guessed perhaps

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they could go to X. "Do you think?" I said I couldn't tell him it would be all right. He said again, "I have to decide. I guess you wish I'd make up my mind." I guessed he wished he could, all this certainly must be tough on him. He was nervous. He drank twelve cups of coffee a day. I thought he certainly must be nervous, that the last ten days were pretty bad. He said he'd thought an awful lot about it. He would talk to her again, out of the hospital. Then he thought it would be all right. He got up to go, saying I must have other people to see. I said I had other appointments. He stood there a few minutes and then sat down in the other chair, nearer my side of the table. I guessed he must feel he'd like me to say "It'll be O.K.," that that might feel comfortable right now. He knew I couldn't tell him that, and he guessed he had something settled in his own mind. I said if it felt that way maybe it was a little settled. I couldn't tell him what to do, but I could try to help him see what he wanted to do. He said plenty of people give you advice but you just knew you wanted to do the opposite. He'd had plenty of advice lately. I said the people who gave advice weren't the ones who had to live it. He said with feeling, "If we get together this time, we'll really have something." I said, something he'd really worked over. He sighed and acknowledged he had worked. He got up once more, and again sat down in the first chair. He would talk to her when she got out of the hospital tomorrow. Then he would come here Wednesday. He wanted to know what time I would be free. He talked a bit about trains and reservations; he had found out about the fare. We talked about when they would need to leave, and were able to laugh a little over one or two things. He finally said he guessed he'd really better go. He looked pretty sober as he left. 12-23-42 Mr. Fletcher phoned this morning before I was in; and later came in. He thought it was really settled this time and they were going back together. He sat back and laughed a little nervously. They had talked it over last night. It seemed quite different when they were able to talk out of the hospital. He thought it was going to work out all right, "at least temporarily." I said the most he could do, was to decide what he wanted to do with the present. You couldn't handle the future. He said this was the thing for them to do now and "well try to make it work." I knew how much had gone into this decision and I thought that gave it a swell chance of working. He acknowledged it had meant a lot of thought. He hoped it was right. He knew it wouldn't be all perfect. It would be harder the next six months or so. I said I felt he knew today what he wanted to do. He thought he did and that what we needed to do now was to settle the details.

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He had phoned the railroad and had a Pullman reservation for her on the 2:15 train this afternoon. He had a coach ticket but wondered if this was good on the same train. The baby would need no fare. We planned how he would get Tommy from the Shelter. We also discussed how much money she would need. I had to explain the difference between our help to her, which could be as a grant, and the $3 we had given him which had to be as a loan. He commented on the separation of these procedures as "something else." We decided how much she would need to carry her and the baby until he could sign a special payroll. I mentioned the Red Cross chapter in X as a possibility if they wanted further help. There was one more thing he had forgotten to ask about. He owed the blood bank at the hospital a pint of blood as she had had a transfusion. I wondered if he felt this had to be handled before they left, if he was wanting me to inquire about it. He thought he could write them and maybe give blood back at his station. They could send it and "it would be the same blood." I knew he had a lot of ground to cover and wondered if I could help him in doing any of these various errands. He thought he would have time but would call me if necessary. He did call later to say the Shelter was having to check up before they would let him have the baby, but he did not think I needed to phone. He would let me know if there was any hitch. Later Mr. Fletcher returned to the office once more. Everything was lined up now, and his wife and the baby were waiting at the hotel. He seemed to want to talk a little. He sat back in his chair and told about getting Tommy; how he had cried when he left; about the toys they had given him. Tommy would probably sleep most of the trip. He had no reservation yet, but he wasn't worried. He'd get on the train; and he laughed. I asked him if he would think it any help if I wrote the X chapter and he thought this might be "like an introduction," if they needed it. I said perhaps he had had enough of Red Cross. He said this had been a tough time but if he hadn't been able to come here he wouldn't have had anywhere to go. I told him I knew how much he had had to do himself to reach today. He said once more he believed it would be all right. It had meant a lot of thinking. At last he thought he'd really better go. I went to the door with him and he tried to say thank you. I said sincerely I wished him the best of everything, and he left.

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

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aspects of practice which go beyond its urgent emergency tasks. If, however, family agencies are feeling more and more an obligation to state their purpose clearly to their communities, we shall have to place the same obligation upon Home Service, as a newly expanding part of the structure of social services in any community. Otherwise, our present confusion of function between family agencies and Home Service gives little promise of abatement, let alone of solution. The confusion comes in that area of Home Service which is officially described as "consultative and helpful activity directed toward meeting those family difficulties which do not require financial aid." 10 Small wonder that family agencies feel this to be cutting across established lines of responsibility carried by the private family agency. The Fletcher case, which in spite of the small expenditure of funds for travel might be considered as falling in this area of conflict, seems to give us a new departure for the consideration of whose function it is to deal with such cases, and a new basis for referrals from one agency to the other. There has been discussion of the availability of adequate skills, or the war connection of the problem, as basis of referral and allocation between the two agencies, but we have not sufficiently considered as a factor the readiness of the client to work on his problem with one agency rather than another. In the Fletcher case most of the worker's activity with the young seaman and his wife has the unmistakable quality, mood, and method of family casework. Take this young man out of uniform and you have a typical family agency problem, heightened by nonresidence. You cannot say that the difficulty between his wife and himself is serviceinduced or war-connected, any more than any activity of this family would have its inevitable war connection, merely because Mr. Fletcher is now in the Navy. Indeed, they both tell of their stormy few years of married life previous even to his enlistment. If you wished to determine the origin of their difficulty, the search would take you into a morass of problems in both their troubled young lives, which long antedate today's crisis. Nor can you find this origin, even if you would, for time is the essence of movement here. Mr. Fletcher has only between the eleventh and the twenty10 Joint Statement, American Red Cross and Family Welfare Association of America, on Services to the Armed Forces, June 1942.

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third of December in which to live through a momentous and tragic experience. The social worker knows that it is her solemn duty to help him live through it responsibly. She knows, too, that his future and that of his wife and children are to be irrevocably affected by what he can achieve for himself of courageous decision in that brief period of furlough. Of course, the nondebatable functions of Home Service, such as communication and reporting, are also involved here, and it makes for simplification and ease of operation that the worker is able to render help in extending the furlough, in granting financial aid and loan for travel. Almost everyone could therefore agree that it is more expeditious for Red Cross to handle this case, and could accept the technical propriety of Home Service function in the situation on that basis. Perhaps all could even agree that the family problem is "service-connected," because of the necessity of helping Mr. Fletcher reach a sufficiently satisfactory solution of his affairs so that he may retimi to service with some peace of mind. It is not so easy, however, for caseworkers to admit that the die was really cast by the two young clients themselves, each of whom, in pursuance of his own needs, called upon Red Cross for help. Stranded, outcast, and ill in a strange community, when Mrs. Fletcher was ready to ask for help for herself and child, her first appeal was to the Red Cross. Many hundreds of miles away, the young husband's first resource for help in finding her was the Red Cross. To both of them the Red Cross somehow represented a source of help which they had a right to call upon. It transcends state lines and railroads and residence restrictions. It belongs to all places and you belong to it, wherever you go, because you have a "service connection" whether you are the sailor or his wife. Both of these young people bring, therefore, a sharpened readiness to work constructively with Home Service on their urgent problem. It is probably the most powerful dynamic in the situation. This readiness might easily have been dissipated if referral to a "family agency" had been deemed necessary when the casework problem became so clearly focused on helping the man to reach a decision which involved the very continuance of this little group as a family unit. If we are inclined to enforce rigid functional lines, some children's agencies might well point out that the worker here even

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encroached upon a child placement function, in taking the baby to the Shelter and discussing at length the question of adoption with the father. In any thoughtful, objective evaluation of this situation, the needs of the family do extend well beyond the service-connected problem, and according to the agreement between the Family Welfare Association of America and the American Red Cross, would "call for the family adjustment service which the local family agency is especially equipped to render." Under such circumstances "there should be consultation between the two agencies to arrange for referral or cooperative service." 11 It would be regrettable if this agreement were to have a tendency to encourage uncompromising functional definitions. In this case the Home Service worker and her clients were able to define a focus of operation which ordinarily falls within a family agency, but it seems here appropriate beyond a doubt that Home Service should handle it. It should be possible for a family agency to yield some of the family adjustment function to Home Service, even at the recognized cost of some loss in potential case load—and to do so without fear of encroachment—if we recognize that in any helping process the client's will to be helped by a particular agency is a factor equal in importance to the agency's function. I accept that this consideration adds complexity to an already difficult situation, but I believe that agreements between agencies on referrals, however clear-cut, are invalid if they omit this factor, if the client's needs are considered but his will ignored. In the first case here presented. Mr. Alberts was sent to a private agency by referral, but he remained to work on his problem with all the force in him, because of his readiness to use the specific services of a private family agency. The Fletchers, on the other hand, themselves called upon the Red Cross in the midst of their distress, because of their conception of its help-giving function and its fitness for the problem they were facing. This conception is neither fantastic nor absurd; it falls well within the community's mandate to the Red Cross. Against many odds the worker presented Home Service to them in such a way that it fulfilled their expectations of help, but she did not have to create the agency or reshape it for them in terms of their need. The helpfulness she provided is inherent in the function. It is because she defined her II

Joint Statement cited above.

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help to them professionally—rich in understanding but limited in service and time, and focused upon the problem at hand—that these few encounters with a young couple, estranged and in a city far distant from their home, could be for them an experience which profoundly affected their way of going forward to the next phase of their living together. No one is able to predict the outcome, and to some it may look dubious indeed; but could anyone doubt that Mr. Fletcher returns to his home port with new strength for the ordeal that faces them and new compassion for his wife? They will probably need further help, and it appears likely that as the occasion for it arises they will again call upon the Red Cross. There is an obligation upon Red Cross to have available for them the kind of skill they have already experienced in Home Service. No social agency can "stake a claim" in a field so vast as problems of family adjustment, without running into conflict and competition with many of the institutions which our culture is continually building up to "service" the family in all its facets. This case seems to ask of a family agency that it share a part of its traditional function with another agency, even accepting some duplication in service and method, but recognizing the other agency's distinctive purpose. Because we live in such critical, changing times, social workers are everywhere in a questioning mood about the social and psychological validity of the services they have been offering. Family caseworkers are openly questioning whether the family service function, having developed out of other social, psychological, and economic conditions, may be likely to find itself outmoded in a world of new forms of social security and opportunity. But I believe that few people could seriously doubt that in any social order, no matter how broad the coverage of security, there will always be many individuals who will need and seek help of one kind or another for more adequate living, at points of crisis in family circumstances and relationship—help which is not provided through public auspices. I have a strong conviction that social casework, when it operates functionally in giving such help, is not evidence of philanthropic cultural lag; that it not only is compatible with "the democratic way of life," but is a development

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of technical process in social work which has evolved out of the contemporary culture. The family agency has a genuine right to a place in the community of social work, but only if it is willing to accept the responsibility for a clearly focused task; and it can ask for support only if it demonstrates a method appropriate to this task. The focus of this task can, however, never be rigidly defined by social workers and supporting community alone, for the propriety and validity of a function derive in large measure, as well, from the individual for whom it exists—from the where, and how, and with whom, he is willing to work in his own behalf. If these factors are taken into consideration by family agencies in that continual readaptation of their function which is necessary in order to meet changing social conditions, family casework will be kept alive and related in service and method to current basic trends in our world.

THE USE OF FEE IN THE CASEWORK PROCESS IN A FAMILY AGENCY Frances T. Levinson THE Jewish Social Service Association established the Consultation Center, a fee-charging division of the agency, with the following definition of its purpose and function: Consultation Center was to be an extension of the family casework services of the agency to a group who could afford and who wished to pay for casework help. Fee was thought of as a way of meeting the psychological need of people to pay for services received and of breaking up the identification of casework with its relief-giving aspects alone. I do not think we anticipated the extent to which fee-charging would affect the caseworker, nor could we forecast its usability as a way of relating the client to his problem and helping him work toward a solution. In starting with the effect of fee on the caseworker I have used the initial, often the extreme, reactions in our experience, since they illustrate not only the caseworker's attitudes, which have to change before she can handle "fee" with any ease, but also the kind of supervisory help which is indicated. At Consultation Center, the staff had insufficient supervisory help and preparation at the outset. The experience was as new to the supervisor as it was to the staff, and instead of anticipating some of the attitudes and difficulties which might arise she did not recognize and handle these problems until they found expression in the worker's performance. There was one more complicating factor in the beginning. The demonstration was new in the family casework field, and the workers themselves carried the burden of determining its success or failure. They were not only being tested by a new group of clients, who were determining the value of casework help through this contact, but the workers were "on the spot" professionally, also. Either one of these factors was difficult to handle, 68

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

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

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

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

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

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

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

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

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

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

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

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

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

THE

SPECIFIC N A T U R E FAMILY CASEWORK

M. Robert

OF

Gomberg

WHILE it is possible to discuss the specific nature of one or another of the services of the family agency, such as relief, housekeeping service, help with problems in family relationships and so on, it is another matter to attempt to describe a specific focus for the family agency as a whole. In other social work functions the specific focus centers upon a single service, clearly defined, which the agency is established to offer. The child placement function is an example. This function, it is true, is a complicated one, and the beginning placement worker has much to learn about work with the foster child, the foster parents, the child's own parents, and so on. Each of these aspects of the placement job represents unique problems. However, all are integrated into a meaningful pattern when each of these problems is related to the central specific purpose of the agency, placement of the child. This makes it possible for the worker to integrate his experience and to develop the specific skills essential to the child-placement process. Although any client of any social agency is usually a member of a family, and the family as a whole is ordinarily affected in some measure by the client's problem, the more specific aspects of the problem, e. g., illness, or behavior problem of a child, will usually determine which agency is best able to be of help to the family or individual. While the understanding of human behavior and of the casework process is generic and basic to working with clients under any circumstances, there is a special body of knowledge and skill essential to dealing with problems in each of the functional areas that extends beyond the generic foundations. This special knowledge has to do with the distinguishing characteristics of the problem, the distinguishing characteristics of the service, and their impact on each other. For example, the feeling and attitude of the 82

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

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

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

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as a whole, to meet this problem. If in the particular family it is the man who is the provider, I believe that his participation in the application for assistance is essential. What this participation may be will vary according to the situation. In one instance the man may just confirm that he is aware of the request and desires the service; in another instance the man may become the continuing client. In no case does his participation have to represent the rejection of the woman. This is illustrated in the Green case, which is presented in detail later.1 Here is another illustration of what we mean by gearing agency service to our responsibility to the whole family: A man applies to the family agency asking that the agency provide a housekeeper to look after the home and children, because his wife must remain in bed for two months due to her illness. Sometimes the situation is acute and it may be essential to place a housekeeper in the home before we can see the mother, sometimes it is not. In any instance I believe that the application should not be considered finished until she is seen, if it is at all possible. There is no question that the service is physically necessary, and within the province of the family agency. However, we do not know what the illness means to this woman. Up until now, caring for her home and her children has been the essence of her role in the family. What will it mean to her to have another woman enter the home and perform that job, when she has had no direct part in arranging for that service? As she participates with the agency, deciding whether or not she wants help, planning the kind of work the housekeeper is to do, the hours she is to come, the probable length of time she will be needed, the woman may indirectly hold on to her feeling of usefulness and to her place in the family. On the other hand, if the agency works out plans without the woman's participation, if it feels no direct responsibility to her, may it not heighten the normal anxieties that come with illness? May it not threaten her security in her role in the family, when she sees how quickly "her job is filled"? The third illustration has to do with the agency's responsibility to the children. A young couple apply to the agency for assistance, part of which has to do with helping them to maintain themselves and their two children, four and seven, all in one furnished room. ' P . 89

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

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

Psychotherapy with Children

(New York: W . W . Norton & Co., 1942), p. 35.

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Neither the worker nor the agency can decide for the client what he is ready or willing or able to do in meeting his individual family problem. But the agency does have a responsibility for the role it assumes in the client's life in offering or withholding service. It has a responsibility for the way in which it offers service and the conditions under which it offers them. These conditions and procedures, which must be established by the agency itself, would necessarily derive from, and be consonant with, its basic focus of "responsibility to the family as a whole." This provides a framework for the contribution of the individual caseworker. The case of Mr. and Mrs. Green demonstrates clearly, I believe, first, how an experience with a family agency can help a family to achieve a more normal balance, so that the several individuals within the family may regain the feeling of value and integrity in their individual roles; and second, how the family agency's responsibility to keep the whole family in central focus, while working with the individual, helps the worker to contribute to this achievement. The Green family, which consists of Mr. Green, aged forty-two, Mrs. Green, thirty-five, Helen, thirteen, Joan, eleven, Ann, seven, and Ralph, five, was known to my agency 8 through several previous applications. Mr. and Mrs. Green have been married almost seventeen years. Mr. Green came of a relatively well-to-do middle class family. He went through college and completed one year at medical school. At that point his family suffered financial reverses and he had to give up the study of medicine. He has had various positions, all connected with radio work, since he had had training and skill in the field. He is a small, stocky man, who speaks well but glibly, apparently anxious to convince one that he is a "nice fellow." His only apparent assertiveness is limited to this earnest effort to get himself liked. He married Mrs. Green at the time when he had to leave medical school. She, unlike her husband, is always described in the records as attractive, impulsive, and spontaneous. She has had very little education but apparently always makes friends easily and is well liked. She describes how awed she was by her husband's education, by the possibility of marrying someone who was "almost a doctor." His education, his fluency, his ability to "talk about anything intelligently" attracted her and led her to believe that anyone "so smart" would earn a substantial livelihood. • Jewish Family Welfare Society of Brooklyn.

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They were able to manage adequately for the first few years of their married life, but at the time of the birth of her first child the depression set in and Mr. Green lost his position. From that point on their economic position was precarious, Mr. Green going from one job to another, his income always marginal. In 1936 the family had to apply for public assistance, and from then on they managed either on WPA or Home Relief. Mrs. Green has made four applications to the family agency in the past three or four years. Each time the problem arose from the inadequacy of their income to meet the needs of a family of six. The requests were always made by Mrs. Green. They were usually specific, i. e., clothing for the children, help to meet a pressing rent arrearage, and so on. Mr. Green never participated in the family's application for assistance, nor could Mrs. Green think of any way of using the agency to modify their difficulty, except for filling the specific needs as they arose. Mrs. Green was the member of the family who was known to the public agency, as well as the private agency. She was extremely aggressive and demanding in dealing with the agencies. She was deeply attached to her children, "never wanted anything for herself," and always felt that she was entitled to assistance because of her trying circumstances. She was very bitter against her husband. She resented his failure to fulfill her own original expectations of him and seemed to reject him completely. She grudgingly admitted that he was fond of the children, and in a negative way she still spoke of how "smart and educated" he was. She apparently shared little with him, controlled all the income in the family, and whenever any additional needs arose, applied either to the public agency or to the private family agency without consulting him. In each of her contacts with the family agency, and throughout her experience with the public agency, she had threatened to separate from him and break up the home. This was generally offered impulsively and in anger, never as a solution thoughtfully considered. At the time of the present application, when my experience with the family began, Mr. Green had a job in private industry, earning twenty-five dollars a week as a radio technician. Receptionist's Report, 9-14-42 Mrs. Green in office, pressed for an appointment today. She did not know she had to renew her application for surplus food stamps, and thus lost out on several weeks' allowance.

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

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

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At this point her attitude changes considerably, and in a tired, almost wistful manner, she says, "I'm still young and I have a right to some happiness in life. Will it always be such a struggle?" I say that with so many things not working out for her, she probably feels that unless she has her hand in whatever happens to her family things can only get worse instead of better. As she continues to sense my desire to help her, the readiness of the agency to do so, she is able to yield a little and to speak of the possibility of her husband's coming in. I agree that I will be ready to see him, but I wonder whether she doesn't want to give it some thought, since she has so much feeling against it. With some measure of relief, she finally decides that she wants him to come in, and we agree that he will call me. She wonders if we have any time left, and I say we have about ten minutes. In a frightened though less emotional manner, she asks specifically what I meant about the agency's help toward separation. Briefly I tell her of the services we have: 1) relationship to the Family Court; 2) our ability under certain conditions to help financially if this is the only problem in the way of separation; 3 ) interviews with a social worker to help a person clarify her own feeling about separation. Mrs. Green doesn't react to this directly, but says if only Mr. Green were more aggressive, with his skill and education he should get a good job easily these days. In the same breath she begins defending his not leaving this job. I say in a way she blames him for not going out and doing something different, and yet she too may be afraid of his trying something else. She nods, and I comment that coming to the agency would be "something else" for him, too, and perhaps she still would want to think about it. She affirms her readiness for him to come in, but says that she would want to come back and talk further with me. I agree to see her after seeing Mr. Green. From our previous agency experience with Mrs. Green, and from the experience in this interview, we can see the degree to which she has literally obliterated her husband's role in the family. Her conscious and expressed motive is to keep her family together and provided for under adverse circumstances. The impulse to preserve her family, which impelled Mrs. Green to move beyond the role she had originally conceived for herself in family life, brought her into conflict with Mr. Green, since it was his apparent inadequacy that created the problem initially. Thus, on the one hand, there is a strong desire to preserve family unity, and yet her very efforts to achieve this create and sharpen the break between

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

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Mrs. Green reacts strongly against this requirement since in effect it challenges her control over the family. She reacts against worker and agency much as she probably does against her husband, that is, with aggression, hostility, and threats of breaking up her family. However, when the agency holds to its way of giving service, Mrs. Green is apparently able, at least for the moment, to forego some of her excessive domination of the family. Whether this yielding on her part will begin to help her to give greater freedom to Mr. Green to assume more of a normal role within the family, and whether he can with help actually assume that role, cannot be known at this point. What is clear is that the request as she makes it does not seem to offer any solution to the family's problem, and the agency cannot meet it on her terms. Yet the agency can offer the service under certain conditions which, it has learned through long experience with family problems, are more likely to further the welfare of the family. As Mrs. Green shows at least a limited readiness to accept this, plans are made for continued service. I saw Mr. and Mrs. Green separately, each for fifteen interviews, over a five-month period. I believe that when both husband and wife are to be seen, a great deal of consideration must be given to the problem of how they will be seen. Should they be interviewed together, or separately? Should the same worker see both clients, or should the case be divided, each client to be seen by a separate worker? I have found in my own experience that when a man and woman are having a marital problem and each is experiencing some impulse to separate but cannot act—either to separate or to adjust the problem between them—it is sometimes helpful to divide the case and have each client seen by a different worker. In a limited and unthreatening way this gives them some experience with separation. If this structure is used dynamically, it helps the client to face and test this feeling ( impulse to separate ) which he may have been denying, and to move beyond the stalemate in the relationship to something more acceptable to both. I did not feel that Mr. and Mrs. Green were primarily concerned with the problem of separation. I felt, after my interview with Mrs. Green and then with Mr. Green, that neither at the time was considering separation seriously. Both were obviously unhappy because of the negative relationship that existed between them, yet

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each continued the pattern of behavior that made for such a relationship. I felt that if each became related to me as the representative of the agency from which both wanted help, it might represent a new element in their relationship, a common bond, even though a bond brought about by the weakness in their family situation. If this different experience could break into the rigid pattern of their relationship, then it might be possible that the agency connection could serve as a fulcrum in their new efforts to find a more balanced relationship. For purposes of clarity and continuity in this paper, I will present detailed interviews only from the experience with Mrs. Green, interpolating pertinent information from the contacts with Mr. Green. Thus, before the second interview with Mrs. Green, Mr. Green had been seen twice. In these interviews Mr. Green was able to clarify his eligibility for the specific services the family needed; also, and more important, he became engaged in a plan to use the agency's assistance, through which there seemed a real possibility that he might get additional work on his own that would substantially increase his income. He needed help in purchasing equipment, and he needed to obtain consent from the organization which employed him, since the work must be done in their plant. It is interesting to note that at first his attitude was that of an acquiescent emissary of his wife. In a detached, friendly way, he would mechanically "do his part." When this was not sufficient to meet our conditions, and more of himself was drawn into the experience, one sensed what at first seemed like an immobilizing fear of doing anything lest he jeopardize in some way the slim thread of relationship that he feels holds his family together. This is equally true of his job. He is obviously dissatisfied with his role, both in his family and in his job, but rather than do anything that "might stir up trouble" in either relationship he would maintain the status quo. Nevertheless, he moves by the end of the second interview to some consideration of the new plan by which he may increase his income. Although this appeals to him, the idea of discussing it with his employer is a great obstacle and he admits his fear. Then, too, he expresses some concern about his wife's continuing to see me. He hopes I won't "misunderstand some of the things she says" about him. This is part of his concern that I may identify with her rejection of him, but also he is fearful of her

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

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

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to her husband's coming in, she begins to yield some of her double role in the family to her husband, and one can sense her concern about what will happen to her as a result. Instead of the total rejection of her husband expressed previously, she evidences a wish that there could be some more satisfying relationship between them, as, "many times she would love to talk to him." It is a feeling which she has denied for many years that begins to emerge. The question as to whether she has any right to ask for assistance for her personal needs seems again to be part of her concern as to who she will be if she does give over all control of the family. In the eyes of the worker, and the agency, is she a person, does she have rights as a separate individual apart from the role she has carried these many years? The worker uses the service and himself to help her experience an acceptance of herself in this new capacity, if she will permit it. However, realizing how tentative and still ambivalent her feelings are at this stage in the process, he makes no effort to press her decision, but gives her an opportunity to work on it at her own pace, for example, letting her decide whether she wants to make any request for herself, apart from the family as a whole. In his next (third) interview, Mr. Green brings in written confirmation from his employer, stating that Mr. Green's plan is acceptable to the firm and that they will help him in any way they can. He is very pleased at this success, although it is apparent that he is quite fearful as to where all this new activity will lead him. It has broken up the mechanical routine of his existence, and although it holds good prospects he is fearful lest it lead to disappointment. Nevertheless "he wants very much to continue. He has told his wife what is happening." This represents the first direct sharing of a hope between them in years. Third Interview, 10-8-42 The general tenor of this interview is quieter than last week's. Mrs. Green seems easier and more comfortable. In describing her situation I get the sense that she begins to share a little bit more of her husband's conviction that something will come both of his job and of his beginning efforts at earning other monies with the help of this agency. Her attitude toward him still is ambivalent. She indicates her respect for his intelligence and capacity and a resentment for all she's been through and for the little she's gotten from married life. It is interesting that in this interview, where there seems to be a greater acceptance of him, she at the same time condemns him not

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

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a person has to take less out of family life than he would have wanted, and yet might find it more than what he might get otherwise. With this she is again able to acknowledge a little more of her positive feeling, not only for her family but for her husband. She discusses specifically the additional needs which they have, but we agree that it won't be possible for us to meet them at this particular time, till we know better what the result of Mr. Greens new venture will be. We will know then whether she is asking for help because he has no earnings, or asking for some help, so that with his additional earnings they can start in with a clean slate "by utilizing some help from us." She is quite accepting of this and we confirm the time of our next appointment after my meeting with Mr. Green.

In this interview there is a developing acceptance of her changing role within the family. She is beginning to limit that role more to her relationship with the children and her responsibility in the home, and she is articulate as to her greater happiness and peace of mind. It is interesting to note that as she works on defining a more satisfying role for herself, although she speaks of this in positive terms, any acceptance of her husband is slower, more cautious, and questioning. Yet the meaning and value of "family," as something of value beyond any one relationship within it, begins to emerge, and the worker helps her to hold on to this feeling. Even at this early point in the case, one notes changes in the feeling and behavior of both Mr. and Mrs. Green. This grows out of the immediate experience, I believe, in which each is related to the agency in an effort to achieve something that alone, between themselves, they were not able to achieve. The agency is the common bond, holding their mutually positive purpose, which their problems prevented them from realizing by themselves. The change in each of them is too new, too tentative, for their own relationship to sustain them through the next period of uncertainty. The agency is actually holding the balance between them as each fumbles toward a role that eventually will permit them to maintain their own balance. This illustrates the technical problem in working with both man and woman at the same time. The experience with one client must never become isolated from the experience with the other, else the common goal may be jeopardized. Mr. Green, in his fourth interview enthusiastically tells me that he has already begun to earn some money from his new project.

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

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

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

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

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

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through in her life and how natural it is to distrust changes that have come within a relatively short period of time. She admits how important coming here has been. She reviews their specific needs which we were able to help with, and also feelingly emphasizes her relationship to me as a factor that has helped her to get more happiness out of her life— "for one thing, talking to you I learned I could talk to an educated person, and so I've had less trouble talking with Mr. Green." During the course of the interview I sense a degree of relaxation and an easing of the tension, and I comment that she is beginning to feel easier, yet in a way the facts continue to be the same and I would not be surprised if for a while she would be having, from time to time, real upsurges of discomfort and worry as to how things would work out. She doesn't react to this except to acknowledge that she has some awareness that she has been trying to "pretend that all the bad was gone and everything now in my life will somehow turn good" and she knows that it cannot be this way. As we talk more specifically about how much further shë and I will be going on, we consider the several specific needs that are still left, the last with which the agency will help. We agree that we have no way of knowing whether actually at that point we will be altogether through with her contact here, or if we might not consider going on for a time to see how they manage on their own. What is clear is that we are certainly coming to an end of a part of the help, and perhaps even approaching a point where she will want to try going on entirely by herself. In the seventh, eighth, and ninth interviews (not presented here in process), one could see opposing tendencies operating within Mrs. Green. On the one hand there is the fear that the constructive developments within her family life will not be sustained through her husband and herself alone. Since the agency and worker have in several respects, for example, through financial assistance andthrough relationship with worker, represented the means through which change was made possible, she is afraid lest upon their withdrawal everything will revert to the untenable life she had previously been living. This fear was clearly apparent when an interview had to be delayed a few days because the worker was out ill. Mrs. Green was obviously upset at not being able to see the worker, and although she knew why he had been out she was anxious as a result of this very limited experience of having to do without the worker and agency. She was reassured when she realized that no pressure was being brought on her to set any immediate time for

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

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

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is to deny this—she looks at me, laughs, catches herself in the middle of a phrase and simply says, "Who can tell, I hope not." Mrs. Green hopes that when I see Mr. Green this coming week, it may still be possible for him to succeed in becoming eligible for the supplementation from the agency. They need this badly until he is well enough to carry both jobs, or until his increase arrives. I confirm the agency's readiness to assist to the maximum of our budget if Mr. Green is able to find some way of clarifying his income. She laughs and says, "Well, this time 111 let the two men handle it. I'll stay in the kitchen." Then quite easily, but thoughtfully, she adds, "You know when his raise comes round in a few weeks we won't be needing any more help and I hope well manage our own headaches. Although I won't be getting any more money from you, I'd like to keep coming in until then." I said that I thought she was getting prepared to say good-by. The last time we had talked about ending here she'd gotten pretty upset. She doesn't discuss this very much but comments in her typical, sincere manner, "I think it's different now. Then you spoke about it, now it's me." I believe this interview affords us an interesting opportunity to observe the direction in which Mrs. Green is moving, as well as the change that already has taken place in relation to two principal interrelated problems—first, her relationship to her husband, and second, her relationship to worker and agency. In the early part of the case we noted Mrs. Green's almost total rejection of Mr. Green. In this interview we see that she still has some impulse to take over some of his responsibility. However, we note, too, how aware she is that this is not helpful, that it is a problem within her, rather than something she must do for the benefit of the family. One senses, to, that in her own way she is trying to curb this tendency, and that as continued experience confirms Mr. Green's ability to carry his role within the family, she may overcome this residual pattern. Again, in the beginning of this case, when the agency introduced a requirement that meant her husband's participation, she responded with hostility both to agency and her husband. It seemed at the moment to sharpen and extend the conflict between them. At this point, when a similar requirement is introduced, which implies some difficulty for them, instead of reviving this reaction, she tells the worker that she and her husband were "a little mad at the agency." This shift in response, to a unity in the reaction of both Mr. and Mrs. Green, I believe is de-

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

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

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

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

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

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

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

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

T H E RELATION OF CASEWORK HELP T O PERSONALITY CHANGE Grace Marcus IN THE last twenty-five years social casework has devoted its major energies to the task of understanding the psychological element in the casework job and evolving a method that would be psychologically sound. Its literature reflects the changing concern of case work with the personality of the client, the changing psychological and social ends to which the concern has been directed, and the changing means used to achieve the ends. The literature also reveals the disorderly character of the evolution. Caseworkers took it for granted that their practice embodied a method, but it had no method in any real sense of the word. There were concepts, valuable in their essence but vague and ill-defined: they harbored unanalyzed contradictions and were mutually inconsistent, and they had a very uncertain relation to practice. Casework had humanitarian purposes but they were not developed into an operating power; they had not come to terms with actual conflicts between the divided will of the individual and the confused will of the social group, and so they were liable to unintentioned and undetected compromise. Casework was possessed of technical devices or "techniques" of sundry sorts, but they were not definitely harnessed to a practical purpose on the one hand, nor to a practical necessity arising out of the client's problem on the other. The specific professional task of the caseworker was variable in its nature, and the determination of its elements was subject to shifting influences in the single case, in the individual worker, in the particular agency, and in the specialized field of casework. Casework was an exciting but uncontrolled flux. It lacked the basis for a method—a defined problem—and it lacked the direction for a method—an explicit, single-minded purpose. The distinctive compelling interest in all the ferment of casework was the interest in the individual and the firm conviction 119

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

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

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

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

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

y

cern for the development of the client's personality; it is inherent in the using of casework help for ends that will be constructive for the basic welfare of the individual client and of the social group. The struggle is the client's struggle for, and with, a purpose of his own. The struggle is waged against the conflicting feelings that beset him in finding and pursuing his purpose with the case-

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

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

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

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

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

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

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

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can be responsible for what she does that affects the result, that is, for the method and process she employs and, therefore, for the degree to which she helps or hinders the client in gaining command of the ego that makes him a person to himself and an asset to society.

A DISCUSSION OF TWO CASE RECORDS ILLUSTRATING PERSONALITY CHANGE Virginia P. Robinson THE two records I propose to discuss and compare came into the possession of the Pennsylvania School of Social Work, in answer to a request to some of its field work agencies for case material which might be useful for teaching. One, the case of Joseph Marks, has been thoroughly used in classes in this School and on the West Coast; the other, more recently acquired, was used for the first time in our summer school of 1943. I myself have taught only the Marks case, and that briefly, once at Pennsylvania and once at the University of Southern California, so that I approach these records, here, not with a sense of familiarity with their teaching points, but rather with a sense of discovery of something new in casework process. These cases came into my hands this summer shortly after I had read Grace Marcus' article, "The Relation of Case-Work Help to Personality Change," and it is because of the striking illustration they afford of that problem that a discussion of them seems a logical sequence to her paper. I face a difficult technical problem in deciding how to set up two case records of some ten pages each with discussion by a third person. There are three possibilities: I have rejected the possibility of placing my own discussion first and the two records following, preferring to give the reader the chance to explore the meaning of the records for himself. I find also that to break the records up with annotations of my own would seem an intrusion into the process as described by the caseworker. It seems essential to me to present these records intact with only so much of introduction as will serve to engage the reader in a search for the common casework method they illustrate and with a few questions which may point up more sharply the difference between this method and others. The records will follow this introduction and in a concluding discussion I will present my own thinking about the method 133

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

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

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Does this projection 1 have an inevitable form and course determined by the individual client? To what extent does agency structure or limits or the worker's difference modify the course of the client's movement? An answer to this last question should illuminate one of the most baffling problems of casework, the problem of ending and its control. The records follow; first, Carolyn Lee, and second, Joseph Marks.

CAROLYN LEE

11-28-40 An appointment had been made by Mrs. S. from WPA for Miss Lee to be seen in application. She did not keep this appointment. 11-29-40 Mr. M. of the Social Security Board telephoned. He wanted to talk about Miss Lee to see if we could help her in any way. It was his understanding that Mrs. S. had called us about her. I said that was so and that Miss Lee was given an appointment for yesterday but she had not come in. He said that he was very much disappointed to hear that, because indeed she needed something and he did not know what to do with her at all. He had known Miss Lee all his life because one of her brothers was a good friend of his. She comes from a very nice respectable family and has no business behaving the way she does. She knows what's right. For the last four years, however, she has let herself go completely. She drinks to excess and has really been a street walker. Mr. M. went down to see her today to give her something to eat, because as far as he knows she doesn't have any money at all. She is living with a man who was employed until recently but is not working now. He found her in a very wretched condition and in a desperate state of mind. She says that she wants to do something different, but how can she when she doesn't have either money or a job? Mr. M. seemed to feel that the girl ought to be given a chance. Her brother, his friend, is a very fine man and holds a responsible position. Another brother, who is here in W. is not much good, drinks heavily, but is kindhearted and is able to struggle along. There is an 85-year-old father who is still working and is heartbroken over his daughter. The mother has been dead for several years. Miss Lee is a typist and at one time must have been pretty good. Mr. M. did not think that she was in any con1 1 am using projection here not in the usual psychiatric sense of the word, but in the literal meaning of putting out some activity from the self upon the object. In this sense projection is the most common expression of living and the basis of all relationship.

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

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

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

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

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

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

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were to give. Again she was embarrassed but succeeded in blurting out a request of some sort by saying that if we could help herfinanciallyshe would be most grateful. We struggled over the budget for some time and finally worked out the following figures: rent $5.00, food $3.00, clothing $1.00, carfare $1.00; total $10.00. Since she had had to stock up with food supplies and since her rent was higher than we had estimated when she had been in on Saturday I gave her the food allowance for the week and an appointment was made for the following Tuesday. While Miss Lee was in the office Mrs. S., WPA, called and wanted to know whether Miss Lee had come in to see me. I told her that she was in the office just now and Mrs. S. said that I could call her later. Later Telephoned Mrs. S. and gave her a brief report of our contact. She told me that as soon as Miss Lee was in a little better shape she could probably place her as a typist. Mrs. S. did think, however, that it would be necessary for her to have a medical examination because she had been running around so much. She indicated that Miss Lee was fearful of being infected with venereal disease and it might be a relief to her to have an examination. I told her that Miss Lee had been thinking about seeing her and Mrs. S. said she could talk with her when she came. Just as soon as I thought she was in shape to work Mrs. S. would be very glad to recommend her. 12-10-40 Miss Lee at the office promptly for her appointment. While she was still wearing the same clothes, I thought that she looked better and had actually some natural color in her cheeks. She greeted me rather brightly as if she had been looking forward to this interview. She told me immediately that she was feeling much better and that she was most anxious for a job. She had gone to see Mrs. S. and Mrs. S. had told her that she might be able to place her soon, but liad suggested that she get some blood tests, so Miss Lee went to the hospital on Friday and she will get the results this coming Friday. I asked her if she was worried about results and she said that she really wasn't, but she did think it was better to make sure. In a rather low voice she added "because I have been running around so much." She was evidently under very strong pressure for work and was thinking of all sorts of things that she could do to earn a living. She felt that if she had a job she not only could provide for herself, but it would keep her busy. This led us into a discussion of how she was spending her days. She said that she had been spending most every night at her father's and that he had said if she was really going to make good and get a job he would see what he could do about their living together after the holidays. This seemed to please her very much. Again she told me how old her father

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

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

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more ready than she had been a few weeks ago. However, it seemed to me that she might want to think about a few more things to get herself in shape before actually applying for work. She wondered what I meant and I told her that I wanted to be quite frank in discussing this with her. There was this item of clothes. While she and I both realized that clothes did not make us good workers they did help in getting us a job and they also were important in making us feel better about ourselves. She said that she realized that and that she had been trying to get those things with her clothing allowance from this agency. I said I was glad to hear that but that there were probably a few things that were big items that she couldn't get with this allowance. Had she thought what she might do about this? She talked about her coat which was in pretty bad repair, and I said that we did receive special gifts around Christmas and if she wanted me to I could give her $10.00 that she could use for a coat. This seemed to give her tremendous encouragement. I was able to find a very nice knitted suit which had just been cleaned and asked her if she wanted this as a change from working clothes. She said that if I could give it to her she would appreciate it very much. This led quite naturally into a discussion of Christmas and she expressed again a feeling of great loneliness. There is nobody she can really go around with during the holidays. Her friends of the old days do not want to have anything to do with her and the ones that she had known during the last few years she doesn't care to associate with. She does have an invitation for Christmas dinner. As she mentioned this it sounded almost like a question directed at me, asking whether she ought to accept it. I said that I thought that sounded very nice, that holidays were far more pleasant if we could share them with someone else and that I hoped she would have a good time. On 12-31—40 Miss Lee came in with a black eye. There were several other bruises on her face and I was concerned as to what might have happened. In walking down the hall together to my office I asked her how she was and very timidly she said that she was all right now, putting the emphasis on "now." As soon as she was seated she pointed to her eye and wondered what I thought of it. I asked her what had happened. She then told me that the friends who had invited her to dinner Christmas had invited her back on Friday to take a ride with them to Philadelphia where her friend was going to visit a sister. At the corner of R and S streets they ran into another car. At first I was not quite sure whether there was actually an automobile accident or whether perhaps she had been in a brawl, because she acted so guilty about it. I thought that in order to clear the air it might be helpful if

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

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

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

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

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JOSEPH MARKS

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

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

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

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gretful about her leaving, for he was attracted to her as a person and felt her interest in him. She told him I would be interested in going on with him, and would send him an appointment. Present contact with Joseph:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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But she refutes the agency's capacity to help with job before the worker can do so, with her honest realization of her own inadequacy. There is no illusion left in her and no strength to project her need on agency or worker, no belief in their capacity to help in her extremity. Rarely does a caseworker have to face so bald a revelation, so desolate an admission, of human failure. There is great temptation to brush it aside in shame and embarrassment, or to deny it in pity, or to put one's own life and strength to its service at once. This worker, on the contrary, meets it directly and simply with a recognition of the validity of her client's reasoning: money is necessary and a job is the way to get it. We all have to have it, the worker adds, including herself in this human necessity. Then she adds that, while it is true the agency does not have jobs to offer, she would be interested in knowing something of Miss Lee's work experience that she might better understand how to help her. What Miss Lee gives in response is factual information about her training and her jobs as typist, but it serves the purpose of bringing to consciousness a former, respectable, independent self. Some further information as to her drinking habits and her family connections follows, which, in the hands of a worker interested primarily either in causes or resources, might have been expanded indefinitely. This worker chooses rather to use what the client has gathered together to present as the basis for the self she wishes to restore. She makes only one telling remark: "She sounded as if she did not like her company." To this Miss Lee responds with greater strength and energy than she has shown before with a move to separate herself from her associations—the place she is living in is so terrible, the people are no good, they expect the worst of her. She simply has to get away from there. She mentions a man she has been living with for two years. She wants to get away from him, too. There is force and direction in this expression. Some part of this person, apparently so purposeless and lifeless, has been galvanized to action. We see it actually moving away from the dead, disgraceful self and its involvements. The worker will not accept so complete a separation as wholly real and questions what will become of the man. Is she so free to leave him behind? Why, if she had lived with him two years, did they never consider mar-

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

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

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

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

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

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

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a note to let him know her vacation time. She will be ready to make an appointment on her return if he wishes it. On his side two months have elapsed since the first contact before he gets back to the agency, but it is clear at once that during this period he has been working on the problem she left with him. She accepts his return as indicating that he wants to work on something here but leaves with him the task of defining what it is he wants. " I indicated that I was really asking him to help me understand how our service was of any value to him." He struggles in genuine confusion. It is not the money, he says, nor just the help which the connection with this agency gave him in the use of a vocational service. The clarity of the worker, her refusal to go beyond him in asserting her capacity to help before he has asserted his will to use it, finally bring him through to an admission of fear at beginning this contact and apprehension about his ability to hold a job. The worker's genuine human response to his feeling gives him immediate relief. She is convinced now that he really has faced his conflicting attitudes and has staked himself to an earnest effort to make a move in a new direction. She puts into words for him then what he has succeeded in convincing her he wants: " I said that perhaps what he really wanted was to be sure that he could have us go along with him in this experience, at least until he was sure he could go on by himself." This has real meaning for him and one feels sure it truly expresses his attitude, but when she sets up this service in terms of time and offers him an appointment, his ambivalence again overcomes him. When he raises objection to any specific time she suggests that he wait and think further before deciding whether he wants to go on here at all. This brings him out of his hesitation; it is not an open question, he insists, and he makes an appointment. It is broken when he is referred for a job by the employment service. When he makes this explanation, the worker again says that perhaps he would want to see how he could manage without help, but he insists on another appointment. Again he does not appear but sends a card of explanation, indicating that he would call later in the week. When no word comes from him, the worker writes giving him an appointment, saying that it is important for her in planning her work to know what he intends to do. He comes on the date set and the change in him is startling. He

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is disheveled, depressed, but not in conflict as before. The worker records, "I had the impression that he had reached some initial decision for himself that if he were ever to come out of his difficulties it would be through his own efforts." He had taken a job as an unskilled laborer, doing hard, dirty work, different from anything he had ever done before. With this fundamental test of himself, so seriously and deeply undertaken, his resistance must at the same time hold on to the old and try to make agency yield to his need. He is earning very little at this point, though he expects to work up to much more. Will the agency supplement his earnings and will it help immediately with enough to get his overcoat and watch out of a pawn shop? He can accept the refusal to supplement on the basis of agency budget policy, but he mobilizes his fight to get help on the watch and the overcoat. The worker's understanding of his fundamental struggle here and his genuine need of help in doing so difficult a thing brings tears to his eyes and an acknowledgment of how hard this all was for him. But she leaves with him the full responsibility for his task when she says with sincere feeling for him: "Frankly I did not know how he could have the strength to do what he was doing. . . . I did not know whether that kind of living would be worth the effort it cost him." So fundamental a realization of his problem is more than he can deal with at this moment. He turns aside to point out a very practical way in which the worker can make it easier for him. He had to lose a half-day's work and pay in coming here at this hour. The worker meets this criticism as practically and realistically as he presents it, offering to share the responsibility for this loss today and to give him evening appointments in the future. She carries his criticism to a more fundamental level by questioning whether in this hard thing which he is doing, so much alone and so independently, these appointments are worth the price. Are they helpful? It is she again who states the doubt and again we see how this releases him to feel and state his own affirmation. He does need, he says, someone who understands what he is going through, to share this experience with him. In the next contact, which turns out to be the last, his strength and purpose are obvious from the moment he enters the office. He describes the hardships of his job but in a way that indicates he has

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

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had provoked the discharge. He was given the slight relief he needed and used no further contact. It was learned from the Federation Employment Service that he had been placed in a full-time permanent job as cashier. In both of these cases, personality change has been effected with the aid of casework help. That help is offered on the conviction that the individual in coming to a service agency is seeking a way of breaking into the chain which his own pattern and circumstance have forged between himself and external reality. Something in this connection no longer works for him. The problem this presents to the caseworker is that of determining whether there is a real will-to-change in the client and whether he can use the particular form of casework help she has to offer in accomplishing change. Convinced of that will-to-change, the worker's skill in assisting it to move with direction and increasing strength and sureness rests on her capacity to recognize the forces in this movement as they are projected on her, as they struggle both to make use of and to resist agency service and agency conditions, and upon her ability to respond to them sincerely and immediately. In the Lee case, the movement toward change had in feeling accomplished the abandonment of the old self and its associates before coming to the agency. But there seemed little more than a timid hope to have things different, without capacity to bring that change about. The worker carried the conviction that change was possible until the client could gather strength to take it over as her own. Through the relationship with the worker who believes in change and who offers the tangible means whereby a new physical environment can be found, life flowed back swiftly and surely into the self and expressed itself in reality attachments with father and job. In the Marks case, on the contrary, the worker stood for the neurotic self of the dependent boy who had never regarded himself as a man nor been treated as one by family or agency. Here the worker had to initiate change for the reason that her own sense of function could not permit her to be a party to the use he had made of agency. Her question to him—did he want to try anything different?—while it disengaged his hold on agency, at the same time offered him a choice if he would take it. It penetrated his

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inner conflict, setting off one trend in a new relation to the others. That new trend engaged with the worker and struggled at the same time independently, finding himself a harder task in job conditions than any the worker would have set him. When he had met this self-imposed test and proved to himself that he could do it, he was through with agency help. He could leave in possession of a new self which had learned how to work and which had measured the value of a dollar. The worker could permit him to leave with his expressed criticism for the past, knowing that he was parting from his old neurotic self in so doing. But in spite of the amount of negative feeling so characteristic of Joseph Marks, one can never doubt that he, too, no less than Miss Lee, was able to effect this change because of the worker's understanding, which includes both sides of his struggle. In a casework process of the kind described in these two records, where the client projects a part of himself into the contact, and the worker responds with immediacy and sincerity from her own deeply carried sense of function, there will inevitably be a sharp point of difference, painful and alienating ( the sense of difference between Miss Lee and the worker when the worker says: "Why did you not marry him?"; between Mr. Marks and the worker when she asks him to question whether this agency can be of help to him ). Such questions penetrate the client's projection and disturb the organization of forces behind it. Out of this disturbance of forces a new focus begins to form, a deeper and more powerful focus, with direction inherent in it. It moves inevitably into new projections, to which the worker continues to respond with immediate sensitivity to what is being put on her, with an undeviating sense of her own role which repudiates the false and unreal while it gives generous, sincere appreciation to the client's feelings and deep comprehension for the nature of the whole struggle. In both cases one sees the extent to which the client, while he is still caught in his struggle, really trusts to the worker's conviction, based on her experience with processes of change, that this movement will eventuate. For both these clients, once the movement to change has found its focus in the self, the tempo is unbelievably swift. Miss Lee in only seven weeks, using nine contacts with the worker, finds a job and is ready to leave the agency; Mr. Marks' movement is accomplished in two months, in contrast to a previous relation to

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agency of two and a half years, and with only three appointments with the worker after her penetrating question to him in the first contact. Many will question the depth and extent of the personality change effected in these two clients. I have no desire to go beyond the evidence of the records on this point. Psychological change is by its nature individual and internal, capable of description only by the individual who experiences it, defying objectification and measurement. But when psychological change is effected with the aid of casework help and the use of an agency service which sets objective standards and conditions for its use, then the degree of that change can be measured in terms of the use of that help and service. Applying this test of use, I believe we have the right to say that psychological change can be considered significant when the individual succeeds in taking in and dealing with the difference expressed by the agency representative who carries a responsible relation to the process. The word "partial" has often been used to distinguish change accomplished with casework help from therapeutic change. True, the definition of agency service and the client's own focus of his problem inevitably and rightly limit and place the problem in partial terms. But no definition and no particularization on the part of the agency can interfere with a client's necessity to place total value on the partial service. Furthermore, when the process of change is felt as inner movement in the self, the client truly risks a total change. This fear of being overwhelmed by his own unleashed forces and invaded by another who has the control, cannot be avoided. It may be reduced by conditions set before him, requiring the break-up of his activity into parts with which he can deal, but somewhere he must take in the shock of the realization of change. This shock involves the whole self for at least an instant of time. It is bearable and therapeutic, not because it is partialized, but because it is met honestly without evasion by a self that has the courage and organization to meet it sincerely. For this reason I would say that the caseworker as well as the client must use her whole self if she meets her client's need. It is this sense of the courageous, spontaneous, and responsible use of the self in impact with the client's need and projection which, when all is said and done, seems to me to account for the experience of change described

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here. This meeting point constitutes the true focus for the process of change. That this focus is fundamental in the personality structure I have no doubt. How pervasive it can become in the total personality, and how lasting, will depend on factors outside the caseworker's control—on the flexibility of the personality patterns, on the strength of the forces of reorganization, and on the nature of the connections with reality.

Part II COUNSELING IN A FAMILY AGENCY

THE FAMILY AGENCY IN THE POSTWAR PERIOD Marguerite

Munro

I T SEEMS a long time since that Sunday afternoon when we suddenly found ourselves a nation at war. Numbed, unable to take it in, unable to feel, except that nothing was true for us any more, —neither the world we had known and which had been swept away, nor the world at war which we could not yet believe had become our world. Then, before we could come to an acceptance of this catastrophe and its meaning to us individually, we found ourselves having to face it collectively as stunned agencies, dedicated by our very existence to serving the endangered community, whose precise dangers and whose capacity for enduring in the face of these dangers we had no way of knowing. It is not with a sense of total satisfaction that we recall some of the meaningless gestures made by some family agencies. I refer to such things as the routine visiting of all families under care, in order to inspect the safety of their dwellings against bombs, urging the necessity for having bathtubs half filled with water and pails of sand available, offering money for black-out curtains, and the like. Not all of us permitted our need for activity to find release in this particular manner, but too often we let ourselves be directed by an undisciplined zeal which led to our placing workers here and there,—in selective service, in industry, in day nurseries,—and to our seeking new avenues of service within the agency, so that we were in danger of evacuating, as it were, our own role as a family agency. Now, again, we are finding ourselves in a changing world; although this is no such dramatic moment as that experienced in the attack on Pearl Harbor, the factors of this change are not without their element of suspense, of shock, of fear. We had long anticipated the opportunity of grappling with the problems of

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reconstruction and of peace, but we had not been able to foresee the extent to which these would be overhung with the shadows of war, the extent to which the problems of building an international peace would be complicated by industrial revolution and racial strife at home, by the threat of another war, by the twin terrors of the atomic bomb and bacteria warfare. This is the background, with its economic, industrial, political and emotional implications, in which the family agency is again facing the problem of defining for itself the part it must play in a changing world, which is itself undefined and unknown. Are we again to define this role in terms of an ill-defined set of environmental factors? Are we approaching this postwar period from the vantage point of the illness from which the world is suffering? Do we still begin by asking ourselves what we shall do for the veteran, in his problem of adjustment to civilian life? Or what our policy shall be in regard to strikers? Or how we shall meet the problem of delinquency, or of unemployment, or the problems of the world ad infinitum? Shall we begin in the same manner as when we asked ourselves what we could do about the potential danger from bombing? To be more precise, are we again so involved in the total problems which the world is facing that we shall again lose our perspective and exert untold energy in finding ourselves in relation to these problems? Or have we already reached an age of maturity which enables us to utilize the experience we have acquired in the past? Is this not the challenge we are facing as we move farther into the postwar era? In addition to this generally challenging factor of universal unrest, there is another equally potent and equally complicating influence which has bearing upon our current predicament: namely, a sense of tension felt within the agency as a result of the certainty of expanding costs for maintaining services, with a more doubtful outlook as to the expansibility of resources to meet the costs. Agencies are finding that the terms "H.C.L." and "inflation" are not mere abstractions, but descriptions of symptoms from which the agencies are suffering in varying degrees of acuteness. Regular réévaluations of food and clothing budgets have affected relief costs of agencies in a gradual but consistent spiral, with no indication of how far removed the zenith may be, surrounded as it

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is by many layers of misty uncertainty. Furthermore, adjustment of salaries in an effort to keep abreast of changing economic conditions has increased the cost of operation to a staggering degree and has in many instances placed an almost unbearable strain upon the agency's resources. The family agency is faced, then, with a dilemma: How can we expand to meet wider needs, yet, at the same time deal realistically with the factors which seem to be urging us toward either a qualitative or a quantitative reduction of services? Within this paradox are implications which can lead to panic and thence to fruitless activity and pointless accomplishment. With its broad functional base, and its historical reputation as a "basic" or "community" agency, the family agency can all too easily be torn by a generous impulse to reach out to offer help. It can be caught too readily in the old and well-known trap of "adapting itself to new needs" and can approach the problems of any categorical group by adding too quickly and with inadequate consideration and clarification to its already complicated definition of function, becoming a "catchall" for ill-defined services. Or, it can react in a manner directly opposed to this, i. e., by finding its direction exclusively in budgetary limitations, by withdrawing services without weighing with sufficient thoughtfulness, in the light of its general purpose, which of its services it can eliminate and which are inherent in its purpose as an agency. But are we so unsure of what we are and of what we have that we must be constantly looking for new avenues of service? Or, are we so fearful of our future that we must cling to a few outgrown relics of the past? Is there no possibility that if we examine ourselves with some degree of conscientious objectivity, we may find something which is sure and tried, something unique to ourselves, which we can use in serving people under any circumstances, even in this uncertain external world in which we are living? Is there not something in individuals, whoever they may be, whether the unemployed, the striker, the service man, or the veteran, which is reaching out, regardless of his external experience, for this particular thing which we have to offer? I am convinced that we do have this quality, that as family agencies we have a function for which we can conscientiously seek community support, and also that we have developed a

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degree of skill which enables us to perform this function convincingly and competently. Our unique contribution is the preservation and strengthening of the family and it is our privilege and our responsibility to offer service when the integrity of the family unit, or of the individuals who comprise this unit, is threatened. This places the family agency in a strategic position. Our society accepts the basic importance of the family as a determining factor in the future of society itself. We, as family caseworkers, are well aware of the effects of general unrest upon families and upon the individual members of families. We have seen this in the period following the First World War, in the depression era, and, more recently, during the Second World War, when the whole structure of the family seemed topsy-turvy, when erstwhile sheltered, dependent women assumed roles of unaccustomed responsibility, when children were left to their own devices, when adolescents were prematurely given the responsibilities and privileges of adults. In this postwar period, families are again having to cope with an adjustment to changing environmental conditions. They are also having to cope with a shifting balance in the relationships among members of the family group. Caught as they are in this confused state of transition, it is important that somehow they do not become lost in the external chaos, but that they find and retain the values which potentially belong to the family, just by virtue of its being a family. It is important that the children in these families, molders of the world of tomorrow, find within their own family group an emotional security and a sense of moral values which will enable them to develop within themselves the strength and the vision necessary for the fulfillment of their destinies. Only those who have experienced inner emotional security can help build a secure world. And if tomorrow's world is to be composed of people who are constantly seeking security outside themselves, this in itself will endanger tomorrow's peace. I have said that it is our privilege and our responsibility to offer service when the integrity of the family is threatened. Probably the two most frequently occurring threats to family life are financial insecurity and strained personal relationships. Other problems pertaining to health, employment, care of the aged, and the like, are so closely related to one or the other of these basic problems

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that I shall confine myself to a discussion of financial service and of counseling service in relationship problems. In both of these, the functional family agency has experienced a long struggle in arriving at a definition and a practice which are sound as related to its purpose. For no other type of agency has it been so difficult to find a common base of operation. Other agencies have had in their beginnings a specific purpose; the family agency, with its early efforts to be all things to all people, had a singular problem in describing a unity which encompassed both its financial services and its services in relationship and personality problems. We have found that unifying principle, not in relation to the multiplicity of specific services, but in the purpose of our services and in the conditions under which we made our help available, whether it be relief or counseling. If we have accepted as our purpose the strengthening of family life, we also have a conviction that this can be accomplished only through enabling the individual in the family unit to recognize and accept responsibility for his own unique role within the group. With this as the central core of our practice, we have learned to concentrate our efforts in this direction and to evaluate our service in terms of its effectiveness in accomplishing this result. I should like to indicate more specifically the application of this principle, first, in the giving of relief and, secondly, in the counseling situation. There is no need to repeat the history of the family agency as it has struggled with its relief function, particularly its efforts to work out a relationship with the Department of Welfare. In our first efforts to distinguish between our services and theirs, we tended to rely upon a description of the commodities which we could provide in relation to commodities provided by the public department; we stressed our flexibility in contrast to the period required by them for determining eligibility; and we differentiated in terms of the duration of the financial need. This type of distinction is outmoded. In New York State, at least, there are very few financial services which our agency can offer that cannot, under given circumstances, be offered by the public agency to those who meet its basic eligibility requirements; emergent needs can be met immediately, and help is given for short as well as long periods of time. There is still, it is true, a group of families with a

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borderline status who do not meet the department's basic eligibility requirements, but who are, from time to time, faced with crises which they are unable to meet without financial assistance. The private agency does have a service to offer to these families. However, if we were to define our relief function in relation to this borderline group, we might soon again be in a precarious situation because, with its constantly broadening base of eligibility, there is no way of knowing when this type of problem may be met by the public agency. We do have, however, a more definite criterion in the practical and psychological use the family can make of our relief. We have learned that when the short-time relief, to which we confine ourselves, is offered in terms of its effectiveness in enabling the family to sustain itself as an entity, the client, in the process of considering this with the caseworker, is already launched in purposeful activity, evaluating whether, or how, he can use this resource to get control again of his own economic problems. If for any reason he cannot use our service for this purpose or cannot accept these conditions, the public department is available to him as an alternate resource. The public agency, on the other hand, because of its legal responsibility for providing maintenance to persons eligible for it on the basis of substantial need, fulfills a different purpose and does not set up the same requirements as to the use the client will make of its services, in terms of his capacity eventually to assume a self-sustaining role. The public agency is not free to refer a client to a private agency for financial assistance if he is eligible for public assistance. The client, therefore, does not have the same opportunity to evaluate both his need and the resource by which it can adequately be met. It is this emphasis by the private agency on the use the client can make of the relief service, in assuming his role as a self-sustaining entity, which differentiates the relief service of a private family agency from that of the public agency. Family counseling, especially in marital problems and parentchild relationships, is being more and more frequently requested as a service of the family agency. Here, too, we have had our problems in defining our legitimate area of helpfulness. It is not so long ago that we were trying to differentiate our function from

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that of school counselors, child guidance bureaus, vocational advisers, and even the intake workers in day nurseries and child placement agencies. We found ourselves freely offering help with children's problems, but so often experiencing frustration in an effort to deal with whatever problems presented themselves, that we had no real conviction as to our ability to help in this area. However, after eliminating areas which seemed inappropriate to our function, we found that there is an area in which a family agency, with its emphasis on the strengthening of family life, can offer a service, namely, in helping the parents recognize and accept their roles as parents. Because both parents are involved with the child, we hold the participation of both as essential. We do not see our function as direct treatment of a child, which implies our assuming either the parental role or that of the child guidance clinic or some other agency—but, rather, we see our function as helping parents assume their own roles, either by carrying more completely the responsibility vested in them, or by making use of a child guidance clinic or other logical community resource. In marital problems we recognize a relationship between two people who are equally responsible for the quality of the relationship. We are convinced that, with normal people, if the relationship is unsatisfactory it is because the roles between the two persons involved are not clearly recognized and accepted by them. Our function, then, is to help each with his own role in relation to the other, in order that their respective positions may achieve balance. If the problem lies not in this area, but primarily in the personality difficulties of one of the two people involved, we feel that there is no structure within the family agency which can so limit the experience that it does not become a pseudopsychiatric, rather than a casework, situation. It is the relationship existing between the two individuals which provides the tangible with which we and the client can work, and by keeping our focus on this tangible we can maintain an orientation which is functionally appropriate. In this brief discussion of the two problems with which we most frequently find ourselves engaged, I have attempted to point out the functional unity in our practice. If we can keep the family entity as our base, and if we can gear our service to strengthening the family through strengthening the individual's concept of his

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own role in relation to the family, and through helping him assume the responsibilities involved in this role, we will be able, even in this transition period, to safeguard ourselves against the danger of going off on new tangents and to assure for ourselves an orientation to a function which is uniquely ours. As we have narrowed the scope of our practice we have deepened and enriched our concept of the service we can give and we have acquired direction and purpose in our activity. We have as our area of service the basic structure of peace—the family. This is an almost overwhelming responsibility. But we have a new assurance of our own strength, conviction as to our purpose, courage to face new situations, zeal to increase our understanding and skill, faith in the people we serve, and hope for a better world.

COUNSELING AS A SERVICE OF THE FAMILY AGENCY M. Robert

Gomberg

IN THE last few years, the family agency has had the experience of observing a marked change in the character of its case load. An ever-increasing number of "counseling" cases has been replacing the more familiar volume of requests dealing with specific tangible services. Particularly as the war years relieved, in large measure at least, economic problems due to unemployment, more and more families and individuals turned to us for help with problems of personal or interpersonal adjustment. The range of problems varied from those of long-standing nature with which the individual or family had suffered long before the war, to others which seemed to grow out of the crises which the war created for people who had previously been capable of satisfactory adjustments on their own resources. It will be valuable to our further discussion to identify some of the problems that have required the type of service which we call "counseling." The following list is not an effort to categorize types of problems, but merely to illustrate from one family agency's experience the kinds of situations we are asked to meet which come under the heading "counseling": Increasingly large numbers of families have applied for help with marital problems. Problems related to mental and emotional illness have been frequent. There is, for example, the family that comes for help with the problem that a psychotic member creates for them, or a parent comes deeply disturbed about the behavior of a child; or a lone individual comes describing his own difficulties which are indicative of emotional disorder, and so on. Other problems which we have come to associate with counseling service are illustrated by the case of a young woman referred for personal help by the dean of the local college which she attends. 191

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While she has the intellectual capacity to succeed, she nonetheless is failing, is unhappy and insecure. Or let us consider the discharged veteran who, although previously self-sufficient and able to provide for himself and his family, comes in saying that he is and always has been unhappy on the job to which he has just returned. He is anxious to make a change but is fearful; he has no idea of what he would prefer and yet feels unable to go on as he is. This is by no means an inclusive list. Our object is merely to identify the kinds of cases to which we are referring when we use the term "counseling." However, the experienced family caseworker immediately recognizes all of these problems as "old business," problems with which he has dealt for years past. The differentiating factor that tends to group these cases together, as in any way different from those of past experience, is the fact that they are unaccompanied by a need or request for specific service, such as money, employment, or housekeeper. The client comes presenting his personal confusion or a relationship conflict as his reason for seeking help. This brings the skill of the caseworker more directly to the fore as the primary service the client is seeking. Obviously the skill of the worker has always been a cardinal factor in the helping process. Yet there is a difference between utilizing one's understanding of personality growth and change in helping clients who request specific services, and utilizing the same generic knowledge directly for help with acknowledged emotional and relationship difficulties per se. I do not for a moment mean to infer an arbitrary or absolute distinction between, let us say, the marital conflict that was so frequently indigenous to the financial difficulty which a family brought to us,1 and the marital difficulty that a family describes as its only reason for coming. Yet, technically, there are obvious differences for treatment that grow out of the difference in the clients' requests and their own evaluation of the problem (although the worker's generic understanding of behavior, relationship and the helping process may be the same ). For example, the client's genuine need for the tangible service often may have been a key factor in his continuing to return for help. Certainly, as this type of case developed and the skillful worker was able to relate the specific problem, i. e., insufficient income, to difficulties in 1

See Green case in "The Specific Nature of Family Casework."

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personality, in relationship, in attitude or feeling, not infrequently the client's emphasis shifted to seeking and using help with his psychological problems more overtly. Nevertheless, the specific service was a sustaining element that could both hold the client and be used by the worker objectively in directing treatment. Then, too, the policies governing the administration of these services as established by the agency, if sensitively and psychologically used, were helpful controls that the worker could use further to direct and expedite the helping process. Yet another element of difference inheres in the fact that the existence of a specific need, such as a need for financial supplementation, helped to define an area of service which was unquestionably within the province of family casework. Whatever other complicating factors existed in a family's problem, medical, psychiatric, legal, etc., the skill required in giving financial assistance, in dealing with a client's conflict and resistance in taking it, in evaluating the degree to which a problem stemmed from social conditions in the environment, in relating the administration of the specific service to the psychological understanding of individual and family, all this was certain ground for casework practice. The foregoing observations do not lead to the conclusion that casework can only be practiced in relation to specific tangible services. I have a firm conviction that casework has a body of knowledge, skill, and method in dealing with problems of human behavior and adjustment that is not limited to helping individuals or families whose problems derive solely or primarily from economic roots. My experience in recent years has deepened that conviction. However, my effort in this paper is to point out some of the additional technical problems that are inevitable in conducting the counseling process. As I see it, there are two major aspects of the problem that are closely interrelated. There is the problem for the worker of developing the necessary skills to work without the supportive structure afforded by tangible services, and for the family agency, always challenged in clarifying and defining its function, there is added the responsibility of deciding for itself ( and describing to the community it serves) the nature and extent of the psychological help it is prepared to offer to families suffering primarily

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such personal and relationship conflicts as those just described. The following statement by Grinker and Spiegel, in their important book Men Under Stress, has bearing on the present situation of the family agency: As the public . . . becomes increasingly aware of the need for psychiatric help . . . the paucity of well trained psychiatrists becomes increasingly apparent. It is estimated that for future needs of peacetime America, 10,000 to 17,000 additional psychiatrists will be necessary. Because of the length of time necessary for training, the relatively few teaching institutions and the limited number of aspirants, it is obvious that decades will elapse before psychiatric services to the people of the United States will even approach their needs, which will steadily increase in the interim.2 This appalling condition, to which the ever-increasing requests for help with emotional and relationship conflicts bear witness, indicates a danger that the family agency may be asked to function as a mental hygiene or psychiatric clinic for those intervening decades that Grinker and Spiegel mention, until there will be sufficient psychiatrists to meet the general need. I term this a "danger" because it may fix the tendency to conceive of casework as a kind of quasi psychiatry. It could obscure and hamper the trend in casework to define itself clearly, to state its method and philosophy as a distinctive discipline which can take its place alongside of psychiatry in the community as a profession that can help through the function and structures of a social agency in certain defined areas of social and psychological adjustment. This brings us to the much-labored question as to whether there is a difference between casework and psychotherapy ( I am using casework and counseling as interchangeable terms in relation to this subject matter). I am not interested in establishing a difference for the sake of difference. Certainly, if one uses so broad a definition as Dr. Kubie's, "psychotherapy embraces any effort to influence human thought or feeling or conduct by precept or example, by wit or humor, by exhortation or appeals to reason, by distraction or diversion, by reward or punishment, by charity or social service, by education or by contagion of another's 2 R. E. Grinker and J. P. Spiegel, Men Under Stress (Philadelphia: The Blakison Co., 1 9 4 5 ) , p. 429.

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spirit . . . " 3 then casework falls within this all-embracing concept. There are other definitions of a much more specific nature that lead to some question as to whether there are significant differences between psychotherapy and casework. Obviously, both casework and therapy draw upon a generic understanding of the development of personality, of human growth and change. As a result, there will undoubtedly be some overlapping in any method designed to effect change. This, I believe, has always been true, and, in my experience, is even more apparent with the counseling case. I think, however, it is an error to jump to the conclusion that, as a result, casework and therapy are identical in purpose, method, and the kind and extent of problem with which they help. However, because of the varied interpretations of the word "psychotherapy," I am afraid we can again get lost in terminology and semantics. If from what I describe subsequently, some prefer to interpret counseling as another aspect of psychotherapy, or therapeutic casework, that does not trouble me. What I believe is essential, no matter what term is used to describe it, is that casework develop a body of knowledge and skill that contains within itself the ability to carry through effectively the helping process with those clients whose problems we ultimately determine as falling within the scope of the family agency. True, the caseworker must consult and work cooperatively with other specialists, i. e., physician, psychiatrist, vocational guidance counselor, etc., whenever the case requires it. If, however, the caseworker views the psychiatrist not as a consultant in a related but different field, but as an authority upon whom he depends for supervision and guidance of his own casework treatment, then casework can never become a complete profession in itself, and must remain a kind of incomplete discipline, an adjunct to psychiatry, which of necessity will keep caseworkers insecure and uncertain as to their skill and adequacy. 4 I believe that the professional 3 L. S. Kubie, The Nature of Psychotherapy, Bull., New York Acad. Med., 19:183, 1943. * If in a clinical setting, offering psychotherapy as m a child guidance clinic, a caseworker is being trained in the practice of therapy, then of course it is necessary that he be supervised by the psychiatrist or trained therapist. Caseworkers can be and are being trained to practice psychotherapy. This, however, should not be confused with the supervision Dy the psychiatrist of the caseworker operating as such, or with the acceptance of casework and therapy as identical or interchangeable. In connection with this point, see a recent pamphlet, entitled "The Case Worker in Psychotherapy," published by the Jewish Board of Guardians, New York.

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independence claimed for casework is possible, and on the whole this belief is shared by most caseworkers, no matter what technical or theoretical differences may exist. It is my conviction that casework has a tremendous preventive and remedial contribution to make to the mental health needs of the community, and may well meet a part of the need which Grinker and Spiegel describe. However, that can best be achieved from the frame of reference of an established, defined profession, rather than from a transitional amorphous service, waiting to be taken over by another group. I wish it were possible to follow these observations with a complete blueprint that would illustrate the exact province of family casework as well as present a detailed analysis of the counseling process. However, such a complete statement will have to wait until all of us in family casework have had considerably more experience with the kind of case that I am considering today. The "counseling" case provides a challenging and stimulating problem, one about which there should be as full an interchange of experiences as is possible together with genuine open-mindedness. In ray own agency,5 we are hard at work trying to develop the necessary skill and clarity to cope with such cases and it is out of that experience that I have both learned the extent of the problem and have also gained a considerable optimism as to the outcome. In my earlier paper, I attempted to describe the specific nature of family casework, the underlying theme that made all the different services offered by a family agency derive from a central purpose that could be concretely visualized and utilized in any family agency case. In that paper I said : I believe that when family casework accepts as its focus a responsibility to the whole family, it defines a useful uniformity of purpose, structure, and method, in spite of the large variety of problems and services with which it deals. This responsibility includes an understanding of family organization and the different roles normally assumed by the several members of a family. It involves an ability to relate a particular request for a service to such an understanding, and to help the family to clarify which member should be the rightful client (or that both should play some part) under the circumstances. It means being able to utilize the policies and services of the agency in such a way as to s The Jewish Family W e l f a r e Society of Brooklyn, now merged with the Jewish Social Service Association of New York City in the Jewish Family Service of New York City.

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help the client or clients to reëstablish or preserve their different roles within the family when the existing problem can be met within the sphere of the family agency service and family casework skill.6

Subsequent experience in our agency has confirmed for us the usefulness of this concept in most cases that come to a family agency. It not only helps to define a uniform function for the agency but when skillfully used it can be deeply helpful to clients in facing, understanding, and working through difficulties in family relationships. In this paper, I should like to consider whether it is possible to describe and delimit an area of psychological counseling that derives naturally from casework training, experience, and orientation. I believe that it is possible and I shall present one approach to the problem. Before doing so, however, it will be useful to review a few fundamental concepts of functional casework as I understand them. Because of limitations of space, I can deal with them only briefly and do not intend a comprehensive analysis of basic concepts of casework, either generic or specific. The first concept is that of the casework relationship itself. While this relationship is influenced by several variable factors, i. e., the particular need of the client, his personality, and his ability to use help, as well as the skill and personality of the worker, and the structure and service of the particular agency, there is nonetheless an underlying, generic premise as to the nature of the helping relationship, which is fundamental. The client brings to the experience a particular problem, feelings, and attitudes about it, and patterns of behavior in attempting to deal with his situation that derive perhaps from earlier life experience. These patterns of behavior, as well as the client's immediate feelings about this situation, are usually projected upon the caseworker and the agency from the beginning of contact. Thus in a sense the client brings his past with him through his very behavior and transfers feelings and attitudes to the worker that stem partly from their current relationship and partly from other experiences, past and present. While the skillful worker understands this, and soon may become aware of the etiology of certain attitudes, I believe that the true power of the relationship as a possible source of help for client does not lie in this ability to piece together intellectually the meaning of earlier « P. 85.

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experiences, so that one thus understands the genesis of a problem, important and useful as this may be for the worker. Help for the client rests in the vitality of the immediate contact as an emotional experience, in which the worker takes full responsibility for his own realness and that of the agency. He does not exist outside the sphere of the client's life and conflict, merely understanding, interpreting, and guiding, but rather for the time of the contact he takes responsibility for becoming a part of the client's emotional life experience. The client who comes sharing hope and despair, love and hate, insecurity, anxiety, and yet some will to change, shares deep, intimate feeling with the worker as perhaps he does with few others in life. Inevitably, he develops feelings about the worker and agency that extend beyond the projection of earlier attitudes formed in other significant relationships, and it is through an understanding of this fact that the caseworker shapes his role in helping the client to use this experience meaningfully for change.7 This leads us then to the second concept, of process. Here again the particular movement in any one helping experience is influenced by the nature of the problem, the client's resistance to and ambivalence about using help, the service of the agency, and the conditions under which service is offered. And yet different as people are from each other, different as the meaning of even the same kind of problem is to different people, it is possible to isolate and examine some of the reactions that accompany an individual's movement toward using help, his use of it, and then his separation from it, that have some universality. Naturally, different individuals demonstrate this in their own unique ways with varied behavior, depth of feeling, and capacity for change through relationship. Yet how familiar is the picture, in the early phase of treatment, of the client who on the one hand looks to the worker for some miraculous solution, projecting the problem of solution completely on the worker, and who at the same time resists any participation that implies that he may in some way be responsible for his problem, that he may have to change a little too,—as if he said, "wipe out my problem but don't touch me." In so many dif7 For a similar point of view, recently expressed by a group of psychiatrists and psychoanalysts, see Franz Alexander and Thomas Morton French, Psychoanalytic Therapy (New York: The Ronald Press Company, 1946), Chap. 4, "The Principle of Corrective Emotional Experience."

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ferent ways clients have evidenced that getting started in the helping relationship has a special significance of its own, which must be understood as a response to beginning treatment—over and beyond a mere reflection of how they behave generally. Some are defiant and demanding, some timid and willing to "take anything." There are many varied reactions, and yet each symbolizes a client in process of finding his own role in this new kind of experience. Can he control, command? Must he yield to the other person completely? The interplay between past patterns and his effort to find himself in the new experience is sometimes obvious and sometimes subtle. In any case, the need for skill on the part of the worker is apparent: to help the client to see what the worker can be and do for him and what he cannot do; to help the client understand what his part must be and that he carries the key for change within himself in his use of help. This indeed calls for skill and knowledge. This experience for the client of discovering his role in the helping relationship is generic and deeply meaningful. To learn that he is permitted a kind of dependency in this relationship, which allows for use of and support by another, and yet that he must operate under controls that do not allow for the entanglements, confusion, or violation either of himself or the other, as may well have been a problem earlier, has potentiality for change and growth which we can but mention here in passing. Once the client has decided to accept help under the terms on which it is available, has lived through the first phase of experience that helps him to gain some understanding of the worker's and agency's role as well as to accept what he must do for himself —in other words, when he becomes aware that the worker can assist only as he, the client, is willing to live through the effort of changing and that the problem cannot be lifted from him—there usually follows the next phase in the helping process. Again the reactions are varied. A common one is that of feeling depressed. The problem feels beyond solution. It is the phase of treatment when client faces the arduous task of close self-examination, of becoming aware of how much of the problem which he has projected onto others he himself is responsible for. Along with his discussion of outside experiences, past and present, his use of the worker and agency are immediate, alive experiences, which the worker utilizes in helping him to understand himself and to inte-

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grate his efforts to use himself differently. This period of actually facing and working through destructive attitudes and feelings so that he can take fuller conscious responsibility for what he does and feels is, I believe, the most difficult part of the case. Then finally, the client faces separation from the worker and agency. Here too, we must understand that there is always a reaction to leaving a helping experience, which has universal elements that can be anticipated, although the particular content for particular individuals will vary. How frequently, as the client approaches ending, he reactivates some of his earlier problem, over which in the course of treatment he has actually gained control! Partly it is some inevitable fear as to whether he can operate without help, partly it is out of impulse to hold on to a valuable relationship which, even if no longer needed, still has a great deal of personal meaning or which it would seem ungrateful to abandon. Here the acme of casework skill is necessary to utilize the client's underlying movement toward independence and, through one's understanding of his conflict, to help him to end constructively. In summation of this point, then, there is an important emotional content and generic process which derive from the client's reactions to initiating, living through, and terminating help, and which must be understood and used by the worker in relation to his knowledge of each client's specific life problem and personality. The last concept that I will consider here before turning to a discussion of the specific problem of counseling is that of the use of structure and function. There is an ever-increasing body of literature on this subject, and I make no effort to recapitulate it. I want only to high-light several aspects which, together with what I have said about relationship and process, seem to me to point to a direction for counseling. Earlier, in discussing relationship, I suggested that helpfulness to the client lies not so much in recognizing the client's inevitable use of the worker and agency as objects upon which he transfers and projects attitudes and feelings that stem from other experiences, as in utilizing the fact that treatment represents a new experience in relationship about which the client feels and thinks and acts. It is as the worker helps the client to differentiate this experience from other experiences, helps him to discover the degree to which his current behavior is not a reaction to what is actually present nor is it adequate for meeting his

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present experience (i.e., the helping relationship and the life situation with which he is in conflict) that some inner emotional reorganization may begin to take place. How vital then to recognize that the structure of the agency, its policies as to service, time, fee, the helping relationship, that these are the reality setting of this new experience to which the client reacts—with old patterns, with his resistance to change, and yet with that part of him that yearns for change too! Almost invariably he attacks the new experience with behavior and attitudes he must ultimately modify if he is to be helped. It is only as the worker is sensitive to the client's diffuse unfocused feelings and attitudes, which attempt to engulf this new experience in the same unfortunate way he has approached others, even though he looks to it for help in feeling and behaving differently, that the client can be helped to differentiate this experience from others and to find a truer use of his own powers. It is for the worker to help the client to discover his own capacity, if he will, to relate to and live with this new reality on its own terms. This marks for the client the beginning of inner reorganization that will enable him to differentiate other life experiences one from the other and to acknowledge the feelings and attitudes that truly belong to them. Moreover, the agency's function is effective in the very fact of relating the client's request to it and in establishing the continuing relationship on the basis of helping him to use a given service of the agency toward the solution of his problem. This results in focusing the relationship on a particular aspect of the client's life. Thus, if the need is for financial supplementation or housekeeping service, help is given to enable the client to cope with his immediate crisis as well as to see whether he can use the caseworker and agency to change his situation so that the cause of the problem may be removed or modified, thus making it possible for him to manage his situation more effectively by himself. The emphasis is on the specific problem and the client's ability to use agency help for that problem rather than on the total personality structure, with a view to its alteration, an approach which treats the specific problem as incidental or merely symptomatic. In the light of all I have said or implied in this paper so far, I think it is evident that using function in this way has never meant a barren, businesslike venture, that limits discussion and relation-

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ship solely to the client's proving his eligibility for a service, and then makes certain that he does not "misuse" it. Our effort has been to utilize all of our knowledge about personality and all of our skill as a means of helping a client to understand and accept himself, his weakness and his strength, with less fear and insecurity, so that he can deal more effectively with the reality problem that brought him. There are no limits as to the content that may be discussed, provided it has a bearing on the problem with which the client requests help, and provided it is meaningful to both client and worker. Frequently, by the end of a case, we have obtained a relatively full history about a particular client, although this is not formally sought as a "preparation for treatment." Rather, when in the course of the process history is pertinent to the phase of help, the worker obtains it, or as is frequently the case, the client spontaneously relates past material which has particular significance for him at the time. Obtaining history as an end in itself has value only for enriching the worker's understanding of the etiology of a pattern, not for changing it. But when we observe the client's use of past information and relate to that, then it becomes vital to the helping process. Thus, some clients eagerly escape into a rehearsal of past experience, as a refuge from the discomfort of considering their present behavior. Conversely, others cling with tenacity to their interpretation of a current conflict, in which they project full responsibility for their difficulty on some individual or situation,, thus blinding themselves to the way in which they have helped to create the problem, through longestablished patterns deriving from earlier life experience. True helpfulness for the client grows out of the worker's skill in relating a client's use of a particular content to his way of avoiding, or coming to grips with, the problem that he is trying to solve. In that sense, while the client may be telling about past experiences, psychologically they have meaning for the present and emotionally are a part of it. Thus, underlying the practice of focusing on a specific problem consonant with the function of the agency and with the help the client is seeking, there is a dynamic concept of help that is concerned with psychological change in the client. Results obviously vary—some clients make a superficial use of agency, taking the tangible service to meet the specific material need and permit the

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relationship no more meaning than that, and that is their right. Others are too disorganized and emotionally ill to use an experience such as this and need a different kind of help, and there the casework service is to help the client accept and use psychiatric treatment. But the largest group, I believe, make meaningful psychological use of the help, varying in results from moderate change to fundamental change or growth in personality. This depends in part upon the client, the extremity of his need, his readiness for help and his capacity to use it, and in good part upon the skill of the worker. I am convinced that the change that grows out of such an experience of taking help, which is focused on a specific part of the life problem, is not just a removal of an immediate set of symptoms which will be replaced with new ones; rather, when the relationship is truly helpful, it provides the client with a constructive emotional experience which enables him to discover a new use of self.8 Parenthetically, I should like to observe that throughout this paper I am differentiating between a knowledge of personality development and the psychology of a method of helping. I am assuming that it is accepted that one must be grounded in the first to develop the greatest skill in the second. However, it is the second in which we are most interested for our present purpose. I think it is possible now to describe a valid focus for the counseling service. In discussing the concepts of relationship, process, and the use of function (partialization), I have tried to abstract those elements that are as true for counseling as for the offering of specific tangible services. I believe, then, that the family agency has a vital and valid service to offer in counseling, when it focuses upon helping an individual or family with a specific conflict or problem. The conflict may be one in the marital relationship between husband and wife; it may be a parent-child problem. It may grow out of a health problem, mental or physical, wherein an individual finds himself unable to face either necessary treatment or changes in a way of life that result from the illness. It may be an individual's conflict in choosing a career or vocation, that grows out of emotional blocking rather than lack of knowledge of opportunities. In every instance, what is focused on is a serious problem either 8

Compare with ibid., Chap. 9, "The Efficacy of Brief Contact."

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of relationship or of some reality decision. The object is not the cure of a mental illness ( psychiatry ) in which all of these events might be symptoms of fundamental emotional disorder, but rather help is directed toward the adjustment of some particular life problem, which is obstructing the individual s fuller satisfaction and usefulness. Obviously then, the worker must have sufficient skill to differentiate diagnostically between the client who is suffering from a deep-seated emotional disorder and the troubled, uncertain, upset and confused individual who nonetheless has sufficient inner integration to use a counseling service. When a worker is uncertain as to the extent of the pathology, we have found it sound to suggest psychiatric consultation before offering a counseling service. This can be dynamically integrated as part of the intake structure, within which the object is to gain clarity as to the problem, so that both worker and client can decide whether the service available in the agency is useful for the problem which the client has, and if not, can work on whether the client can accept and obtain the service he needs elsewhere. This use of psychiatric consultation implies necessarily some orientation of the psychiatrist to the agency's service and way of working, so that he will consent to give client and agency the benefit of his diagnosis but will leave to agency and client the decision as to what they will do in the light of it ( except when the client is ready and able to undertake analysis, if that is the recommendation). Unless the agency is clear in describing its purpose and operation to the psychiatrist,0 it places him in a role wherein the client looks to him as an agency authority who will be able to commit agency to one or another kind of continued treatment. This removes a fundamental dynamic from the worker-client relationship that grows out of deciding on the service, working out conditions, i. e., suitable time, fee, etc., which we pointed out earlier to be a vital part of the helping process itself. Just as I caution against undertaking treatment of the client who is too ill, on the assumption that whatever strength he shows in coming to ask for help is enough to indicate his ability to use counseling, so I must affirm that in my experience to date, I have found that many deeply troubled and confused personalities obtain invaluable help with 9 There are other aspects of cooperative working with the psychiatrist as consultant that are not considered here.

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basic problems in personal and social adjustment from a skillful counseling service. To recapitulate, then, counseling raises to the center of interest the client's particular problem and his efforts at solution of the problem. This can be illustrated in observing how one focuses the helping relationship in a marital problem. It will be interesting to observe, too, how a sound and helpful structure for the service evolves naturally from this approach. The client (usually it is the woman who initiates contact) comes describing an unhappy and conflicted marital relationship. As her description of the problem unfolds one gains some understanding of the meaning of this conflict to her. She may be frightened, confused, hostile, anxious —usually she offers her version of the basis of the marital discord, and this frequently is full of projection of blame onto the husband. Whatever the description of the particular situation may be, as she describes the difficulties one begins to gain some initial appraisal of her personality. She may be aggressive, hostile, and demanding. She may be timid, unassertive. Her pattern begins to be evident in her description of her relationship to her husband, and usually it is apparent in the way she attempts to involve the worker and agency in her effort to change her situation. As the patterns of behavior emerge with some definition, one can begin to reflect on their meaning for the kind of personality with which we are dealing. The object is not, however, to offer treatment for the personality problem per se. Rather the service is focused on offering help to see whether and how the relationship between herself and her husband can be different. We utilize our growing understanding of her behavior and personality in helping her to see how her own attitudes and feelings contribute to the problem. However, since our focus is on the relationship between two individuals, rather than on the complications in the personality of the applicant, and since any relationship is a reciprocal phenomenon, we naturally ask that both husband and wife participate in the helping experience. The object with each partner is to utilize our knowledge of his personality problem and our relationship with him, to deepen his understanding of his own behavior as a contributing factor to the conflict, and to help him to accept, if he will, greater responsibility for that behavior. Throughout, the worker relates

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each client's activity to its meaning for the relationship between husband and wife. In the course of the process, he helps them as it were to reëstablish their own "lines of communication" with each other. Each partner, in deepening his understanding of and control over his own behavior as a contributing factor to the marital conflict, is better able to understand and adapt to the rights and needs of his spouse. Obviously, the particular changes in attitude and behavior vary from case to case. And the particular content in relationship between clients and worker will probably never be the same in any two cases. But in every case, if the clients can accept and use it, the service will consist of help to work out some change in the relationship between husband and wife that respects the needs and rights of each of the individuals involved, so that a tenable, satisfying balance between them can be established. For some, help may result in a decision to separate, and to achieve that responsibly, with a minimum of guilt, hostility, and destructiveness, requires a good deal of skill on the part of the worker, as well as new courage and self direction on the part of the clients. I have presented this discussion on the focus in the marital problem briefly with no intent at full discussion or analysis. My object is solely to indicate a procedure whereby the counseling service deals with a particular problem in living and adjustment, rather than with the total personality; and yet, in offering this help, we use all we know about the personality as well as all that we experience with the client in the helping relationship. The structure the agency now uses in offering marital counseling grows naturally out of this approach to the problem. Briefly, we require that for marital counseling both partners participate. In intake, we establish with the client who applies that before offering the service it will be necessary for us to see his spouse. After each is seen separately, we see both together once, to discuss appointment hours, whom they will work with, etc. This joint interview has considerable value, both psychological and practical. It brings the man and woman, so much at odds with each other, momentarily together on agreeing that both are unhappy about their relationship and are willing to do something to change it. Also it offers them the possibility of reaching an agreement on something, even if so small a matter as to when they will come for their appointments.

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The agency has been using this structure for a little over three years and I would like to point out that, as with any structure, if it is rigidly and uncreatively applied it of necessity loses value. Frequently, a woman protests that her spouse will refuse to come in. To insist adamantly in the first interview that unless he comes there can be no service, since this is the way the agency works, is not helpful. True, if it is clearly determined that the help needed is marital counseling, we do not offer continued service unless both partners participate. However, we can offer a limited number of interviews (about a month) if the wife desires it, to consider with her why it is that this requirement feels impossible. Frequently, by the end of the month, the client does find a way of including her partner, whereas in the first interview she was unable to, for one reason or another. In some cases, these interviews lead to an awareness that the major problem does not lie in the marital relationship, and the client may be assisted to obtain help for the basic problem, either within the agency or elsewhere. However, in the last analysis, structure in counseling cases, as in all others, is dependent for its maximum value on the skill and creativity of the worker, who must constantly relate his use of structure to the particular client and to the specific problem. In concluding this paper, I wish to illustrate with brief abstracts from case material, how some of the principles described in this paper operate in practice, but first, one factor needs further clarification. Throughout, I have emphasized that counseling focuses on the client's efforts to work out an adjustment in a particular area of living. I believe it is clear from what I have said earlier that this approach to the problem, which attempts to delimit the area of counseling, does not for a moment assume that the client will carry the burden of this focusing, of limiting himself to the particular problem with which he sought help and for which the agency offered its service. It is the worker's responsibility, and his only, to stay skillfully within function and to maintain his focus in the developing process. It is for the worker to help the client to see the relationship between whatever the client introduces, and the problem both are working on together. At times, the client brings in extraneous factors, in an effort to escape from his growing awareness of how he may have to use himself differently; at other times, the apparently unrelated information is his own way

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of discovering that what is happening to him through this experience affects him in other areas of living. It is a skillful task to keep a continuing thread running that constantly ties the experience together and brings out the meaning of the client's behavior in relation to the particular problem. Almost ten years ago, Dr. Taft, in discussing the relation of function to process, wrote : . . . there remains to us a large and comparatively unexplored area for future development, an area in which to learn how to maintain our functions intelligently and skillfully and how to isolate whatever can be isolated from the particular situation, in terms of the law, the nature or the general pattern of the helping process. This knowledge, however, can never be applied to the control of the client, . . . but only to ourselves, to refine and reform our professional selves as well as to increase our professional skill.10 While this was written in relation to offering tangible services, it is nonetheless equally true for the counseling service. The Gold case, presented in detail later, illustrates the use of the structure I have described for marital counseling. It also demonstrates, I believe, how one can focus on the conflicted marital relationship throughout the course of treatment so as to help husband and wife to a better understanding of themselves and to an improved relationship with each other. The case material I cite at this point in the paper is counseling with an unmarried young woman whose family does not enter into the contact. I choose this case for several reasons. First, it is characteristic of a peculiarly difficult though frequent problem in the family agency, in which the validity of the counseling service is put to a crucial test. Second, although this case is very different from a marital problem or any other conflict in immediate family interrelationships, it illustrates that the approach to the problem of counseling that I have described so far,—namely, helping a client in his effort to solve a specific problem,—is nonetheless applicable. 11 Miss Black, a young woman twenty-three years old, was referred Jessie Taft, Relation of Function to Process, Journal of Social Work Process, I, 8, published by the Pennsylvania School of Social Work. 1 1 Also, this case raises the question as to whether service for the "unattached" man or woman is best met within the setting of a family agency. This is open to question and needs further exploration. However, I am not considering this problem further in this paper. 10

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to the agency by her physician. He had known her for many years, having treated her for peptic ulcer. She had had frequent and sustained attacks that were extremely painful. The doctor was referring her to the agency to see if we could help her with vocational problems. She had had a half-dozen jobs, but could seem to find nothing which held her interest. She had been at her present job, writing copy for an advertising firm, about seven months and was thinking of resigning. She is restless and unhappy about her employment difficulties. Miss Black Uves with her mother and stepfather, is a high-school graduate, and takes courses in journalism at night. In describing the case, I am not reporting process. Instead, I have chosen excerpts primarily to illustrate the method of focusing the problem and the use of structure. The use of time will also be considered more fully. In her first interview, Miss Black repeated much of the information given by her physician. She is an attractive young woman of obviously superior intelligence. While she seemed tense and uncomfortable in describing her situation, I noted early in the interview how urgently important it was to her for me to believe her and like her. As she described the many jobs she had had, she went into minute detail in proving to me why each had been the wrong one for her. Now she seems faced with the same problem. What was apparent in all of this was that the intensity of feeling, the defensiveness as well as the fear that she would not be believed, and her confusion and insecurity in trying to say what she wanted of a work experience, indicated emotional difficulty out of all proportion to the practical problem. In the course of the interview, I explained that we had no vocational guidance service in the agency. If this was the service she needed I could refer her to one. Yet I expressed some of my doubt as to whether that was really the problem. I commented on the intensity of her distress, when there was no apparent reason for pressure. From what she had described, her parents had no need for her money. She had savings of her own. She reacted quickly to this. She doubted the doctor was right in thinking she needed vocational guidance. She had frequent headaches because of her misery about job and yet she could not understand her own concern. She could even quit working if she wanted. She just did not know what was wrong with her. In none of her other relationships with friends or family did she seem to have this problem. What could she do? She could not take much more of this. I said that at

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this point I too was unclear about her problem, although I could see her suffering and would like to help, if we could. If she wanted to try it, the agency did offer three or four interviews in application, before either the client or agency made a commitment about continuing, to see if we could together come to some clearer understanding of the help she needed, and then could either offer it here, if we had the service, or refer her elsewhere, where she might be able to get the necessary help. She grasped at this eagerly and wanted to arrange time to come in. I wondered whether her mother knew of her coming here. She said that she did. However, they had not discussed it much. They lived pretty separate lives and have not much in common. Her mother is sorry for her when she is ill but thinks that all of this fuss about job, as well as her stomach aches (ulcer), were just "nonsense and nerves and she ought to get a tonic." There was little feeling as she described this, and she added that if there weren't the housing problem she would have sought a place of her own a long while ago. I explained that as a family agency, as long as a family continued as a unit, we ordinarily did not undertake helping one person, unless it were acceptable to other concerned members of the family. It might be that while coming here she would make a decision about job that would create conflict between her and her parents. She felt it was not likely and I agreed that she knew her family better than I did, yet if we were to be of help, this was necessary. She had no problem about having her mother call or come in. We agreed on an appointment date following our talk with her mother. At this point, I should like to discuss the use of time in this intake. Generally, the first interview in a counseling case is full of intense, accumulated feeling. In one interview, the client may describe a conflict in relationship, express a degree of insecurity and anxiety that is indicative of a need for therapy, or present his problem in relation to some outside situation, such as a job or school. It is difficult to know where the essential problem lies, or with what the client will be able to take help. To offer counseling service vaguely on the spot for any or all of the problems mentioned, usually leaves the client confused as to what he is coming back for. With the worker equally uncertain, the case may easily flounder or get lost. We have found it helpful in the first contact to set up a definite time for the intake process during which we will attempt both to crystallize the problem and to concretize the service, so that worker and client can break through the totality of

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feeling and profusion of problems, to determine what can and should be worked on. For example, in such an intake period the worker, relating to what the client describes as his problem, may point out the service that exists for a problem in relationship and how it is given; or the service that is available in relation to problems of vocation or education; or he can help the client to see that the kind of problem he describes is one requiring psychiatric treatment. In the initial impact with agency, the client has no basis for knowing whether or not he wants a counseling service. He knows only that he wants relief from his conflict but that he fears the outside source of help. I believe that in this prolongation of intake it is not only more possible to identify and clarify the problem that is central for the client but the actual experiencing of a helping relationship in these few interviews affords the client the opportunity of choosing more responsibly and specifically the service that he wants, just as he would do in applying for more tangible services. For the worker it offers an opportunity for a dynamic diagnosis, which on the one hand arrives at a fuller understanding of the personality, observing possible evidence of the existence or extent of pathology, and its implications for this kind of help, and on the other hand, through the extent of the relationship already established, indicates how ready the client is to use help and for what. I believe this structure is worth experimenting with and offers useful possibilities in setting the counseling case in such a way that the client is given a greater sense of clarity and responsibility for participation, and the worker additional control and direction of his own role. In response to a letter, Miss Black's mother called up to say that she would be grateful for any help we could give her daughter. She saw no point in coming herself. She is not very well and her daughter is an independent young woman who always decides things for herself. I made no effort to insist on her coming in. Although it was evident that their relationship was a poor one, there was a degree of separation between them that each expressed and seemed to prefer at this time. I saw Miss Black three times in intake. What emerged was that her problem in her place of employment was not at all that she becomes bored and disinterested. On the contrary, it was as though it began to mean so much to her that she could not face it. The satisfaction she got from it, her very wanting it to the extent that she did, seemed to

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frighten her, and her feeling was that something terrible would happen if she continued there. As this became clearer in our interviews, Miss Black seemed, on the one hand, relieved to share this and to know it in this way. She always "sensed something of it inside," but had never thought of it quite like this. While it was a relief to face the problem more squarely, it was also upsetting to know it, and she wanted to see if it could be different. I said that the agency could offer a counseling service to see if we could help her improve her relationships with people at work. I indicated the possibility that she might need psychiatric consultation or treatment. However, in the light of her apparently more stable use of herself in other areas, I did not set this up as a requirement for the service. In discussing the continuing service and arranging appointment time, Miss Black asked how long she would have to come in, had we seen other people like her, did they ever get over it. (I should like to repeat here that I am not recording the process of the interview. ) I explained that when we offered such a counseling service, we asked the client to commit herself to coming in for eight interviews. From experience, we knew that usually it took at least that long if counseling was to be helpful. Sometimes, that was enough time; sometimes, there had to be an extension; sometimes, the service proved not to be helpful and there would be no point in continuing. But for the agency to begin to offer its service, we felt that an applicant had to be ready to go on that long. Miss Black was quick to accept this. I wondered in the light of her troubled feelings about what she had found out as a result of the first few interviews, whether she really felt she wanted to continue. She said that she had lived with her problem for years and it was getting worse; investing a few months that held out some hope seemed worth trying to her. The use of time just described in setting this case is certainly open to question and needs further clarification. In my experience, this determination of time is not merely an administrative device, nor yet a purely philosophic abstraction. One has but to interview people oppressed by a burdensome life problem, seeking some way to overcome it, escape it, or modify it, to know that time to the disturbed client is an urgent part of his conflict itself. When the problem is so acute or overwhelming that he feels lost in exercising any control over his question "how long will this last?" it is as though he has lost a fundamental control over life itself. Man

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from childhood on must come to terms with the question, "how long?" for an indefinite number of life's experiences; only as he can know, control, or share in determining "how long" can he accept and live with it, or be helped to accept and live with it. When an individual comes for help, seeing no end to his difficulty, he has a twofold problem : first, the specific life conflict itself, and second, the pressure that grows out of his feeling that it may go on forever, or that he is exposing himself to an unknown process with no way out in sight. Through the suggestion of a time span set by agency in the helping process, it is as though the client can get back, through this very use of agency, at least a temporary control over his dread that there is no end to his problem, which I believe affords some release of energy toward its solution, while the fear of being caught indefinitely in an unknown situation is reduced. Time does not permit any extensive discussion in this paper of this subject. Dr. Taft in Dynamics of Therapy 12 and Dr. F. H. Allen in Psychotherapy with Children deal with both the philosophic implications of time and the use of time in the therapeutic process. A more recent contribution, to which I have referred earlier, Dr. Franz Alexander's Psychoanalytic Therapy, illustrates a new experimental use of time in psychoanalysis, where it is recognized as a vital factor in the treatment process. It is my conviction that unless the worker assumes some responsibility in using time, brings to the intake process something tangible and known about the duration of treatment that the client can hang on to, resist, or react to, in whatever way he chooses, an important dynamic for helping is lost, as well as support for the client's urgent need of some temporal underpinning in tackling his problem. If we gently ignore his question of "how long" on the assumption that it will take care of itself, after he has been helped with his particular psychological problem, we forget that his feelings about time and being controlled by it are interwoven with his feelings about everything else and are in truth a very part of himself. I do not believe, however, that the agency can set a rigid or arbitrary time limit for counseling cases. Personalities, problems, and the pace at which people take and use help vary. The use of time which I have suggested here provides a flexible structure 12 Jessie Taft, Dynamics of Therapy in a Controlled Relationship (New York: The Macmillan Company, 1933 ).

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which meets the necessity to use time as part of the helping process, but leaves room for individual adaptation to the particular client. Thus, a set time for intake, to clarify and focus the problem, helps the worker and client decide about continuing; then, a suggested terminal point, based on the agency's experience with similar cases, which can be modified according to the individual situation, provide a potentially dynamic time structure. Why eight interviews beyond intake? The only reason I suggested this was that our experience had shown that a majority of cases lasted about two to three months, and thus this time span seemed to have some general validity. However, further experience may prove this a poor choice. Indeed, further experience may well require other modifications in the structure I suggest. Whatever proves most effective for helping is our goal, and certainly no vested prejudice in a particular structure must stand in the way of pragmatic experience. The next four interviews with Miss Black clarified the basis for her very complicated and exhausting experience in her work relationships. What was revealed was her antagonism, her competition and rivalry with co-workers and contemporaries, and her zealous efforts to become indispensable to her employer. While her own description was full of projection onto others, always high-lighting her feeling of responsibility for her job, it was apparent that she tattled on other workers, got them into difficulty, anything to gain the attention and affection of her employer. In the course of our relationship, as I began to bring some of this out into the open, she was horrified. While she wanted to argue and disagree with me, get angry with me, the same pattern that made her operate with her employer as she did, and which was apparent in our first interview, i. e., the need to be accepted and liked at any cost by someone who represented a parent symbol, blocked her. In the fifth interview, her way of trying to cope with this was by projecting all of her hostility onto her co-workers (siblings) with intense vehemence. I helped her face some of her anger at me and what that did to her. I pointed out that it was so important to her to have me like her, that she was frightened that I might not want to have anything further to do with her, in the light of what we had discussed about her relationships at work, and because of her negative feelings about me too. I assured her that I was not here as a judge or parent. I could only help her if she could examine her feelings toward me, whatever they might be. I knew that no one could feel only one way about

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another person. I expected that some of the things I had said about her must have angered her, but could she admit even to herself, annoyance with someone she needed very much? As the interview progressed, she was able to risk a fuller, more spontaneous expression of feeling. I asked if she had always tried to divide her feelings this way, i. e., all negative for people her own age, whom she needed to feel stood in her way, and all positive for adults who might have some power over her. After a heavy silence, she began first to recapitulate school experiences, and then painfully she described early relationships in her own family. As far back as she could remember, her mother had openly rejected her for her older brother, to whom she gave her full love. She was unwanted, and her mother told her as a very young child that giving birth to her had made her a sick woman, and she wished Helen had never been born. As a child, her way of coping with this problem was to fight constantly with her brother. When she was about five or six she began lying to her father in such ways as to get her brother into trouble. When her father returned from work, she would tell some story of injury that the brother was supposed to have done to her, and her father impulsively used to grab her brother and beat him severely. No matter how the mother protected the boy, the father responded to Helen's story. This was brought to an end traumatically when the father was killed in a railroad accident when she was 9. She remembers not quarreling with her brother for a long time after that. While she got on with her mother, it was by never disagreeing with her. The mother remarried when Helen was 12. Then, as soon as she was old enough, it felt to her as though, except superficially, they had nothing to do with each other. All of this material is highly summarized, and I am not attempting to interpret any genetic implications. Telling this story about her early life, just at this point when we were working both on her problem in expressing feeling toward me, and on her use of herself with people at work, i. e., fighting with "siblings" and attempting to secure herself with the "parent," she needed little help from me in seeing how in various ways she had been re-creating the same family conflict all her life, although she never risked it again in her own home. After this deeply moving interview, her relationship to me became more spontaneous and, simultaneously, her relationship to co-workers began to change, although this was extremely hard, since they could trust her, at first, but slowly. It may be worth not-

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ing the point at which Miss Black's recall of her earlier life experience came and the role it played in helping her. In the course of our relationship, she was made aware of her pattern of projecting the cause of all of her difficulties onto outside objects ( at work, co-workers) and the hostility contained in this projection; and also of her need to be the good, compliant, and indispensable child to important adults (e. g., employer, worker). Until now, she had been able to use this pattern very self-righteously, with an ideal image of herself as a good and almost martyred person. Her need to run from job to job, however, was an indication of the anxiety, fear, and guilt that she experienced in consequence of the underlying motivation of her behavior. Her rationalizations for this pattern could no longer continue to operate, since I helped her to see what she was doing in relation to me as well as to co-workers and employer. The desperation and intensity with which she attacked her co-workers in the fifth interview, as against her earlier attitude of virtue and smugness in describing their faults, seemed to me an indication that some change was taking place. At this point, I introduced a question that led to the recall of experiences other than her difficulty at work. This was not a general question asking for earlier life history but rather was specifically associated with the problem we were working on at that moment; the recall focused on earlier experiences that had similar emotional quality and need and through which she could see the similarity in her own behavior running through these different experiences. This came at a psychological point when she seemed ready to break through her denial of her part in her problem. The life drama she revealed was utilized not so much in understanding the past or the etiology of her behavior, but rather to clinch the understanding of herself in present experience that she was now ready to find and accept. A significant factor in this process was her inability to relate to me in the helping experience with her characteristic pattern toward a parent object. I held to the uniqueness of the helping experience, and the fact that this experience, in its own right and difference from all others, had to produce hostility and fear toward me as well as strong positive feeling. As she could both feel accepted and yet express such feelings, the old pattern was not only inadequate but

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unnecessary; consequently, as her security and possession of herself increased, other relationships were affected as well. When we reached the eighth interview, the first terminal point set by the agency, Miss Black could now participate meaningfully in a discussion of ending. She felt as though she had made considerable progress, yet relationships at work were in a state of flux. She was not yet accepted by co-workers, although they were feeling differently toward her. She was avoiding an effort to "buy her way in," which would shut her off from expressing justifiable negative, and she wanted further help in working out more balanced relationships. Actually, the case ran to fifteen interviews, but it was evident that we had reached a turning point by the eighth interview. The subsequent experience had to do with helping her to live through the ups and downs in this new use of herself in preparation for going on independently. As she had had to work gradually into a use of the helping relationship, so she had to work toward its relinquishment in favor of independence. At the conclusion of our contact, I felt that there was a significant change in her. In the fourteenth interview, she made no mention of her job at all, which seemed quite under control, but spent all of her time telling me about a young man she had been going with and that they were now going "steady." She had solved her problem of leaving me behind, it seemed to me, in an admirable fashion. We used the last two interviews to help her complete the experience. In a follow-up interview five months later, which we had arranged at my suggestion, she seemed to have more than held onto all the progress she had made, but she had exchanged her "steady" young man for another. ( Incidentally, it is of interest to note that she reported that the "stomach aches" due to her ulcer had diminished almost to the point of complete disappearance. ) Throughout this case, my focus was to help Miss Black work out her troubled relationships in employment. With this as a continuing focus, I used whatever I possibly could to increase her understanding and responsibility for her own part in creating her problem. From my experience, working with a more or less unattached individual is in many ways a more difficult problem than when we work with intrafamilial conflict, involving the respective members concerned, i. e., husband and wife in marital counseling,

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parents and child in a parent-child counseling, etc. Nevertheless, the concept of focusing on a partial aspect of the problem, rather than the total personality per se, seems to hold for both. The written word, unfortunately, carries an aura of authority and finality that sometimes feels irrevocable. What I have described here is a progress report of an experiment in casework practice, not a description of a finished product. However, it points to a direction for counseling which may be useful. To develop an agency service that individuals can use to work out adjustments to circumscribed problems which are obstructing their progress, is, in my opinion, a legitimate goal for functional casework.

THE GOLD CASE, A MARITAL PROBLEM M. Robert Gomberg THE Gold case has been selected to illustrate the potentiality of the counseling process for helping with a marital relationship that has become too difficult for one or both of the partners to bear without some outside support or interference. It was this case which confirmed my growing belief in the possibility of focusing the agency's service on the marital conflict itself, involving, as it must, the nature of the interrelationship and the contribution of each partner to it. Unless the emotional disturbance of one or both is too internalized to permit of any but purely individual psychiatric or psychoanalytic treatment, the workers in this agency have found that it is not only possible but therapeutically advantageous to define the goal of treatment as helping each partner to gain a better understanding of his own part in the marital problem and at the same time to begin to take more responsibility for modifying his own behavior in order to better the relationship. The Gold case is important, too, because it represents an experiment with the use of time as an essential part of the structure on which such a case rests. Also, it was this case which confirmed the agency in the development of the policies that have been described in the previous paper for the handling of a counseling service. A common difficulty encountered by many caseworkers is conducting a marital case without tangible services to focus it has been the frequency with which contacts are ended by the clients after one or two interviews. The Gold case shows how important it is, for the continuation of the contacts, to relate time to the treatment process as a whole. In suggesting an arbitrary time limit to Mr. and Mrs. Gold, one of my objectives was to see whether it was possible thereby to sustain a client more surely beyond the impact of the first few interviews, by giving him some tangible sense of a time span to 219

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hold on to or to resist. Thus, by naming a specific time, short enough not to be too threatening but long enough to require real work on the problem, I hoped to keep the impulse to flight-fromtreatment within the natural dynamic of the helping process. However, Mr. and Mrs. Gold taught me something of the deeper meaning of time as a factor in treatment beyond the mere holding past the first interviews. Although both Mr. and Mrs. Gold reacted constructively to my use of time, I think that I was perhaps in error in setting such a specific time limit at the beginning. What was validated for me, however, is the necessity of a flexible time structure, such as I have already presented in the preceding paper, that can be adapted to the specific needs and problems of particular clients. However, a time structure is not the only essential for helping clients to utilize a counseling service past its initial stages. Unless something beyond sympathetic listening characterizes the first interviews—some immediate experience of being helped, however slight—many cases will still continue to be lost in their beginnings. The client must experience from the start not only a genuine acceptance of himself and his problem; he must also gain some sense of the worker's difference, an understanding and perspective which promises new light on, and possible change in, the nature of the conflict as presented by the client. The structure set up through agency policy, which asks for the participation of both marital partners, is one of the objective ways whereby the worker brings something new into the client's preconceived idea of his problem and what he thinks he needs to be helped. Whereas it is human for the applicant to see and present the absent partner's responsibility for the bad situation, the first interview can begin to break up a one-sided projection of blame and refocus the problem to include the applicant's part in the conflict and the necessity for mutual participation in bringing about a change in the marital relationship. The record of my contacts with Mr. and Mrs. Gold follows. One might question accepting Mr. Gold for a counseling service because of his previous neurosis and the psychoanalytic treatment. However, it was the very help he had been able to take previously in psychoanalysis that determined my acceptance of him, despite the apparent recurrence of his symptoms. It seemed to me that if

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he could differentiate between the kind of help he had received from the analyst and the way he would be expected to participate here, in using the counseling service as defined by a family agency, the very experience of separating the two forms of help would in itself be releasing and constructive. The results would seem to warrant this conclusion. Mr. G. -1916 Mrs. G. -1920 Betty -1942 WORKER I know of Mr. and Mrs. G. personally, and their request for assistance with their problems came out of this personal contact. Mrs. G. is a young woman of twenty-four, who is a college graduate, having majored in Home Economics. She comes of a very closely knit family, which has always had economic struggle in order to survive. The parents are deeply affectionate to each other, and always had a great deal of love for Mrs. G., and her older sister. However, the older sister was the "favorite" and Mrs. G. felt this. Although the older sister was unable to go to college and had to work to help support the family, thus providing Mrs. G. with an opportunity for her education, she nonetheless felt that she took second place. The father was a warm, lovable, extremely unambitious person, quite content with his marginal earnings, and feeling quite secure in his wife's unusual ability to manage. Essentially, the tone and feeling of the family was one of warmth and affection. Mrs. G. is deeply attached to both father and mother, and in spite of the resentment and rivalry for parental affection with her sister, her essential feeling for the sister is warm and affectionate. Mr. G. comes of a broken home, had to go out to work rather early, and had to leave night college, where he was majoring in Pedagogy. He is a City employee and helped to support his mother and sister all the years prior to his marriage. Mr. G's difficulties were brought to my attention about a year and a half ago when I saw him one time. He described what seemed to be an intense anxiety neurosis, with all the concomitant physical symptoms—palm sweating, dizziness, nausea. The latter seemed to be the most aggravated of his symptoms, the feeling that he was going to regurgitate always occurring when he was upset. He described his great fear of what the other people thought of him; his fear of offending others; his constant preoccupation with how what he did would sit with other people. This seemed to immobilize him from any activity favorable to himself and burdened him with a tremendous amount of responsibility which he carried because

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of other people's feelings (even though partially he was identified with what he did; e. g., support of his mother and sister; work in his Union, etc.)· At that time I referred Mr. G. to Dr. L.. a psychiatrist, who subsequently saw him in analysis for about a year. He seemed to make some progress, being able to give up the night shift on his job which interfered with his family life, also being able to give up a little of the additional responsibility that he carried, and he seemed to feel more comfortable with himself. The G's have a little girl, 21 months old. They have been married for about three years. 6-14-44: Mrs. G. called, saying she wanted to discuss personal and family problems with me. We arranged an appointment for 6-15-44. 6—15-^44: I saw Mrs. G. today. She is an attractive, bright young woman, obviously quite troubled, and with mixed feelings about her husband. When I made some mention of her uneasiness in beginning and in coming to the agency, and related it to talking with me about her problems —we had known of each other differently—she acknowledged that she is uneasy, but quite anxious to discuss her situation with me. Throughout what she tells me, there is anger and resentment against her husband that seems to fill her, now with defiance, now with despair. She complains that she can see little difference in him since his analysis. She centers most of her unhappiness on their limited income. His earnings are approximately $50 a week, and although she is a very good manager, in these days that is not very much, nor does it seem to give them very much of a future to look forward to, since his is a static job. She is very worried about Betty's education, and on top of that, she sees very little for any of them. She can't see this kind of life for herself forever. With a little help, she expresses a great deal of anger and hostility towards her husband for being apparently quite content with his earnings, and showing no ambition to earn more. If he can't earn something more in these times, what will happen when the boom is over? Her fear of a marginal existence for the rest of her life makes her miserable. I comment on her having had some experience with that in her own family and she bursts forth with, "yes—but I am not my mother; I can't see that kind of life." I said I could see how unhappy she was and I gathered, too, that it had been going on for some time. I wondered how she thought I could help her here. She really had no idea, except that it was clear that she was hoping that somebody could make her husband do more of what she wanted him to. This led to a continual kind of complaining against him. He not only lacks ambition, but he has an

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unreasonable selfishness. For example, he will go out bowling with the boys or play cards and overrun his allowance and not feel too badly about asking for money out of the family budget. As she describes all of these difficulties, her dissatisfaction with her husband, with her own role in the family, I just wonder what keeps her going on this way. Everything seems to be so untenable. At that point, with genuine sincerity and deep feeling, she talks of the fact that she does love him. She doesn't deny that over the past few years, from time to time, she's thought of giving up, but she admits that this is a markedly lesser feeling. In answer to my question, she says that although she had hoped that it might be otherwise, she had suspected that he was this kind of a person even before they were married. I comment on the degree to which she seems caught between her love for him and the unsatisfying life that she seems to have, and again I wondered, both what she hoped could be of help to her, and in what way we could be of help here. Indicating again her wish that something would make him different, and yet her obvious lack of conviction that this is possible, she talked about work for herself. She has had secretarial experience before marriage. She is sure that if she could provide nursery care for Betty, she could get a job. There is a quality of resignation and defiance in this. I commented that we could sometimes help a person get work, and I could even discuss nursery care for Betty with her. However, I had some serious question about her request. At first she thought that this would be about leaving Betty during the day, and expressed a good deal of guilt about that. I acknowledge that that was a real problem for a mother to think of, and yet, it was not quite what I had in mind. I said that I knew that for some families the solution of their economic difficulties did lie in both husband and wife working, yet I was wondering whether she saw this as a way of moving more closely together with her husband, because she accepted that he could not be different than he was, or was this being considered in protest against him. On the one hand she might be getting more money, but on the other, she would perhaps be driving a deeper wedge between them. She cried when I spoke of this, and she acknowledged that she is full of resentment and that she is not sure but that she may be doing this as a way of punishing him and showing him up. On the other hand, she does enjoy working; they need money and she loves him. Maybe it could be a solution, but she is honest enough to know that it isn't all of her motive. I comment, then, that perhaps she and I have gone as far as we can, at this point; that she may really not be ready to do anything about employment right this minute. I can tell her it is something that we

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can help with; yet I could not offer the service to her without knowing what her husband's feelings in the matter would be, and without knowing that she and he had begun some discussion on the problem between them, and had agreed that they want our help, either on something as specific as this tentative solution of employment, or perhaps on something less clear—namely, the problem they are having in their marital life—and I describe the service we do have for the latter. She has no disagreement with my need to see him, and in a forthright way again could admit that part of her wish would be that I could take him to task and make him over for her. However, she realizes, from what we have been talking about today, that she has a part in this, too; that he may not become what she would ideally want, and that unless their life together is to become an "armed truce" she may have to find some way of yielding a little and sharing more. We agree that she will discuss her visit here with her husband (who did not know of this appointment ) and that they will be calling about an appointment. 6-21-44: Mrs. G. calls. Her voice is very upset. She wonders if it will be possible for me to see her husband this afternoon. She has not really discussed with him all the things that we talked of because there has been a new development. He seems to have suffered a complete relapse; is very agitated and upset and is very anxious to see me. Can I possibly see him today? I arranged an appointment for four o'clock. I comment on how disturbing this is for her, and she pleads with me that I try to reassure him that she will not mind the expense involved if he and I find that it is necessary that he go back to the psychiatrist. (In her interview she described her own suffering in trying to manage on Iiis income, while he was paying $30 a month to the psychiatrist. ) Her feeling seemed genuine in this, and yet I sensed, too, some of the bitterness that went with it. Later ( 1 ) Mr. G. Mr. G. was in about fifteen minutes early for his appointment. I was free and ready to see him. He is a clean-cut young man, who, obviously, is extremely tense and unhappy. After our brief greeting, he describes how worried he was lest he be kept waiting, since he feels so miserable he is so afraid he would have thrown up in the waiting room. I commented that when one was upset, any additional burden would feel like the last straw. I thought that coming down, in general, must have been a pretty difficult undertaking for him, since I know that it was his wife who called, and not he. No—he said—he was not able to make the call because of his job, and he was so anxious to see me that he did not want to take a chance of a possible delay. With a desperate and hopeless gesture, he said—"I'm scared—I'm afraid I

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am going to have a nervous breakdown. It's just worse than ever before." I commented on how sorry I was to see how badly he was suffering. I just wondered how he could have any faith in coming to talk with me, since the last thing that I had suggested to him ( analysis ) apparently has left him open to such a relapse. He expresses doubt about anything being able to help him. He takes it mostly on himself—rather than putting any reflections on me. I wondered what he had in mind in coming in today. He said he would want to tell me what was happening, to see whether I could possibly help him decide what he ought to do. He divides his problem in two parts. Throughout, one senses complete lack of self-confidence (he says this himself) and his feeling of helplessness for fear that he will "start all over again," since he hasn't found any real answer to his problems. He describes his relationship with one man on the job. They have known each other for a long time. This fellow has gotten some additional responsibility and is using his authority pompously, alienating all of the men who have been his friends for a long time. Mr. G. does not know what to do about it. His friend has become increasingly oppressive, for the last month or so, and he is caught between the devil and the deep blue sea. On the one hand, he knows how the rest of the men feel, and he feels as they do. Yet, this person is his friend. He does not want to alienate the other fellows, himself, by being so identified with him, and he can't get himself to talk with this man about what he is doing. One senses the degree to which Mr. G. feels the whole burden to be his own. But I do not comment on this, at this time. He mentions this as a background to his current disturbance and tells how it came to a climax the beginning of this week ( not in relation to this friend). His own feelings of distress came to a head, and he was sure he was going to break down. He was working at the information desk, the only part of the whole job which does give him any pleasure at all. A pretty, blonde girl came to the window and asked for certain forms and information which he was not responsible for. At first he explained that his department did not have that service, but then he told her to wait a moment and he went back and obtained it for her. He told me that while he was doing this, he suddenly began to become extremely conscious of the girl who was very attractive. When she got back in the line, he saw her out of the corner of his eye and became increasingly worried that when it came time to write out the forms, he just would not be able to. His hands began to quiver and he felt himself going faint. In a very upset way, he finally was able to pull himself together and fill out her slips. Then he had to leave the desk and get someone to cover it for him. After that, whenever a pretty

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girl got in the line that day, he went through the same intense agitation and he was afraid that he would collapse on the spot. Mr. G. is sweating, as he tells me this, yet there is some relief in it too, since obviously he has not discussed this with anyone. I said I could see how disturbed he was in just telling this to me, how distressing it must have been when it really happened. He tells me he just feels helpless in trying to explain it. I said that that, in itself, might almost be as aggravating as the experience. He said yes, because it leaves him so fearful that it is just going to keep on happening until he cracks. Acknowledging how upsetting such a thing could be, I told him I felt uncertain that I could know the real cause of what happened any better than he did. I wondered why it would be a pretty girl that would precipitate the difficulty this time, as against anything else, since we both knew he had had some of the same feelings before, but they seemed to grow out of other situations. He becomes quite intellectual in telling me that as a young man—like other men— he is attracted to pretty girls and likes to look at them, although he is never really drawn to them sexually ( the latter somewhat defensively ). I acknowledge that it certainly was true of all men—that getting married didn't prevent or control the attractiveness that other women had for a man. And yet I wondered why, then, if he knew this so well, it should disturb him so deeply. I wondered if anything had been happening between himself and his wife that might have been disturbing to him. He shakes his head and can think of nothing, and then tells me— although he seems, obviously, not to have made the connection—how their baby really was an "accident." They hadn't planned her. His wife was deeply disturbed when it happened, and although both love the baby, it has left her constantly fearful. Every month produces a great deal of anxiety and panic, and if she is late with her menstruation, so much as a day, she gets very upset, weeps, and both of them are miserable. Last month her menstrual period was delayed for a week, and he described the intensity of her upset, as well as his own. He is afraid not only for her, but suppose she does have another baby and appoaches it this way, he is afraid of what it would mean. When, at the end of the week, she finally got her "period," she was extremely joyous, yet worried, too. He knew that her feelings would not be settled until another month went by and she got her period on time again. He spoke with her about it and asked her whether she preferred not to have sexual relations all month, and she gratefully admitted that was so. He and his wife have now, for a little more than a month, not had any sex relations. One senses that part of his feeling was a genuine concern about her, and, as he describes it, there is warmth and appreciation on her part.

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I comment on the fact that it was interesting that he told me this as a completely separate matter from his anxiety attack about the young girl at his place of work. Did he feel they were entirely separated? As he thinks of this, he begins to acknowledge that it has been hard for him. He does enjoy his sexual relations, as does his wife, except for the distressing time once each month. Coming home each day and sleeping with her, and yet being denied what he was used to and in a sense felt was rightfully his, was not without its disturbance. With some puzzlement, and a little relief, he says, isn't it strange that he has no resentment against his wife for all this? I said I thought so, too, the difference being that I thought he really had resentment and that his way of expressing it was through all of this sickness; that while apparently he was not letting it out directly at her, none the less it did get expressed indirectly against her, too. He was deeply thoughtful about this, and for a moment he talks about his old problem of never being able to express resentment. I said that sometimes a person feared his own destructive feelings so much, feeling that they are so dangerous, that he just cut himself off from them completely, as though they did not exist. He replied that it was interesting to him that that was what the Doctor came to after a year's analysis, and had told him to express his feelings and take a chance—and here I had found out about him within this hour. I said that that seemed to put a great deal on to me, as against the Doctor. I was afraid that whether it was an hour or a year, just knowing this about himself somehow did not seem to be enough to change it, did it? He acknowledged heavily that it was so. Although he moves away now from his dread of a recurrence in relation to another girl, he goes back to the totality of his illness and symptomatology, expressing, though with not quite the same despair, a sense of hopelessness about what he can do about it. I agreed that it was an oppressive fear to have, and I wondered how he thought we could help him in this agency. I wondered, too, how it was that he did not go back to the Doctor. He projected all the reasons for not doing so on to his wife ( although admitting a little of his own doubt), by saying that he is afraid that if he had to start that expense again, it would be just too disturbing to her. Then, repetitively, he describes his symptoms and his upset about them. I said I could see how overwhelming this all felt to him—that his illness and symptoms seemed almost a thing in itself that he wanted to tackle separately, apart from the details that he had been telling me about, the events in his everyday life; something of his problems on the job, with his wife, etc. I knew how upsetting the symptoms were,

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and I wished I knew of a way of wiping them out—but I did not. The two possibilities which I saw were—first, going back to the Doctor about his neurosis; secondly, something that related to this agency. We did, as a family society, know a good deal about problems in family life, about the difficulties that a husband and wife sometimes have in living together, and we had a service and experience in helping families to see if they could work out a more satisfactory life together. I wondered whether, amongst the many things he had told me, there weren't some specific spots in his everyday family life that were causing him some concern. I didn't know, but perhaps we might be able to be of some help there. I added that I knew how preoccupied he was with his illness, and perhaps this latter could mean nothing to him. Well, yes, there was something that bothered him. That was the matter of finances at home. He knew how unhappy his wife was with his limited earnings. But as he described this, I sensed he feels she is unreasonable. She should be able to manage on $50 a week. In fact, he can't feel too guilty about it because she keeps the home beautifully; they eat awfully well—so what is lacking? On top of it—and this quite angrily—she gets herself involved with expenses that are so unnecessary on account of "keeping up with the Joneses." In just about four months she has spent about $100 in gifts. If her aunt gave her $15 when she was married, now that her aunt is getting remarried herself, his wife has to give her $15. If their purse is so limited, why can't she control this business of gifts and get something for two or three dollars? His working hours are odd now. He works from 6 A. M. to 3 P. M. and he gets up about 4. If he got an extra part-time job, he would have to work till midnight, which, he feels, is unreasonable. I wondered whether he knew anything about my having spoken with his wife about her concern with money when she had been here. He knew about it vaguely, since all of this difficulty had come in between. I thought that not knowing about what we had talked of might have made him a little annoyed with me, since I can see how annoyed he is now. No, he didn't feel that. He just feels a kind of relief in talking to me. He goes on describing some of their differences in management, implying basically an unreasonableness on her part and a kind of acceptance of his own justification. I said that while his arithmetic might be right, I guess that it could be only a limited satisfaction to him, since right or wrong, it did seem to represent a real problem between his wife and himself. He hasn't thought of it this way, and in a troubled way, acknowledges that it is so. He goes off on a tangent for a moment, describing some of his upset in the place where he plays cards every afternoon. He has been

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playing with one partner for a long time. For several months now, this partner has been caustic about the mistakes Mr. G. is making, and this has been so upsetting to him that the other day he came home and had to tell his wife about how miserable he felt. Instead of getting what he wanted, she just asked him why he had to take it—why he just didn't quit playing—and in this there was some resentment on her part that he felt free to play cards. While he discussed this to show how upset he becomes at another person's criticism, I commented on something quite different I said it was interesting to me that though he described his illness in many different experiences, somehow they all seemed to lead back, one way or another, to some difficulty between himself and his wife. Here, for example, with the problem of cards— when he talks to her about it, he is apparently unhappy with the results. When he thinks of the Doctor, and using him as a source of getting well, it is his wife that seems to stand in the way. His difficulties with his job, his present limited earnings, become a problem because of what she seems to feel or do. I said I knew that each of these things seemed so big to him that he might not really think of them as related to his wife. When he has this attack, in relation to ostensibly a completely strange girl, I tend to tie it back again to a problem with his wife. He looks at me and says that he has never thought of it in those terms—yet, as he thinks and feels at this minute, he can see that somehow it does seem to go back to his married life. For a person as lacking in confidence in himself, if only his home were safe and comfortable, maybe other things could be less disturbing. I said that I did not know that for sure—yet I did know how important one's family life was. Help with problems in marital relations was something that we did have here, and that I could even consider with him—and yet, this was different from the problem which he brought in today. Rather eagerly he wants to discuss this with me. He tells me that during the analysis and after many months, the Doctor had commented how he never seemed to bring in any difficulties with his wife, and that he felt he was fairly honest in saying that they did not exist, or that they were trivial, and somehow, I didn't permit him to make it trivial. There is an aliveness and an ease about him now, quite different from the tensity of the whole hour. He feels that this is different, and with a little help from me, he is able to connect his fear that his own married life would collapse with the way his mother's had. He talked of the unhappy childhood, as well as about the misery of his mother. Maybe he has not been able to talk too much about his own marital life because of this fear. Momentarily, he sees this âs the entire solu-

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tion. I say that I think it is important, but I did not know that it could be quite the answer, although I could easily understand his looking for the panacea, after having lived for so long with his difficulties. He does more and more now, about applying for help from me and the agency, for himself and his wife. It is interesting, though, that he would like me to "explain him" to his wife. I laughed and said that I really could not do that for him; that I could not be the means that would get him across to his wife, without his being any different than he was. That was one of the risks in coming to this agency and to this kind of experience. Unless he himself was ready to take the chance of making some effort to meet his wife part way, and discover that he, too, perhaps would have to give up something, rather than use his illness as a control against change, I thought there would be little purpose to our getting together. He wondered whether I had told his wife that, too. I said that it would be natural for him to be concerned about what went on between his wife and me. I couldn't take away all of his fear that I might take sides, but I could tell him that I did let her know the very same things I had been telling him. The next step was u p to both of them. If they would talk it over together and could begin to face some of the difficulties that existed between them, and if they felt that they would want to come to the agency to see whether we could help them carry out their wishes to find a more satisfying way of life together, then I would be ready to make such arrangements. However, it would mean facing out together some of the grievances against each other which they had bottled up and saved up as resentments, without sharing them together, and which had seemed to be drawing them farther apart. This had a great deal of meaning to him, but he made one request. He wanted to talk it over with his wife and then he asked whether they could not come in together once to get started, and then go on separately. I said we did that sometimes, and if he and his wife were agreed that they wanted it, I would be glad to make that arrangement. When he left, he seemed much more at ease, said he felt a great deal better, but then wondered how he would feel on Friday when he had to go back to work and had to take over the information desk again. Would he get distressed again when he saw a girl? I said I really did not know. He might, or he might not—but I just could not feel that each one of these spots of disturbance could be the all-out of what was going to happen to him that he made of them. I think it was a real relief to him that I would not get involved in a longer discussion, or try to anticipate it with him. It seemed to leave him something to work on by himself. It is interesting that throughout the interview the only direct feeling

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of anger or resentment that he could express, other than against himself, was that which he could express against his wife. It seemed to me to be the symbol, not only of anger against her, but of some love and security, as well, that he could risk so much feeling against another person, in view of his pattern of denial of his negative feelings. 7-5-44: Mrs. G. called. She had been wanting to call for some time but she had been so busy taking care of the baby, taking her to and from the children's play group that she goes to, that it seems to occupy all of her time. However, she does want an appointment. She sounds rather calm and well controlled, and informs me that her husband has not suffered any recurrence of his attack. She wonders whether she should come in by herself, or whether they should come in together. I commented that I thought she knew that her husband had requested their coming in together. It is not essential, so far as I am concerned. However, I could not tell her which way to plan it. Is this something she could talk over with her husband, and when they have made a mutual decision, she could call me and I would plan to see them separately, or together. She felt she could do this. 7-7-44:

Mrs. G. called and said they would come in together on 7-13.

7-13-44: Mr. and Mrs. G. in the office together, promptly. Immediately I see that both are tense and upset. They want to come in together, yet it is hard for them to begin. After greeting them, I commented that this was different for all of us. We had never had a three-way talk before, and I thought that in spite of their having decided this way, they may be finding it extremely difficult. While Mr. G. tends to nod some agreement, Mrs. G. denies, almost belligerently, that she is in any way uncomfortable about it. This pattern is inherent throughout the interview. Whenever something in any way challenges how she feels, her response carries a note of belligerence. Mr. G. looks poorly, and rather hesitantly says that he had had another bad day yesterday. Then, both of them participating, describe to me what happened. The following description does not represent the sequence of the interview, but rather the sequence of events that they themselves felt led up to this crisis. Apparently they know of some couple who have just been divorced. The man had a heart condition, and the reason for the divorce was that they had an unsatisfactory sexual relationship, the woman never being satisfied by the man. Both go on to describe their problems about this. Mr. G. claims always to have been concerned that he is not satisfying his wife sexually. She, on the other hand, says that this is completely

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untrue. She finds the relationship very satisfying. They have talked it over many times, and she has told him this. Again there is a note of anger in her voice, and I sense her irritation and intolerance with many of his anxieties and fears. His concern about this is not new. There has been discussion ever since they were married. In their sexual relationships, he is aware that he is not impotent, by any means. The tendency, at first, is to put all of this on to Mr. G. I injected a question as to whether the problem rested only with him. At first, Mrs. G. would have it only that way, but then, when the question of her anxieties about pregnancy were raised, she could begin to leave at least a little room for some part of her own in the problem. At this point she tends to insist that the sexual experience, as a thing in itself, is complete and satisfying to her. The fear of its consequences never interfered with her pleasure of the moment. However, even as she says it, one senses a little awareness on her part, that this might be a factor, at least, in the part of the problem they are describing. In addition, there was discussion of the other problems, that have been previously described in the separate interviews. Throughout, Mrs. G. expresses some irritation with his concern about what other people are thinking, and in general, with many of his anxieties. There is a land of troubled "why should such petty things bother him so much?" They described an incident which occurred while they were riding on the train the other day. He saw somebody he thought he recognized, but he was not sure. It kept bothering him and he made mention of it many times to her. As she describes this to me, her voice is full of irritation and anxiety. Why should that bother him? If he thinks he knows her, say hello. Suppose he is wrong—so what? I said that I knew how provoking, for both of them, such situations could be. I was less concerned with the specific incident than I was aware of how something like that could become a real problem between them, and rather lightly commented to Mrs. G. that she herself seemed to me to be pretty much upset, in one sense, over the same petty incident, didn't she? This leaves her a little more thoughtful, and the ready, defiant expression on her lips is cut short. The thing which she describes as having been most upsetting to her is her husband's inability to share anything with her, and his complete self-absorption, so that at times he doesn't even hear her when the talks to him. He acknowledges that this happens. During all this time, Mr. G. is at first very defensive, saying that his concerns have been for his wife in sexual relations—but towards the end bf the interview, he expresses some of his own hostility by saying, "Do you see how hostile and angry she gets—well, that is what always happens between us." Very honestly, she is quick to admit that she is

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short-tempered, and she knows that it does contribute to their difficulties. I said that I had a feeling that each of them, in his own way, was disturbed with what was happening—and yet, in a sense, from what we were talking about today, I thought each was more or less convinced that it was the fault of the other person. Mr. G. was feeling that Mrs. G's ready temper and intolerance were the cause of their conflicts, and Mrs. G. was feeling that her husband's worrisome and anxious behavior was the cause of their difficulties. I wasn't sure, then, that we could be of very much help here because in my experience, sitting in judgment, and agreeing or disagreeing how wrong the marital partner's behavior was, would not help very much. It was a question of being able to take the risk of seeing whether each one on his own was in some measure contributing to the problem, and what might be done to modify that. They nodded recognition of their awareness that both of them felt that the other was to blame. Yet they were aware too that this feeling only deepened their problem. With earnestness each expressed a desire to go on to see whether somehow they could be helped to a more satisfactory life together. I said that this was the purpose of the interview, to see if both of them felt that the service the agency had for problems such as theirs was something they wanted to try, knowing the conditions under which the service was available. They entered fully into discussion of specific plans for their continuing. I explained that going on meant that each had to be ready to undertake a series of weekly appointments. Mr. and Mrs. G. expressed their readiness to do this, and spoke briefly of specific appointment hours. There was discussion, too, about the length of time we would go on. This grew naturally out of their planning to be able to make appointments—e. g., she would have to work out arrangements to have the child cared for, and he would have to make arrangements with his supervisor for the time. I explained that the agency could offer eight appointments to each (running between two and three months). It was our experience that it did take that much time if our help was to be effective. I wondered, since I knew how difficult it was for them to arrange the time, whether they felt able or ready to decide about going on now. They felt no need to delay the decision. Later ( 3 ) Mrs. G. Mr. G. had gotten up to leave as though it had been accepted between them that she would be the first to stay. There was a moment of quiet. Mrs. G. looked unhappy and troubled. Suddenly she burst into tears and said, "Please don't let me cry for these fifteen minutes. I have been crying for four years." I said I knew how miserable she felt, and that in a way I had added to her troubles. She had more or less hoped that I might, by some miracle, make things over for her, and instead, I participated in this experience which was so painful to her,

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rather than relieving. She is quick to acknowledge that she had hoped for a miracle, and yet she knows that that was really not possible. She says, "I have known that my hot temper makes some of these things happen, but I have been through so much." I said I thought she had, too, and I would wonder what keeps her going on. First she says that she loves him, and then adds with some of her former belligerence, "and don't ask me what love is." I smiled and said I guessed that was her way of telling me that it was quite different from what she had hoped it would be. She sighs, and says, "You know that I don't mean to be ungrateful—he was so much better during those few weeks after he saw you, almost better than ever before." I said that I could understand how that, in itself, could constitute a problem for her. It must feel as though she could never trust his really getting well, since periods of recurrence did seem to come. She acknowledges this and it leads to a long and full discussion of her bitterness and anger, and worry during the time of his analysis, when she felt so left out. He shared so little with her. He had the Doctor to talk to. The Doctor did not see her, and yet, as time went on, she felt as though she were going to burst. With some awareness, she adds, "feeling that way, myself, I could not have been of much help to him." I said I could not promise her that coming here would necessarily have a different result. On the other hand, we did see many families here and had been helpful to many, and unless there was this possibility, I would not have accepted their application today. I hoped this might be the beginning of a better life for them. W e arranged an appointment for the following week. Later (3) Mr. G. When Mr. G. came in, he seemed quite tense and his first words were that he felt pretty panicky. Then, without awaiting anything from me, he added that he felt it was because this was so much closer to the thing that worried him most, his life with his wife and child. He told me a little more about his concern about satisfying his wife sexually. He told me that this had been a worry from the first day of their marriage. I commented on the little reassurance he took out of his four years of actually having satisfied his wife. We talked about something we had mentioned last week—that is, how much of his worry for his wife was in part a cover for his anger at her for marring his own satisfaction with her periodic fears of pregnancy. This did have some meaning for him, since he introduced it at this point himself. However, in talking further, I asked whether he had any sexual relations prior to marriage, and he said he had had none, although, like any other young man, he had a great many desires. W e spoke of what it must have meant to him to live in a home with two women, his mother and his very attractive twenty-three year

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old sister. He acknowledged, a little fearfully and not very fully, that seeing his sister, particularly just partly clothed, so often, had been stimulating and had aroused a good deal of guilt in him. He tied this up with other attitudes and relationships about sex, all of which had been productive of some guilt—and with little help from me, he was able to tie it up to his relationship with his wife, recognizing that he carried some of his guilt over even to her, and that it has been a hampering factor for him. We considered what it would mean to him to have this experience of having his wife participate in the help that this agency offered. I thought he might be pretty concerned about her seeing me. At first he tends to shrug this off, but is able to acknowledge some worry in that he knows how readily he blames himself for many things, and is fearful of what people are saying about him—and here she will be coming in, certainly talking to me about him. I said I could tell him that as I pointed out to both of them together, I was less concerned with Tightness or wrongness on either of their parts, than in seeing whether they could use the help we offer to their advantage. But I knew that such reassurance might be of little help to him when he actually saw his wife coming to another man for these appointments. Although I could see that this was a troubling factor to him, I felt it was useful to consider that together. We arranged for an appointment for the following week. 7-17-44: ( 4 ) Mr. G. Mr. G. came in for his appointment. He is looking much better today and he comments on feeling ever so much better. He has been thinking a great deal about our discussion last time. The first part of the interview centers about a continued discussion of his sexual disturbance. He says he has never been fully free in discussing this with the Doctor, and I can see that he is pretty frightened about talking with me, too, but he does want to tell me this. He told me of his concern, during childhood, about masturbation. He had experienced parental threats and warnings of disaster (as their attempt to make him stop masturbating), but of course he had not been able to control it. He did not feel that his masturbation was excessive, but when he had mentioned this business of feeling guilty in the last interview, it had struck such a deep note for him, because that's what always happened to him. All the information he ever got he picked up in the typical back-alley ways, so that even when he was older and learned the facts about masturbation, e. g., that it was normal and not harmful, it relieved him very little. I said that I could see he still carried that feeling, even at this moment. I knew how burdened and dis-

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tressing it could be to carry that kind of a feeling all these years. I said I thought, in a little way, he was challenging me, since I had started him on this track, to find a way of relieving him of this guilt, since just knowing the facts apparently had not helped him. I said that I knew that frequently getting the real facts did not help one's feeling, since somehow just needing those facts made them, in a sense, as "dirty" and unaccountable as his feeling about sexual activity itself. He shook his head vigorously and said that somehow those facts were told in the same hushed whisper as were the original exchanges of the kids on sexual information. I wondered how this carried over into his life with his wife—and here in a rather embarrassed way, he told me that he does enjoy sexual relations, and his wife does, too. In the excitement of any one experience, he wanted to do what he knew other people did—that is, "try different ways"—and yet, in even suggesting this to his wife, he felt "dirty" and as though he was asking for something to which he was not entitled. Thus, when the first time his wife protested, he became completely suffused with guilt and felt miserable. I said I just would not fall into the trap of saying to him that his desires represented common and normal sex experience, since both of us knew that words alone somehow did not make things different enough for him so that they could change his feelings. At this point, he swings back, apparently quite relieved at having discussed this, and for a few minutes we have some practical discussion about the sex relationship—things that he did not altogether know. I wasn't sure as to how useful this would be to him, but he did ask specific questions and I did answer them. Particularly relieving to him was a discussion on postmarital masturbation. I had commented that it was not uncommon for young men to carry this practice on even after marriage. With great relief he acknowledged that he had done this too—quite infrequently—and yet it bothered him greatly. It was a relief to know that it wasn't unusual. He thought he was quite alone in it. He speaks feelingly of having felt guilty in relation to his wife for having any "need" at all for this masturbation, and tied it, too, as a possible reason for his fear about not "satisfying" her. When I said that it wasn't easy suddenly to stop this long established habit just because he was married, he agreed and added that it took a while to get secure in the heterosexual relationship. He doubted that he would have any further need for it now, however. I said I knew he wanted to be done with it, but I wasn't sure but that it might take a while yet. In a rather puzzled way, he says, "I have something to tell you. After my wife and I left you last week, at first we were pretty tense and almost did not know how to talk together. But then later, when

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this was eased, we felt closer together than we had in a long time and we had intercourse for the first time since 'the ban,' and both of us were more satisfied than we had ever been." He goes on to say that during the week he even spoke with his wife about many of the things he told me today; about his early childhood worries, his feeling of guilt and something of his feeling of how it had interfered with them. Instead of being belligerent and angry, she was very sympathetic and seemed so happy to be able to talk with him, that he found it relieving to talk with her. He says this tentatively, as though not wanting to be held for having really effected a certain change. I said it certainly did sound different from what they had been describing to me last week. He acknowledged that it was, but he was uncertain whether her receptivity and warmth were a real change in her, or whether it was a determined effort on her part, as a result of our getting together. I said I thought he was telling me that he could not trust what was new and satisfying, and I could certainly understand it. Nor did I feel, on my part, that things were solid between them, and therefore, I would not suggest that it was no longer necessary for him to come here. This is relieving to him, and we confirm that we will be going on, no matter what happens, with the amount of time that we have set. I said, lightly, that I saw that that was what he wanted today. Maybe, at a later point, he might want to pull out, and be annoyed with me if I held him to going on. He shifts, now, to another matter that they are a little troubled about. In order for his wife to make her appointments here, it is necessary for her mother to take care of their baby, and they have been talking about what they could possibly tell her mother as the reason for this regular need of her. He is quite troubled, and wonders whether I think it would be best to tell her the truth. I said perhaps I could give them an answer, and they could hold me responsible for whatever happens, but I wondered whether this problem was not typical of their reason for coming here, that is, their inability to come to a mutual decision that might represent some giving in on each of their parts. He acknowledges that this is so, and says that he will talk it over further with his wife. His wife and his mother-in-law have such a close relationship that it might even be good for her to have somebody to talk with. I laughed and said—"instead of me?" No, he did not mean that. He knows how bottled up she had been, all of last year—how painful that could be. I said here he was, being so concerned about his wife again. I wondered about his own feeling in letting anybody else know about something that he felt reflected on him (his illness), and he acknowledged that that has been his primary concern. How could he come into their home

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again (in-laws)—what would they think of him? I said I thought it was a difficult decision to make. I could not know just what they would think of him, but I could tell him that if he had some concern lest I might think less of him because of some of the things we had spoken of today, that certainly wasn't so. Earlier in the interview, in telling me that he felt much better today, he said "of course some of my symptoms continue, b u t I know that it does not mean anything. They are not important." I said that I was not so sure of that, since it was his symptoms that caused him so much discomfort and distress. I thought they were pretty important. I knew, in one sense, that he was telling me something that he had learned about himself—namely, that if he could overcome some of the things that caused his disturbance, his symptoms might disappear. But I thought that on the other hand, he was tending to save them as a kind of "ace in the hole," so that he could perhaps hold on to his sickness so that no one, including himself, could expect too much change on his part, and perhaps this was his way of telling me that. At this point, Mr. G. made little protest and seemed to be quite aware of what I meant. W i t h some relief, he said, "I would be glad to get rid of them, and not feel that I am not supposed to worry about them." In general, he was calmer today and more related to continuing in this relationship that saw him and his illness as something important, b u t as only part of the basis for his coming here, since the agency had responsibility to his wife as well as to him, and our interest in relating his problems in turn to the problems that existed between him and his wife. 7-20-44: (4) Mrs. G. Mrs. G. called for her appointment. There is a considerable change in her attitude today. She seems calm and more at peace with herself. When I commented on this, jokingly she answered that it was "the lull after the storm." She tells me that her husband has been well during the week and things between them have been much better. I commented that while I sensed she was pleased with this, she was somewhat uncertain and distrustful, too. She agrees that it is so hard for her to know what she can count on as change in him. However, no sooner had she said this, than with a great deal of satisfaction she tells me of a specific instance which occurred during the course of this week, which she felt exemplified real progress between them. He had promised to do something for a friend, and it coincided with the only time that she and he could go to visit a sick and favorite relative. She felt that it would be natural and simple for

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him to call his friend, explain, and then make other arrangements for another time. However, his fear of incurring disfavor with his friends was something to contend with, and he was fearful about calling him up. With real understanding, she says that the situation had all the elements of one of their typical conflicts, wherein each would feel hurt, fight, and withdraw. With pride, she tells me that it really worked out differently, and she describes her own behavior which, in effect, was a kind of yielding to her awareness of the problem he was having. Instead of creating an either-or situation, she went along with him in seeing what arrangements they could make. This resulted in his returning later in the day, after work, to let her know that on his own he had called his friend, made another arrangement and was free to go with her. I said I could see how happy she was, and I teased a little, saying that in a sense she got her own way in the end. Seriously, she said, the thing she had wanted him to do was a justifiable one, but what was different was that for the first time she could understand that he wasn't fighting her because he did not think it was right, but because he just did not know how to go about getting himself to do it. Just knowing that, seemed to be a help to her. This discussion led to further consideration of situations between them that create problems. The balance of the hour centered around a discussion of their respective relations to Mr. G's mother. Apparently Mr. G. is not very thoughtful about visiting or calling his mother, and Mrs. G. is forever reminding him of this responsibility and speaking with some annoyance at his inability to assume it. This sounds as if she, alone, is feeling the family responsibility. However, with a little help from me, she expresses a great deal of hostility toward his mother. His mother never knew of his illness, of the expense of long psychiatric treatment, etc., but she always nagged about how poorly he looked, or the fact that they seemed too cautious in buying clothes, etc., implying that the fault was all Mrs. G's. I said I knew what an unhappy situation that created for her, and how angry she must become. I just wondered, then, why she insisted that her husband, on his part, be so responsible to his mother. She is puzzled, goes through the motions of detaching all of her feeling from the relationship as it really is, putting it purely on the ethical implications of a child's responsibility for his parent. And yet, she is obviously dissatisfied with this, herself. Then, with some hostility, she bursts out that she wishes that her husband would tell his mother the facts of what they have been through and make her feel a little badly, too. I said I could certainly understand her wanting to get back at any one who implied that she was responsible for all that had happened. After a moment's pause, she begins to talk reflectively about how

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persistently she has nagged her husband to call or visit. Well, it's produced no results in so far as his actually carrying the responsibility himself. It has, at the same time, been a continuous element of irritation between them. She talks now of letting him alone. It is his mother, after all, and if, out of his own feeling, he does not find it necessary, then why should she press him? Maybe if she would let up he might even do it by himself. I could see that she was thinking of doing things a little differently, and I knew that took an awful lot. Sometimes, much as we wanted to change a certain way of doing something, we found that just deciding it didn't necessarily carry it through. Oh, she says, she knows that about herself well enough—and again, reflectively, "but I never thought about that in relation to the troubles we have had about my mother-in-law. I felt so 'righteous' about what I was doing that I never realized that there was any question about it." We reached the end of the hour. She has a tendency to hold on and linger, and I said I was sorry that here I had led her to talking about such important things in her life, and then, the end of the hour came, and I seemed arbitrarily to cut off what we were talking about. I thought it might make her angry, and perhaps even disturb her and make her distrust my interest. She acknowledges—not the negative feelings—but her sense of irritation in not being able to talk more. We confirm our appointment for next week. 7-24—44: (5) Mr. G. Mr. G. was in about a half hour early. He told the secretary that he knew he was too early, but he would wait for me. Since I had a previous appointment, I had to keep him waiting until the time of his appointment. After our greeting, he discounts any discomfort of having been kept waiting. He explains that he had the day off and thought maybe if he came a little earlier, and I could see him, he would leave a little sooner. I didn't do too much with this, except to say that perhaps another time he could call me in advance and if I possibly could, I'd be glad to see him sooner. He begins to talk in an almost narrative fashion. He tells me that things have been going along quite differently than before. Some things are much better, especially between his wife and himself. They seem to be able to share more and have more to talk about together. He assures me, however, that some things are not so "hot." He tells me, again, of some of the discomforts at his place of work, repeating what we knew earlier about the tensions that various relationships cause him. There is an unsure kind of rambling in his discussion today, and a skipping from one subject to another. He tells me again the story about his card-playing sessions. It's very interesting, however, that while he

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thinks he is repeating the story to me, a new factor entered into it. He tells me about his fear of making mistakes and being chastised; his unhappiness at having a number of observers at the game, all of which makes him more nervous. However, whereas last time, the story ended with his conflict and not knowing how he could tell his partner that he did not want to play any more, today he tells me how he plays cards because he used to enjoy it so much. Then, almost with a little defiance, he adds, "in spite of everything, I still enjoy it and get a kick out of it." He discusses the last time he played, wherein in spite of an error that he made in the beginning, he was able to keep going and then finish the afternoon winning. He got a great deal of pleasure out of that. He is quick to let me know, however, that when he sits down the next time, he will still be uneasy and fearful. I said it seemed that today he felt both ways—both a sense of pleasure in wanting to play, and on the other hand, still some fear and a wish to pull out. He acknowledges this, but the emphasis seems to be on his acceptance that he will continue to play with the other men. I commented on the fact that there was something about today's appointment that reminded me of our first one. We were talking about so many of the same things, whereas the last few times, we had tended to talk principally about what was happening to him and his wife. This precipitates some uncertainty on his part. On the one hand he implies that things are so much better between them, and yet, he talks about having these other experiences which bother him. I thought that it might be disconcerting for him to have me bring in the question of his wife in this way. He doesn't react to this directly, talks vaguely about his wish that he could feel more secure and then says that maybe when he does feel fully secure in his own home, that will help him in other relationships. I said that I thought that while he offered this in good faith, he isn't too sure of that himself. He acknowledges this in part and then with more conviction adds that he does feel that if he could really feel sure of himself in any one place, it would "add to his own comfort." This brings us to a discussion of our own relationship. He talks of some feeling that he has about what I might be thinking of him and his insecurity about that. He says that he did protect himself against that feeling by really knowing that this was professional and that I understood him. He knew that, because it was helpful to him to come here. However, having expressed this, he is able to express some of his negative feeling by saying that at times he feels so inferior, in comparing himself to me, since I seemed to be so free of the land of worries that he has. I say I know how disturbing such a feeling can

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be, it must make it a trial for him to come here. He denies this, comments on the help that he and his wife already have gotten as the thing which brings him back. We talk further about the way he feels and thinks of himself. I say I think he feels unique—as though he were different not only from me, but most people. He acknowledges that it is so, and gives a number of illustrations. I say that it is natural that he be preoccupied with his own difficulties and situations, but I wonder whether he is aware that some of the feelings that he described to me are typical for most people. I thought that one of his differences from others is that he invests so much more into every little experience that it makes him feel as though all of life depends on how he behaves in a card game, or a political argument, etc. He follows this up eagerly. He is anxious to feel like other people and talks animatedly with real understanding of the things we were discussing. There are two incidents that he mentioned today that I didn't record in their proper sequence, but that are significant. In talking about his wife, he spoke again of their increasing sexual satisfaction, and then mentioned that during the week, after they had had sexual intercourse one night, he just couldn't control the impulse to ask again whether she had been satisfied, describing this as a little worry he had in the back of his head. He said he knew it would irritate her, and it did, breaking up some of the pleasure for her in the experience. In part, he describes this as a greater freedom that he feels in sharing his feelings with her. On the other hand, there is a kind of bad boy defiance about this, as he describes it to me. I said he did not sound very worried about whether he had satisfied her or not. As though he is surprised by this, he acknowledges that now that he thinks of it, it is so. I wondered then if part of this might not come from something a little different. I wondered if he didn't want to succeed in irritating his wife, since he acknowledges that he knew that that is what would happen. After a considerable pause, he ties this up to our previous discussion, saying that perhaps this is a way that he has of expressing some of his own hostile feelings when up until now he has been so sure that he never does. With some insight, he says, "I guess love and hate are pretty close together, aren't they." He adds that he is aware that in doing this, he spoils his own pleasure, too. The second incident which he describes goes back to the card game. With real relish, he says that it may seem funny to me, but he almost hopes, as they play, that his partner will make a mistake so that he "can bawl hell out of him." Although he wants to win, sometimes he

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would just as soon lose, as long as it is his partner's error. This was something he could never previously express. Just before leaving, Mr. G. tells me of a very sad instance where a close friend had been killed in action in France. It is interesting to note that although he is extremely unhappy and concerned about his friend's wife, the experience does not throw him into the kind of anxiety attack that it would most certainly have done some weeks ago. One of his major conflicts that he has had over the past year was due to his guilt for being out of the army and yet being so completely identified with the war. Some of his previous crises grew out of the contradiction of pressing other peole to be more conscious of the war effort and yet not volunteering himself. We don't discuss this today, although by inference he expresses some feeling of difference in himself in the way he described to me. 7-27-44: (5) Mrs. G. Mrs. G. greets me in a friendly fashion. The first few moments of the interview are taken up with a kind of casual getting settled; she talks about the weather, etc. Then she tells me that this week has been a good week. She is so much happier because her husband shares so much more with her. That is something new, and something she has always wanted very much. Her first impulse is to put it on to, "He's different." Then, with a little laugh, she says— "but I am different, too. I am really able to control myself better, and we have not had a temper fight in a long time." I say it sounds as though it was more satisfying for her and I could see that she was trying in her way to share some of the burden of working things out between them. I knew that it was not easy to control an outburst of feeling and it might even be that she would give in to it again, and I was not sure that that had to prove that both of their efforts were for nothing. There is some relief on her part in this, and I said I thought that she almost came to tell me, as though I were her teacher or her probation officer that she had been on good behavior. Did she really feel, each time that she came here, that I was all set to criticize her. Thoughtfully she says, "No. It's not so much you—it's my own feeling of self-criticism." Mrs. G. says that during the week she has been thinking of something we had spoken of several times and she is anxious to talk with me about it because she wishes something could happen to make it different. That is the question of her fear of pregnancy. She says that when she is delayed in her menstrual period, she does become extremely upset. Partly she knows why it has played such a significant part in her life. She remembers that as a child, and as a growing young

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woman, in her own home her mother suffered similar fears. She knows that contraceptive methods are much more effective today, and yet she does have this sense of worry. She wants to reassure me that she is trying to control it in relation to her husband, so as not to upset him, but it is something that troubles her deeply. I say I can sense that the experience does trouble her and she is also unhappy that she is the kind of person who is bothered by it. She agrees strongly. Her mother always urges her to be more carefree, like her older sister. But, she says, "it is not in my personality." I said it sounded to me as though she were saying that, not only in relation to pregnancy, but in many ways she is a person who has to do a lot of worrying about what might happen. Yes, she acknowledges, she always has. She pauses and says, "I was miserable when I became pregnant—not so much because of the pregnancy itself, but because it happened to me unexpectedly. I did not choose it. I love the baby and I got used to having a baby, but the upsetting feeling is in having no control over what happens to me." With some help on my part she talks more about this feeling. It was true of the job she had had. It was true of many things that happened while she was still a child at home, and she talks of having played second fiddle at home, although she knew her parents loved her, but she had always been second to her sister and had had to take, more or less, what was left over ( emotionally ). As she describes this, she is aware that, factually, it's not altogether so. She was the one who got the education and her sister had to work. Yet, that's the way it had felt to her. I said that it seemed as though for a long time she had been waiting for something completely her own and something she could count on. With a sigh, she acknowledges that this has been missing in her life. I wondered how this ties up with her marriage. She tells me that although they had known each other for years as children, actually they had a brief courtship. She didn't know many of the things about her husband that she subsequently discovered. As she thinks of it, in the light of what we talk about, she says she realized that she wanted marriage to fill that feeling of emptiness for her; to put something safe and secure into her life, which she herself had chosen, and in which she came first. I say that it hasn't worked out that way for her. She acknowledges this to be so. Instead of finding someone on whom she could lean, she was again forced to be more grown up than she felt, and in effect, to be the person leaned on. As she thinks of it, she says that she has probably been revolting right along and "taking it out in my own little way." I said I thought it was hard to be a mother to a child and a wife to a person who needed her in the way she describes that her husband does, when

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she, herself, is yearning to be free of responsibility and to have somebody else care for her. After a pause she says, "I'd like it, I think, but I am not sure, now. I'd like to do my part, if only I did not have to do so much for both of us." There is a quiet strength in this, which feels to me as though she is differentiating between a residual, never fulfilled wish, and her readiness, at this point, for a more mature role, even if that earlier wish remains unfulfilled in its entirety. In the course of this discussion, linking it back to her feeling that she is not the kind of a person who can be carefree, and does tend to worry and plan for tomorrow, a pattern begins to emerge in which, whenever something good and satisfying does occur, it carries with it an almost superstitious fear that it won't work out. She describes a full measure of satisfaction in her sexual experience, and yet, the fear of pregnancy that tends to disturb it. She describes other experiences that are promising and which she enjoys, always marred by the fear that they won't work out. When I comment that it seems that she can't trust that something good will really happen and stay, and that she seems to protect herself with this kind of fear, so that she can say to herself—"I told you so"—she laughs and says, "that's me." Suddenly she says that it's not really just being afraid of being pregnant, is it? "It's as though I am afraid of the future." I said that's the way it must feel to her, and I guessed, in a way, she must have that feeling about coming here, too. She thinks a moment and says, "I have confidence in coming here. I never felt as confident that my husband could get well as I have these past few weeks." At this point, this seems as much as she can carry, and she turns to a discussion of her child. With exasperation, she says—"What do you do with a child who whines and cries all the time? She is going to be two next month. She gets up at five in the morning and she makes a lot of noise, and of course some neighbors complain. No matter what I do, she seems to contìnue making noise or crying unreasonably." I say that I can see that it seems to take everything out of her. She nods that it does, and she knows how wrong it is, but she's wound up by slapping her, or by threatening that a neighbor was going to scold her. I say that I know that in exasperation one sometimes tries almost anything. I wonder why she is dissatisfied with this treatment of the problem, since it seems to have some results. She says she does not want the child to grow up fearful of other people, and so should not threaten her in that way, and slapping her seems to produce the need for more slapping, and she just can not continue it. And—I add—"nor can you stop it." She says, plaintively, "if only I knew what else to do." I say I thinlc, in a way, I

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am going to disappoint her, the way I did the first time we met, since I did not think any trick or formula could produce the miracle that would change things overnight. She says that she is getting to know that; she continues to be very thoughtful about what she can possibly do. I say I am little concerned lest she find that for a while nothing will make it different, because I know that some children go through that kind of behavior in growing up. She says, "I know that in part it is a question of patience. It's as though I can't see past this stage of her development." I say it isn't uncommon for a worried parent to feel that a particular problem may just go on forever. She tells me now that her husband is concerned that the baby is a little cowardly in relation to other children or grownups. The balance shifts now, and she begins to explain how silly this is, and with a great deal of feeling she tells how bright the child is, how far advanced over other children of her age, and gives many examples of her advancement both in talking and motor coordination, etc. ( which do sound advanced). She describes this with pride and pleasure. I say I guess there is some satisfaction for her, along with the headaches. "Oh, yes," she acknowledges, "there are many times when she is a real joy to both of us." But she is pleased that her husband (who never lost his temper with the child) for the first time acknowledged—after he spent a day with the baby alone—that she was entitled to the exasperation which she feels with her at times. I say I think it is a relief to know that she is not the only one who feels that way. I guess that she is telling me, too, that if I had to spend the whole day with the little one, I'd know better what she meant—and I don't doubt it. We laugh, and she says—"but she is so sweet." During the time that she talked of wanting somehow to control the things that happen to her in life, she mentioned again her wish to work. However, at this point, she wants to wait. She feels that if her husband really gets better, then they'd both know a little more surely how they want to plan. I wonder that she can risk putting off something which would give her satisfaction (work) against so much uncertainty, and then, quietly and with sincerity, she says "but both my husband and child give me satisfaction, too. I'd like to get our family life straightened out a little more before I consider work further." 7-31-44: (6) Mr. G. Before describing the content of this interview with Mr. G., I should like to mention an important element of the last interview, which I failed to record. Mr. G. was describing to me the intensity of his feeling at one point, when he felt that he really had come to some understanding of something that was bothering him a

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great deal. He just couldn't wait to get to my office. He told me that he described it to his wife as "bursting to talk" with me. Then, he added, with a combination of satisfaction and real concern, "that's the trouble with all this psychoanalysis. I'm not sure what really belongs to me, or what I have to bring to you, and how much I feel that I have to keep running to somebody for them to explain things to me." I said I thought he was telling me that in a way he had come to this deeper and relieving understanding by himself and that he was not sure that he wanted to make me responsible for it. I added that I guessed that one of the differences between his earlier experiences and this is that this is not a psychoanalysis. I wonder if he recalls that at the time that he and his wife decided that they wanted to try our help, I explained that the agency could offer him a limited amount of time. I guessed if he were to make use of that time, he'd really have to feel that he could carry within himself the things which he achieved since I would not be available indefinitely for him. This whole discussion had a great deal of meaning for him and the discussion of time, which he had obviously precipitated, did not seem a restricting or threatening factor to him, but rather a confirmation of something he was seeking. In today's interview, there is a considerable change in Mr. G.'s general demeanor. In contrast with earlier appointments, he seems at pase, even as he describes some conflict situations. I comment on this, and he acknowledges he is feeling better, but again reminds me that while at home things are really "smooth" (this with genuine satisfaction) in the job he still is very uncomfortable. One point emerges through today's discussion—namely, that he is aware of a strong tendency to put off things which he does not like to do and generally he feels quite guilty for it. While at first he puts it on to relationships outside the family, e. g., he tries very much to avoid certain parts of his job, or carrying out certain necessary responsibilities, I help him to identify similar situations within the home. He describes one situation, and it is interesting that he tells this with a quality of humor rather than anxiety. He has certain chores in the house for which he is responsible in order to help his wife. He hates doing them and usually keeps putting them off until the pressure from his wife makes it impossible to hold out any longer. He describes certain situations to illustrate. While he is annoyed at his wife for pressing him, at the same time he feels that he is by no means asked to do an unfair share. I say that I know this can be an uncomfortable situation for him, as well as between his wife and himself, and yet I notice that it does not upset him too much. I think perhaps he has worked this out in the way that satisfies him. Since he does not like the chores and he does not

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like the nagging he waits until the discomfort from his wife is greater than the discomfort of doing the chores. In a little way it might give him some satisfaction to trade doing an irritating job by doing a little irritating of his wife. Mr. G. responds thoughtfully—he never thought of it that way, and yet it does describe just what he does—and with some relief—even to the fact of irritating his wife. He ties this to our earlier discussion, in which he expresses some negative feeling toward his wife indirectly by insisting on asking her whether she had achieved satisfaction in a sexual experience, even though he knew she had, and really was not concerned about the factual answer. With warmth, he affirms real love for his wife and says that though she has a way of irritating him, he is annoyed with getting back at her in these "underhand ways." He doesn't think he has to, any more. He feels sufficiently safe and comfortable to talk directly with her about difficulties, and he knows, too, that things can't always go entirely smoothly between them, since he has seen other married couples who have their difficulties, too. I say I think he is telling me that he is really getting ready to manage his life with his wife pretty much by himself. He nods, but then strongly reminds me that he is not finished and he needs the time left here. It is interesting that he describes the difference which he feels in himself as that of being more "spontaneous." He says things to people without measuring every syllable. Toward the end of the hour, apparently out of no special thing that we have been talking about, he tells me that he has been concerned about earning some additional money. There is some confusion as he presents this, putting some responsibility on to his wife for being so concerned about money, but then adding with sincerity—"but I know, too, that a family like ours needs some extra money." I say that for a person who has been so worried about himself, I thought it was a lot for him to think of the rest of the family in a way that implied even more pressure on him. His ambivalence comes out when he tells me how hard his job is, the peculiar hours, etc. However, a week or so ago, on his own, without even telling his wife, he arranged to do certain overtime work. He was very fearful of doing it. He has not been very well. ( This has occurred in our discussion from time to time. ) He has lost a great deal of weight and people are always commenting on it, which he finds disconcerting. The job didn't pay very much, either. However, he found that it didn't take too much out of him and he was very pleased with the thought of having done it. With some resentment, he tells me that when he got home and told his wife, instead of being grateful her reaction was to become a little upset and say that she did not think that he ought to do it in the hot summer weather;

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that it should wait until the fall. I said I could see how disappointing that was for him since, in a way, he was bringing this home to her, not only as an achievement of his own, but as something that he thought would give her great pleasure. He nods, but then tells me that he thinks she might well have been right, if only she would not have said it, but waited a couple of times to let him find out and then put it off until the fall. I say that in a measure he sounds as though he was in some agreement with his wife that it might be too much for him now. He laughs and says, "I guess nothing she would have said would have been right. If she were too happy, I'm afraid I would have been a little annoyed that she did not think of my health. Maybe it's because I'm not so sure myself." I say I think, too, that when he is more certain of what he wants and feels able to do, he will be in a better position to know how he'd like his wife to react. With some conviction he says, "But I think I will do it again, surely in the fall, if not sooner." I comment again on how much he's done, even if this first effort has so many uncertainties for him. One additional thing that is significant is the existence of some differentiation between a real dislike of his job because of its lack of satisfactions, and taking complete responsibility onto himself by implying that his discomforts and tensions are exclusively signs of illness. In discussing this, he tells me with much relief that many of the fellows "down there" hate the job, too. I say I guess in a way it is a kind of hardship to decide whether he was like the other fellows in disliking the job, or whether he would always have to look at himself as different from the other fellows. He seems to make good use of this by simply repeating again some of the common distastes the men share. We discuss briefly the fact that I will be on vacation for two weeks. He denies any resentment and says he thinks it may be useful since it will give him a chance to try being on his own for a few weeks. We plan our next appointment for the 21st. 8-3-44: (6) Mrs. G. Today's interview is marked particularly by a general peacefulness and an apparently growing sense of security "that things will be all right." Mrs. G. gives many details of incidents that happened to her husband and herself during the week. However, the dominant note is not that of the earlier feeling of frustration, but rather some demonstration that she can handle things between them better. When I comment on this, her first impulse is to put it onto differences in him. I say that I think it is a little easier for her to think of it in those terms. She laughs and says she knows that there are real differences in herself, too. To illustrate this she tells me of an experience that obviously has far-reaching meaning for her. She and a

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few close women friends were having lunch together at her house. A not unfamiliar topic of conversation came up when one of her friends began to tease her that she had been "caught" with Betty; that is, the child was an unwanted one. She says that quite easily, and without thinking, she laughed when it was mentioned and acknowledged that it was so. After they left, the experience just left her until later, when she realized that usually when this had been thrown at her before, she would become almost hysterically upset, could not wait for her friends to leave, and then would have a "crying jag." Somehow it was so different this time, that it took the "wind out of the sails" for her friends and they teased her very little before dropping the subject. She does not know quite why she felt so differently, but she knows that it is a vital difference and that it comes from her experience here. I say it certainly sounds to me as though she is less troubled by what went into having the baby, and more ready to let her be here. She laughs and acknowledges that she does not find herself getting all tangled up "in the whys and wherefores of things," but rather is more able to take things as they come. This leads her back to some discussion about her husband and she begins to tell me that he does seem quite different, too. She describes an experience which both of them felt was very amusing and which demonstrates that he is less plagued by and fearful of relationships with people, and more "spontaneous." Apparently he was in the lavatory at his place of work and he saw a co-worker spending a great deal of time grooming himself, particularly combing and recombing his hair. Apparently her husband watched for a moment and said, "You're a pretty boy." She says her husband giggled all night in repeating the story and both of them knew that earlier he would have died a thousand deaths rather than risk anything that might antagonize anyone. Toward the end of the hour, when I comment on the general feeling of this interview that seems to imply things are so much better, and that it might be getting to be something of a burden for her to come here, she denies this and affirms her feeling that it has been and is so helpful to both of them that she looks forward to her interviews here. When I mention that I was going to be away on vacation for two weeks, and question whether she may not be annoyed with my breaking up her schedule, she said—"Oh, I can wait—if it happened a few weeks ago, I would have been very afraid, but both of us have confidence now." The one note of uncertainty throughout the whole hour is her question whether now that things are much better between them, will he ever be equally comfortable and sure of himself outside

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the family? I say that I know that this is terribly important for her, because so many of the things that she wants are dependent on his success in work. I can not guarantee that this will happen. On the other hand, when we started together I told them both that I had no way of knowing whether this experience would be of any help for them in relation to their immediate life together, and yet, at this point, she feels that it has made a difference. She nods, doesn't seem to seek reassurance for the sake of reassurance and adds, thoughtfully, "maybe I will be more helpful to him now, even with the things outside our own relationship. One thing I have learned is that sometimes I help him better by not telling him the 'right' thing to do as I used to." 8-14-44: I wrote Mrs. G. to let her know that I could not be in the office on the morning of the 21st., but offered her an appointment in the afternoon of that day. I knew that it was almost impossible for her to arrange for the baby's care in the afternoon, but I suggested an alternate time in the event she can manage it. 8-21—44: Mrs. G. telephones to say that it is impossible for her to make an appointment in the afternoon. However, her husband plans to keep his appointment. She was warm and friendly, and says she looks forward to her next appointment; asks about my vacation. She says that things have gone well with them. 8-21-44: Later ( 7 ) Mr. G. Mr. G. is friendly, and asks about my vacation and says that everything was all right with him, too. Then, with conviction, as though moving away from a casual comment to one that has much meaning for him he adds, "Yes, things are going awfully well." He does not know how to describe the difference between his wife and himself, but, in a nutshell, they are happy. He had always hoped to find that look of confidence and respect in her eyes that most husbands want and which, for some reason, he had never found until now. He feels that she accepts him and even looks up to him. I say that from the way he describes this I can sense how important it is to him. He agrees, adding that in some measure it lightens things for him on the outside. His tendency is to recapitulate the change in their relationship. They talk to each other; they share problems. He knows comfortably within himself that both his and her sex experiences are extremely satisfying, much more so than previously, and they can work together better with any problems about Betty. With humor he adds, "I never have to ask her any more whether or not she has been satisfied."

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He adds, too, that he feels better himself. He eats and sleeps better and has become heavier. With this he tends to move away from his relationship with his wife, almost as though this is finished. He begins to describe numbers of situations about his relationships where he works. He tells me, with much pleasure, how he has found himself doing things much more easily and without such intense selfconsciousness and planning. He describes the "kick" he got out of one of the card sessions there, when he found himself "bawling hell out of his partner" for some error he made. He says that he was annoyed and without thought or anxiety he just expressed his annoyance. As he continues to discuss a more confident use of himself, but still mentions real dissatisfaction about the whole job, I wonder whether he is not beginning to question more seriously than before whether some of his conflict now might not really be due to the fact that he dislikes his job, rather than to his previous tendency to blame himself and his illness for anything that went wrong. He reacts to this thoughtfully, relating it to our earlier discussion along these lines and then speaks more fully of how much he hates his job, what little satisfaction there is in it for him, and how any person in the place with any education is just as miserable as he is. He talks more slowly now and more cautiously. I say it is a big risk even to think of shifting the emphasis from his illness to his job, since it tends to take away a long-standing safeguard and put him in the position of facing what he wants to do about his job more squarely. He nods, seems clear as to what I mean, and says that he has been growing convinced that he feels different; that many of his complaints are justifiable, but unlike other people, he has never dared to think directly about what he would do about a different job. He has been there for many years; as a civil service employee he has a kind of security which up until now he needed more than anything else. While he did plenty of "grousing" he never had any conviction that he could or would attempt to change things. I say that perhaps in one way coming here has helped relieve him of one big problem, but faces him with another. He says it is not a new problem, it is just that he feels more willing to look at it. Then, gathering some momentum, he goes on to talk of what he might have been had he completed school, and then moves toward what he still might do. There is a thoughtfulness and a lack of anxiety that dominate all the discussion. One wish that he has now, and it is something that from time to time he has thought of fleetingly, is that he go into business for himself. He elaborates the attractiveness of "being his own boss." I said that from the way he describes it, it sounds to me as though

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he might be talking about more than his desire to do something different about his work problem. I have the feeling that he is getting ready to take over and manage his own affairs. Without anxiety, he nods his head and says that it really has been a long time since he was his own boss in that sense, and he is looking forward to doing things by himself and trusting his own judgments. We relate this to the fact that we have only a few more appointments left. With sincerity he says he knows that so much has changed between his wife and himself, that while he wonders and is not without some concern about how he will feel about not continuing here, he feels extremely secure about his married life. 8-28-44: (7) Mrs. G. Mrs. G. greets me warmly. We talk first about the long gap since our last appointment. Comfortably she tells me, "this family is going to be O.K." It is interesting that she has a new hair setting, and when I comment on it, she says it is just an experiment. She knows she wants her hair done differently, but she is not altogether sure of this style. Lightly I say that from what she tells me, a number of things are different for her. She nods and says that this few weeks' trial of being on their own (without appointments) have convinced her that she can handle her part in their relationship pretty much on her own. I say that she seems to be telling me that she is just about ready to go on without me. Again she nods agreement and says that while it is almost a mystery to her how she feels so differently within a few months, she knows that she is different. It is interesting that for the first time she puts the major emphasis on herself, rather than onto her husband. When I comment on this she says she wants to tell me of an incident that occurred during the last few weeks that settled for her that there really is a difference in her, as well as in her husband. The first week of my vacation, she was very grateful to me that I had forewarned her that not having an appointment, on the regular basis, might produce a little upset for them. During that week, Mr. G. had had a very distressing day at work. He shared with her fully, when he came home, and she knew that this was helpful to him, but she also knew that it was still on his mind. At about four in the morning, when he usually gets up for work, he told her that he had not slept well and he planned not to work that day. She was too sleepy to react at the time, but as the day wore on, she could see how restless and uncomfortable he was with this decision. He fidgeted and "mooned" around the house. She got herself busy with her own "routine," and for an hour or so completely ignored him. She was annoyed at his having stayed home in this way and she felt some resent-

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ment. Suddenly she realized that although she was pretending to be busy, actually she was using this as a way of punishing him and letting him "stew in his own juice." When she became aware of what she was doing, she dropped everything and went in to talk with him, not about the particular situation, but just to be with him. She said that this was so different from their usual pattern—namely, a dead silence which would grow ominously through the day, and by nighttime, usually wound up with a miserable argument. Mr. G. was so appreciative of her difference in this situation, that he admitted to her how sorry he was that he had not gone in to work; that while he had a desire to stay away from the uncomfortable situation at work, there was not nearly the panicky feeling he used to have. He was sure he could have gone to work without very much difficulty—and with a conviction that she felt she was sure she could trust, she said that he would never again have to do that. When she finishes relating this story, she leans back, literally beaming, and comments that "for once I did not fool myself about my 'selfrighteousness/ and I feel pretty sure that I won't have to again." She went on to talk about how well she gets on with her husband and how much more peaceful she is in handling the child, in accepting her as she is, rather than worrying that everything might be a symptom of something wrong—e. g., frequent crying, etc. She said that "although I know that we are not ready yet, I don't think I'd ever again be so upset if I were to become pregnant. Somehow I don't get as worried about being pregnant as I used to." I tell her that I feel, too, that she has a right to feel more secure about her part in the relationship, and while I know that it would be inevitable that from time to time they will have difficulties, I think, too, that it looks as though they can take them on, much as other people can. I relate our discussion today to the fact that we have but one more appointment. She comments that while in the beginning we were talking about how long she would be coming here, she really did not see how a situation which was of so many years' standing could grow appreciably different in two months; today she really knows that she has achieved what she wanted, and she feels certain that she will be ready to say good-by after our next meeting. She honestly does not know what there would be to talk about, if it were to keep on much longer. Although things happen, she can handle them. She adds, too, that her husband, quite on his own, had a talk with his mother, told her "everything," and since then she has been much more considerate of Mrs. G. She apologized for having been such a problem to Mrs. G. all of last year, and all three are getting along better now. W e con-

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firmed our next appointment, again two weeks off, because of the intervening Labor Day holiday. 8-28-44: (8) Mr. G. Mr. G. eximes in a little late today; he has a very preoccupied look, and from the way he picks up the discussion, it is almost as though he has not stopped thinking about our last discussion. He starts by saying, "I have been thinking and thinking about the things we talked about, and it has really got me worried." I say that for a person who was supposed to be helping him, I seemed to be giving him plenty of heartaches. He grins and says, "What I haven't got, you can't give me." He has been thinking about job change. He has come to a fundamental decision. He wants to make a change. He is really frightened of this decision, but as he describes it, the fear is that which any man faced with making a change, after having been in one place for so many years, would have. I say that for a "frightened" person, he did not sound so very upset! He elaborates on what he means. Inside himself, he had long ago agreed to two contradictory things—1, that he hates his job;—2, that he would never leave it. Our talking together of the things that had happened between his wife and himself have broken the stalemate. He wants to go to something that will give him a better livelihood, so that they can have more comforts, and he will have something of greater interest. But now that he has made the decision, he wants to get started quickly. He is worried for fear that he may not get what he wants, or that he may not be able to carry things out. I say I can understand the restless and uncertain feeling he was describing. Since, in a way, he holds me partly responsible for his new decision, he may feel that I am not being very helpful in what I say next. I think it is a great deal for him to make such an important decision; that it means involving risk in taking on so many new responsibilities. And yet, for my part, I do not know that he can realize all of his ambitions, nor would his inability to achieve what he now wants in any way lessen my conviction that he is as different as he seems to feel himself to be. Certainly I hope that he will achieve what he wants, but I am wondering whether the things that we are talking about today aren't moving beyond our original purpose in getting together about the problems that he was having—e. g., the relationship with his wife, and his original concern about his symptoms and illness. He is quick to sense what I mean and says, in his typical manner—"You mean that this is what a million other guys are worrying about—"how to make a better living and get a better job.' " I nod and say that I think maybe this faces us both with something I spoke of much earlier, namely, the

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fact that one is never without problems, but the question essentially is how ready one is to tackle them, by one's self, as against needing another's help. Mr. G. is very thoughtful and says that he realizes that these new problems—what he calls his "personal postwar plans"—depend not only on himself, but on so many things that will be happening to the country at large, that he no longer feels so different or isolated from other people. He still has some of the concerns that he had before, but they are so different and so modified that he finds himself freer and more able to keep going on the job and in his family life, without all the intense self-preoccupation that had been typical of him. This discussion leads naturally to the fact that our next appointment is planned as our last one. I say that I think that in a way he may feel that in talking of his next appointment as the last one, that I am letting him down. Here he has come to an important decision about what he wants to do next, and he has some complaints left, and I am not offering to see him through all the things that will be happening. He answers slowly, "No, I don't feel that," and adds, referring to last week, "You see, I still want to go into business for myself." 9-11-44: (8) Mrs. G. Mrs. G. is prompt for her appointment. Again her hair is changed. She has cut it so that she looks much younger and quite attractive. When I notice the change, she laughs and says that this is the "permanent" style. Comfortably, and yet quite self-consciously, she says that she really doesn't have too much to talk about today. "I can keep repeating all the things that I have been telling you, but they boil down to the fact that we are all happy." Before I make any comment, she says, "Oh, yes, there is one thing. My husband is really driving me crazy with something new." It is obvious that she is quite pleased with this, although as she describes it she does have a little impatience with it, too. They have talked about his decision to leave his civil service job. Now that he feels sure that he would like to go into some kind of business if he can, every day he comes home with a new idea and he expects her to drop whatever she is doing and review the facts with him. She laughs and says, "So far, we have been in the photography supply business, the liquor business, and we have even had a delicatessen store." I laugh and say it sounds to me as though they are planning something quite different from what they have known, but from the way she describes it it doesn't sound as though the agency or I have a place in the new plans. She nods in agreement and says that she never expected that her husband would reach the point where he would become dissatisfied with his earnings, his job, and begin to want the same things that she has desired for so

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long. She admits to a little fear about his giving up his civil service job, with its secure if minimal income. Then she reminds me of an appointment about two months back when she had said that even if he never earns another nickel, if he would only admit that things could be better and that he wanted them better, she would feel satisfied. She nods, "Now that I have it, I still want it, but I'm a little scared." We speak about this seriously for a little while. I comment on how natural it is to be concerned about giving up something that you really know and taking a chance with an unknown venture. I think they may even decide against it. So far as I am concerned, I feel that the important thing is that they seem so much together in making this decision. Quite seriously, she says that they are, and then adds—"You know, it is not nearly so scatterbrained as I made it sound. Actually, there is a very real possibility that he and my brother-in-law will be opening a business together." She goes on to tell of the fact that the brother-in-law has had business experience and is fond of her husband and when he was on furlough last week they had a serious discussion and were making tentative plans about a business after the war. She said that although it does mean waiting a while for this plan of her husband's, she is now beginning to realize that it has more possibility than she had originally thought and she is looking forward to it. As we came to the end of the hour, she expresses a great deal of warmth and gratitude and sounds almost a little guilty at being so ready to do without me. I say I think she has made a great deal of use of the agency's help, and I, too, am not without feeling about giving up our appointments, but that it did seem to me, from all the things that she has told me today, that she has a pretty busy life ahead of her and one that she feels more able to cope with. She nods and says, "I am so sorry that we could not have gotten this help a year ago. Maybe my husband would not have needed the other help." I say that while I can't tell what might have been different before, it sounds to me as though she feels more comfortable about going ahead. She says she feels really confident of herself and of her husband and will, in some way, keep me informed of how things will work out. 9-11—44: (9) Mr. G. Today's interview with Mr. G. is extremely interesting in its difference and feeling from most of the preceding ones. Usually he comes in with most of his feeling and energy centered on some one problem that he wants to discuss. Today, there is an ease and a friendliness and a tendency to bring in several different things. When I comment on the fact that our interview today seems almost to be a kind of chatting, he agrees that it is so. He feels that he is able to go on

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by himself, now. He is very surprised because he had rather expected he would get panicky, and in an almost mischievous manner, he says, "In the beginning I had in mind that I could probably get an extension of time from you anyhow, but today I feel that it isn't necessary." He wonders whether his wife told me anything about the several business developments. He repeats the information in detail, and it is interesting to note how much they are together on it. When he speaks about the business venture, he speaks with so much conviction that this is going to happen, that I comment that I have some concern about what will happen to him if things do not work out, or at least do not work out in the near future. He says it may seem strange, but now that he has finally admitted he wants to make a change, and is going about doing something to make it come about, his job does not make him quite as unhappy as it used to. "I guess living with the feeling that I could never change jobs, that I was stuck there forever, used to have the power to make me so miserable. Now that I know that I don't have to pretend that I love its security and that that is what keeps me there, but can actually say aloud that I don't like it and want to move on, even the things that used to upset me there don't bother me quite as much." He goes into detail about an altercation that he had with his immediate supervisor today, before he came down here. The gist of it was that he had been called on to do more than his share of work. He was resentful of that, and also because he was afraid it would make him late for our appointment today. What was particularly interesting was his evenness, and even some aggressiveness, in describing how he handled the matter with his supervisor, standing up for his rights, and not being as concerned as he used to be about how the person would react to him. I comment on his ability to hold his own and he agrees that he feels able to do so. He refers to our last week's talk when he spoke about some of his symptoms continuing. Actually, the only one that was continuing was what he was aware of as an exaggerated concern of how people would react to what he might say or do, and yet, as we talked about it, the real diiference apparent was that whereas at one point his fear had the immobilizing effect of preventing him from doing things on his own, now he really feels free and able to act. Very simply he says, "I don't think that a few months back I would have dared think seriously of getting into all the involvements that a small business entails, but now I feel really free to do so." He elaborates and tells of having gotten a temporary appointment as clerk in charge at his job. Whereas, at one point, authority over other people frightened him, now, in spite of his initial uneasiness, he carried this through successfully.

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He handled the men well and got the work done. He was obviously proud of this and it confirmed for him his readiness "to come out of hiding and take a chance with life." As we terminate the interview, Mr. G. finds it hard to express himself fully. He repeats many of the things that he felt were accomplished for him, mentioning again the happier relationship between himself and his wife. In describing this in great detail again, it was interesting that he mentions that their sexual relationship is so satisfying to both of them, that since our talking about it, he has no desire for masturbation. It was quite clear that this meant a great deal to him and that it was a real symbol of the successful change in their relationship. I say that I feel, too, that things are very different for them and that he has done a great deal to help bring it about. I know that on leaving he faces many new problems, and I do not know how they will work out, but I feel with him that whether or not he gains everything that he wants, he certainly is readier to "take the breaks if they come his way." (This is his own expression.) Mr. G. left, promising to let me know, after a while, how things are going, and telling me that he felt we had helped him to a "new lease on life." 1-2—45: For the first time since my last interview with Mr. and Mrs. Gold, I heard from them today. I received a Christmas gift with a letter expressing gratitude for the help they got here. Quite enthusiastically, Mrs. G. described that not only has their life continued to be a happier one together, but "plans" which she doesn't describe seem to be on the way so that financially they will be better off. The letter is a very warm, self-confident one. 1-17-45: I saw Mr. G. once and spoke with him on the 'phone. He did not come in about the marital relationship. In so far as his family life is concerned, there is a quiet security. He discussed other matters, an important one being his plan to take on additional part-time work, since for the time being he realizes that it is not possible to work out plans for a business. He will be working three extra hours a day, four times weekly, in private industry. There is no pressure that I sense that makes it essential that he take this on, but rather it grows out of his own desire and it affords him a great deal of satisfaction. In describing his interview with his new employer, it was interesting to note his self-assurance and apparent freedom from anxiety. I felt that this interview was his way of terminating our relationship on terms which he helped to describe—that is, the recent achievements have grown

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out of his own adequacy during a period when he had not been receiving help. 2-5-45 Closing Entry, Reason for Opening: On June 15, 1944, I saw Mrs. Gold for the first time. She came to ask for some assistance with a serious marital problem which she was having with her husband. She knew of me indirectly, and she also knew that I had seen her husband one time about a year and a half ago, at which time I had referred him to a psychiatrist for treatment for an anxiety neurosis. Mrs. Gold, in application, described her fear for the future because of her husband's limited earnings and apparent apathy about doing anything more. Additionally, she described a great deal of strain and conflict that existed between them. Mr. Gold was seen in application, the following week. Apparently he had suffered a recurrence of his anxiety symptoms. Much of his problem seemed focused on a sexual conflict, as well as acute feelings of fear in relationships in general. It was clear that there was an essential correlation between these problems and the conflict he was having in his relationship with his wife. Both of them seemed anxious for our marital counseling service. Development and Service: Mr. and Mrs. Gold were seen over a period of approximately three months. There were 17 interviews in all, nine with Mr. G. and 8 with Mrs. G. ( this does not include the time Mr. G. was seen in January of 1945, five months after the close of our contact). During the early part of the relationship with Mr. Gold, he was ver)' much preoccupied with his fears and anxiety. Through his preoccupation with the symptoms as such, he was able to deny and avoid their relationship to his current difficulty with his wife and the part that he contributed to the marital discord. He was helped to see the relationship between the many apparently unrelated symptoms he described, and his difficulties with his wife. He recognized his deep-rooted fear that his marriage was inevitably doomed to failure, just as his own parental home had failed, and was able to free himself of this destructive identification. As the experience developed, it was apparent that it afforded him relief and a greater sense of direction to his efforts to relate his many difficulties to his immediate relationship with his wife. He put more and more into developing some understanding and control over his behavior in the relationship, giving up some of the neurotic security which he had in hiding behind his symptoms and the feeling of not being understood by his wife, and began to assume more direct responsibility for meeting her half way in sharing the problems and efforts at solution of them. Mrs. G. on her part, needed help in overcoming her projection of full responsibility for all of their difficulties on to Mr. G's

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behavior. In the course of her relationship here, she was able to develop some understanding of the degree to which this projection denied and evaded her own part in the problem. As she felt his efforts to change with help, she began to put a great deal into controlling her own impulsive, resentful behavior against him. Their fundamentally positive feeling for each other was strengthened, so that they approached their differences more on a give and take basis, each yielding enough to the other so that they began to work out joint decisions. When they had established this means of sharing and working together, they seemed able to approach any of the problems that existed between them with a confidence of arriving at some mutual solution. This important constructive development in their relationship played no small part in Mr. G's ability to deal more effectively with relationships outside the home— e. g., social and work life. Reason for Closing: Both Mr. and Mrs. G. felt secure in the change in their relationship. There was a quality of working together, of sharing, of being aware of the other partner to such an extent that the various facets of their relationship—e. g., sexual, financial management and planning, care of the child, etc., were immeasurably improved. On my part, too, I felt that the change in their relationship was real and could be trusted. The degree to which they were able, on their own, to come to solutions of both serious and everyday problems of married life with less and less help from me, convinced me that there was no need for any further help and that the case might be closed.

DISCUSSION Jessie

Taft

are one or two points which the editor would like to consider in the light of Dr. Gomberg's material, particularly the diference between casework or counseling and psychotherapy, and the use of the arbitrary time limit. A recently published book entitled Psychoanalytic Therapy, by Franz Alexander and Thomas Morton French, together with a group of Chicago psychiatrists, presents so many departures from the traditional methods and techniques of classical psychoanalysis —including frank acceptance of responsibility for the current reality problems of the patient—that any attempt to differentiate between casework and psychotherapy must take account of this new and enlarged comprehension of psychoanalysis as defined by the Chicago group. Not only has this group questioned the validity of many traditional beliefs regarding the relation of therapeutic results to the length and intensity of the treatment, 1 —dogmas on the basis of which psychoanalytically oriented casework has always labeled "functional casework" as "superficial,"—but they have advocated an approach which places the reality problem of the patient and his immediate emotional experiences within the therapeutic relationship at the center of treatment. As Dr. Alexander puts it: THERE

The nearer the analyst can keep the patient to his actual life problems, the more intensive and effective the therapeutic process is. From the point of genetic research it might be advisable to encourage the patient to wander way back into the Garden of Eden of his early youth; therapeutically, however, such a retreat is valuable only insofar as it sheds light upon the present. Memory material must always be correlated with the present life situation, and the patient must never be 1

Alexander and French, op. cit., pp. v, vi.

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allowed to forget that he came to the physician not for an academic understanding of the etiology of his condition, but for help in solving his actual life problems." 2

With this statement, Dr. Gomberg is in obvious agreement, but for that very reason, it becomes necessary to reëxamine the differences between casework and psychotherapy, particularly as it affects the counseling case and its right to be included in the services of a family agency.3 In the light of this new contribution from Dr. Alexander and his collaborators, it is evident that psychotherapy has taken cognizance of the patient's immediate reality problems and that fact brings it more closely into relation with social casework than ever before. In fact, I think it is difficult, perhaps impossible, to discriminate between Dr. Gomberg's first case (Miss Black) and cases which are cited in the Alexander and French book, in actual method, in time form, in therapeutic results. In the Gold case, the fact that the man and his wife work on their problem together at home, as well as separately with Dr. Gomberg, introduces a substantial reality setting which might be said to differentiate the casework process as contrasted with the analyst's concentration on the individual patient. However, there is nothing to prevent the analyst from discovering the control value of working with a triangle in reality, as well as in mere recognition and reference. In the Black case, Dr. Gomberg relies for objectivity on keeping the focus on the employment problem as such, but this way of holding the patient to his present problems is also advocated by the Chicago group and is considered by them to be one method of controlling the psychotherapeutic process. I believe that my original distinction between casework, as a way of giving an agency service helpfully, and psychotherapy, is valid, although the generic helping process is necessarily present in both, and I also believe that the only reliable index of difference lies in the degree to which the overt functions are dissimilar and "third person" reality factors are included. However, there would necessarily be a borderline area, as in the counseling case, particularly with the unattached Ibid., p. 34. Quoted by permission of The Ronald Press Company. For the sake of clarity, see my statement on this subject, Introduction to Part I, footnote 2. 2

8

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individual, where the reality distinction would be at the vanishing point. Indeed it may be equally true that psychotherapy itself will decrease its distance from social casework as it becomes more and more socialized, so that emphasis on the individual doctorto-patient relation is gradually reduced. In order to lay a base for discussing the counseling case as social service, it is necessary to begin with the concrete functions which clearly differentiate the work of social agencies from psychotherapy. For example, an agency which is set up by the community to place children in foster homes may be producing therapeutic results for parents, children, and foster parents, but that is not its primary aim, nor its function. It works continuously and practically in a three-dimensional world, never in a purely one-to-one relation with a single individual. The agency itself is a realistic structure and in order to carry out its placement process it must relate to every child, not only in terms of his particular personality and needs but also in terms of the interrelationships of parents, child, foster parents, and agency. Moreover, it must understand and handle the problem that its very function creates for the child, his parents, and his foster home. The agency is always present realistically, and it is this reality of the larger whole which carries the worker as an essential part and on which the worker may rest in following impersonally the policies which it imposes on him as well as on the client. True, the worker is there for the client, unselfishly, but he is also there for agency, and that dual identification provides a more objective, realistic dynamic than is usual in the psychotherapeutic situation. In my experience, it would be safe to say that the psychotherapist as a rule carries no such responsible and at the same time subordinate relation to an agency.4 He himself as medical authority is the functional center, and assumes full responsibility for the treatment process, unless he is a student. The patient, also, relates to him as the final medical authority, who is personally responsible for imposing conditions of time, place, and fee. In a clinical setup, the patient may not choose his therapist, nor does the therapist 4 An exception to this is found in the Philadelphia Child Guidance Clinic, which offers a truly socialized psychotherapeutic service in which therapy is provided for the child but only as the parent is helped by the caseworker to meet the problems inherent in using this specialized service, that is, this clinic works on the actual relationship between parent and child, through the medium of psychotherapy for the child, sustained for and with the parents, through a social worker, in cooperation with the therapist.

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necessarily determine the fee, but the relationship is primarily between the two, without the background of an agency whole, which acts as a determining reality for both, as it does in the clientworker relationship. Thus, not only the function, with its realistic tangible service, but the ever-present actuality of agency, form a new reality situation in which the client must struggle with the help of the worker to find his own direction. True, he enters into a meaningful relation to the worker or he gets no help, but it is never just the worker who is the source of the service, but agency itself, with its community roots and its varied resources. As long as the service is rendered by a social agency, the service may be psychotherapy itself and yet the role of the caseworker can remain clearly differentiated. When there is no separating and, at the same time, supporting medium, such as the social agency supplies,—no application process through which the applicant may test relation to agency and to the service he apparently seeks,— there is, in my opinion, no place for the social worker. He himself may become the service, as the therapist does, but he no longer operates in his own unique profession. While this is reasonably self-evident in the case of the tangible services, particularly a service as essentially practical as child placement, it is less clear in the operation of a family agency, aside from concrete, traditional areas of financial assistance and practical family rehabilitation. In Dr. Gomberg's cases, he himself is the primary source of help, as is the therapist. However, there is clearly a difference in the goal or function of the family agency, and that of the psychotherapist. Dr. Alexander speaks of the psychotherapeutic goal as an effort "to increase the patient's ability to find gratifications for his subjective needs in ways acceptable both to himself and to the world he lives in and thus to free him to develop his capacities." 8 While this goal might be an actual by-product of family counseling, and hopefully would be, it is not the way in which the family agency conceives of its purpose or presents it to the client. In his earlier paper, "The Specific Nature of Family Casework," Dr. Gomberg says: I believe that a determinative focus for family casework does exist in the seemingly obvious but overlooked fact that a family agency, as differentiated from any other, is intended to deal with the problems 6 Alexander and French, op. cit., p. 26. Quoted by permission of The Ronald Press Company.

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which primarily concern the family as a whole. It is accepted generally that the essential purpose of the family agency is to help preserve and enhance family life and coherence, wherever this represents a solution for the family and is within the facilities of the agency. It follows, then, that in carrying out the agency's purpose, the worker's perspective must necessarily embrace the relation of the client's application to the family as a whole and the effect that the agency's service may have on it. True, the client must be individualized but certainly he need not be isolated from his role as a family member. This definition of the family agency service seems to me to distinguish it as a social service, as compared with Dr. Alexander's psychotherapeutic aim for the individual. It is evident throughout the Alexander-French book that the Chicago group is striving for greater reality in the psychotherapeutic process, and to that end advocates many innovations regarding time form, the patient's use of the couch, and the direct influencing of the patient in regard to his behavior outside of therapy, all of which help "to make the therapy understandable to the patient, to rob the psychotherapeutic situation of its mystery." 6 They endeavor by these means to make the therapist more of a real person to the patient, thus reducing the one-sidedness of the latter's projections, and they also try to bring the patient himself into therapy more realistically by concentrating on his actual life problems at the moment, rather than placing major emphasis on uncovering the infantile memories. However, with all due allowance for the new factors in their approach, psychotherapy remains an affair of two, the physician wholly responsible for the treatment, and the individual patient coming for his own personal problems, present or past. Even in the counseling case the ever-present background of the family agency, to which the worker owes his first allegiance and whose purposes and policies he is responsible for administering, brings a "third-person" reality into the office setting, just as the actual involvement of other members of his family, and the focus of the agency on his role and responsibility in that family relationship, increase the client's reality—make him, as it were, threedimensional also. Moreover, there is a determinative difference in the way an individual approaches a family agency as compared with his approach to a psychotherapist or a psychiatric 6

Alexander and French, op. cit., p. 86. Quoted by permission.

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clinic. On the whole he brings a social problem to the social agency, whereas he knows, however he trys to deny it, that he comes to the therapist for his inmost self, than which nothing is more fearful and alien to everyday living. There may be shame attached to having to apply to a family agency, and undoubtedly fear and hesitation as to the controls that may be exercised, but there is nothing in such an application to compare with the irrational fear and resistance attached to a situation which makes the inmost and immediate self the focus of attention. Indeed, the chief reason for the difficulty which most caseworkers experience in handling the counseling case is the fact that the objective focus provided by the concrete service is lacking and the natural externalization of the helping relationship is blocked by its absence. The obvious difference in the education and training of social worker and psychiatrist remains to be considered. Certainly the difference is very great and includes in psychiatry a level of medical knowledge and responsibility which is clearly outside of social work. However, unless one is prepared to say that no professional help shall be given except by a medical therapist or under his supervision, and that no psychology of helping is authentic or justifiably utilized in rendering a social service, unless it is under psychiatric auspices, there remain the large areas of the social services toward which the training of the social worker is primarily directed. While only two years of graduate specialization are at present required for the M.S.W. degree, the student of social work has the advantage of being placed from the very beginning in a triangular relationship, so that it is never just his own relation to a client which is involved, but his relation to the supervisor as well, and through her to the agency, which he must learn to respect and lean on for protection when his own judgment fails or his identification with the client threatens to imbalance him. The psychotherapist until very recently, at least, has no such experience of working under supervision, of being held to his responsibility for learning to help the patient skillfully through the requirements of agency standards for the rendering of its services. 7 The psychiatrist, even 7 Since this was written a paper by Dr. Frederick H. Allen on "Training in Child Psychiatry," published as part of a symposium on "Preparation of Psychiatrists" in the Amer. Jour, of Ortho-psychiatry, July 1946, presents supervision as essential to training and relates the training of the individual student to the agency in which he is learning to work.

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as student, is merely waiting to become the authoritative, competent "whole"; the social work student, on the contrary, strives to increase the skillful use of himself as part of agency, to find his place in the whole and to work in the midst of complex interrelationships on which the carrying out of agency function depends. The very source of casework dynamic lies in this dual identification, which permits the worker to resist the client's projections, in terms of the agency's particular requirements, and at the same time to provide through his understanding of the client's dilemma and his immediate recognition of the feelings involved, a medium of likeness and unity in which they can meet and work together. T h e psychiatrist, as a rule, makes no such use of an organizational whole and must carry in his own person the responsibility for good and evil, so far as the therapy is concerned. W e are justified, therefore, in asserting the value of social work training, which actually equips the student to work within social relationships, as part of a social agency, and does not attempt to train him to deal primarily with the individual's emotional problems. T o come back, then, to our original consideration of the differentiation of casework from psychotherapy, it seems to me that only in the "pure" counseling case is there any difficulty, and that even in such cases the fact of the social agency as a determining whole and the presence of the social worker, not the psychiatrist, as the helper, are sufficient in themselves to make the casework process different for the client and for the worker. In the instance of the unattached individual, it seems to me that the family agency has a decision to make and an explanation to offer as to how such a case is to be included under "family" service. Because I have been largely responsible for stressing the importance of the time element in social casework, I feel obligated to clarify so far as it can be done briefly here, the generally misunderstood conception of the arbitrary time limit. This is important not only in relation to Dr. Gomberg's paper, but also because of the marked change in the psychoanalytic use of time as proposed by Dr. Alexander. The Chicago group now accepts without reservation the fact that brief therapy may be as effective as long-time therapy, that interviews once a week or twice a week, in fact at any interval that seems suitable, can be as helpful for the patient as the five-or-six-times-a-week convention of classical psycho-

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analysis. In fact, flexibility as to the use of time is considered essential to meet the needs of particular cases. However, Dr. Alexander rejects the use of the arbitrary time limit for therapy, as he conceives it to have been used by Rank. Although, in my opinion, he has misunderstood Rank's theory and misinterpreted his practice, I agree with Dr. Alexander that the ending of a therapeutic experience must always be related to the patient's natural and inevitable movement toward independence but, as Rank has pointed out, an ending must occur sometime and on a particular day. It is this deciding on the day, as well as the month, that always seems arbitrary, as it really is, for surely no absolute Tightness inheres in a Monday rather than a Saturday, a Tuesday rather than a Friday. Since any prearranged ending will at times feel wrong to the patient and as if it were imposed externally by the therapist, it remains only to help the patient to realize his own ambivalence and contrary-mindedness in the face of any day that feels final, even one he selects himself, however much he may know that it is really what he has been moving toward and what he actually wants. My own suggestion of an arbitrary time span offered in advance as an agency limited and defined service 8 was intended to further differentiate counseling as family casework from psychotherapy, and in still advocating this procedure, I must disagree with Dr. Gomberg. It seems to me that the fear of being arbitrary, of not meeting flexibly enough the therapeutic needs of the client, is not unlike an older fear once experienced by many workers in relation to any firm definitive utilization of agency function. Even to stand on the particular function of an agency once seemed to the average worker harsh or unhelpful, as it still does to many. Functionally trained workers and functionally oriented agencies like Dr. Gomberg's have long since come to realize that they can be truly helpful only when the agency's service and operation are clearly defined and presented, so that the worker is free to help the client in his reactions to that defined service. The agency may not have money to provide a budget that meets the individual client's conception of what he needs, but workers no longer advocate the giving of money on a purely individual basis. Only when there is a thought-out, objective, agency policy on which the individual 8

See p. 15 Introduction to Part I.

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worker can base the amount of the grant in a given case, is the rendering of such a service tolerable or helpful. It is apparently very difficult for us to look at time in the same objective and realistic way, when it becomes not the medium for therapy, individually determined by the therapist who is individually responsible, but the particular service which the agency offers to meet a family relationship problem. Neither agency nor worker needs to take on therapeutic responsibility for the length of time it can offer. Instead, on the basis of its past experience, it can offer what it has found to be a useful length of time for dealing with certain kinds of family problems. There is a practical element in this arbitrary limiting of time, just as there is in the limiting of a budget. It should represent what the agency can afford to give in terms of the available time of its workers and the needs of other services. What we evidently fear to trust is the capacity of a client to make his own best use of the time offered, if he can accept its limitation in advance, indeed can choose it as something impersonal and a general policy of agency and not the decision of an individual worker for his case. Although we have learned that clients are helped through the very process of finding and asserting themselves, in the struggle with the agency's conditions and limitations, even in the instance of learning to use a far from ideal budget, or to accept the visiting restrictions of a foster care agency, we still do not believe apparently that the client is equally capable of wrestling with, and creating on, the very limitation that a definite time span imposes. In my opinion, the agency's authority for a time-limited service, even more than its setting of a fee, marks a reliable differentiation between therapy and casework, not only for the client but for the worker. That Dr. Gomberg is a skilled therapist, who could be helpful in any setting, seems evident, but he possesses a background of academic and professional training not usual for the social worker and certainly not required for social work training. He is quite justified in taking on himself full responsibility for setting an ending in terms of his own relation to the case, and because he can be therapist as well as caseworker, he naturally takes on a degree of therapeutic responsibility which would and should terrify the therapeutically unequipped social worker, just as he was once terrified of having to decide how much money a particular client

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was entitled to receive. In my opinion there is only one way in which the counseling case can remain legitimately in the area of family casework, and that way is to give the worker the kind of support in structure, policy, and procedure that he needs and has a right to expect from agency. Because this service tends to feel intangible, the factor of time as well as fee must take on tangibility. When a worker can accept a limited time, a certain number of interviews, as what the agency can give, as easily as he accepts a limited budget, then he can be free to help the client in his struggle with, and creative overcoming of, the limitations that he has nominally accepted in deciding to use this particular service. In my opinion, personal responsibility for determining the ending in each case is the most difficult and peculiarly professional obligation that the psychotherapist carries. Unless the social worker is prepared to qualify as a therapist, this therapeutic responsibility should remain with the psychiatrist, and the client of the social agency should be allowed to make the best use he is able of a limited number of interviews, understandingly and helpfully given by a caseworker under casework supervision and agency authority. T o be convinced of what a human being can do with an arbitrary time span, one has only to look at the student in training and his use of the semester, the year, the final graduation, to carry a fundamental learning process, for whose time-limited aspect neither teachers nor supervisors carry individual responsibility. The student accepts the conventional time form of a school in advance, and he must accommodate his learning to repeated endings of year and semester, endings which are not arranged in terms of his individual need nor necessarily well suited to his natural tempo, but are impartially applied to every student. Every student reacts to these endings with varying degrees of resistance, fear, and satisfaction, as does the client or the patient, but because they are an inevitable part of the training process that he has chosen, he is enabled, with the help of teacher and supervisor, to take a new kind of responsibility for his own reactions to a time limit, and to gain a deeper understanding of what endings can moan for clients as well. I realize how harsh this conception of a time limit must seem to one who feels it as something imposed and hostile. Our sensitiv-

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ity to endings in time is too closely related to the ultimate limitation of death, to which all must yield finally, for it ever to be without its personal, developmental implications. For that very reason it seems necessary and valid for the agency itself to take from the individual worker the too great responsibility of deciding how and to what extent the client is to be limited in time, in order that he may be free to carry full responsibility for the helping process that is his.

T H E FOX CASE, A PROBLEM IN REFERRAL Jessie Taft Case Record by Celia Brody by another social agency, Mrs. Fox applies to Consultation Center, the original fee-charging district of the Jewish Social Service Association, now merged in the Jewish Family Service of New York. She comes to a family agency with an urgent family problem, a twenty-one-year-old daughter who is obviously in need of psychiatric help, which Consultation Center itself can not provide. This very fact, that the dreaded but necessary care is once removed, not immediately available, creates an interval in which a sensitive, skillful caseworker is enabled to carry through the family agency function, with a perfectly balanced recognition of the three members of the family directly concerned and the skill to help them to carry their parts in a painful movement toward the inevitable, but fearful source of ultimate help. Seldom does one see the concept of family agency responsibility for the effect of its helping relation on the family as a whole, so perfectly realized as in this counseling process which enables a mother, father, and daughter to overcome sufficiently their fear and confusion in the face of mental illness to act as a family unit despite the limited participation of the daughter. REFERRED

Mrs. Celia Brody carried this case as part of her field-work assignment in the Advanced Curriculum of the Pennsylvania School of Social Work, under the supervision of the district head, Miss Sonia Penn. Mrs. Brody came to the agency, after many years of experience as supervisor in the Department of Welfare of New York City, a year and a half before she entered the School to complete her work for the Master's degree, so that she was already closely identified with the function of Consultation Center and imbued with the sense of family agency responsibility, not only 273

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to an applying family as such but for the Center's referrals to other sources of help. Further discussion of the case is postponed until the reader has had the opportunity to read the five interviews that follow: two with mother and daughter, one with father, mother, and daughter, and two with the mother alone. First Interview, 10-11-46, Mrs. Fox and Lillian: Mrs. Fox is a woman in her late forties, extremely pretty, with golden hair, clear blue eyes and lovely complexion. She was accompanied by her daughter, a girl of twenty-one, who is quite plain looking, with a badly broken-out skin. In calling for the appointment, Mrs. Fox indicated that she had learned about us from another social agency which she had called first, only to learn that they could not help with a problem of a twenty-one-yearold girl. When I greeted Mrs. Fox, she seemed rather hesitant to introduce me to her daughter. I asked which of them wished to talk with me first, whereupon Mrs. Fox turned hesitantly to the girl, who made the decision, saying that she preferred that her mother go first. She looked tense and anxious until I told her that I would see her later, too, at which she began to giggle. We left her pacing up and down the waiting room. Mrs. Fox seated herself uneasily, and looked at me searchingly, as though she expected something from me before she could start. I mentioned that I knew how she had been referred here, but wondered whether she knew anything about us. She was eager for me to tell her who we were; and no sooner did I mention that we were a family agency, than she was able to begin, saying that she is certain she is in the right place. Mrs. Fox said that Lillian, her daughter, had been a sophomore at college until about a year ago, when she had "a nervous breakdown." This was due to her severe anxiety about her brother, Joseph, who had had been a flier overseas. He is two years older than Lillian, and they have always been very close. While he was away, she was completely preoccupied with him, constantly writing and sending him packages. She also felt it her duty to keep her brother's spirits up, in fact, Mrs. Fox at times had the feeling that Lillian was taking it harder than she, even though she is the mother. There was a note of resentment and bewilderment in this observation, and when I remarked that this must have made her quite uncomfortable, she said that it annoyed her terribly, because she saw no point in carrying on to such an extent. She, herself, suffered intensely. There were times when she did not believe that she could survive, particularly after Joseph's plane was shot down and, for a long time, he was missing. She felt, though, that she had to hold

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on to herself, because she could never give up the hope that he would be found; and as it worked out, they did finally hear that he had been located in a prisoner-of-war camp. When Joseph's life was spared to them in this way, she felt all the more determined to keep going, so that he would find her as he had left her and not come back to a sick wreck of a mother. I thought it required tremendous strength and will to go on coping with the normal daily problems of living while in such a state of worry and suspense. Mrs. Fox replied that it took every ounce of strength in her and when she felt she had nothing left, this other blow came. It happened last November, shortly after Joseph came home. At that time, they felt they were the luckiest people in the world, with everything to live for, when suddenly Lillian took ill. She had left college because she could not concentrate on academic studies, and had taken a job in a department store, where she was doing very nicely. Then one day she said she could not get up to go to work. She took to bed, and for weeks would not dress, or talk to anyone, or even eat willingly. Their family physician advised them to give her time to get over it; but when they saw that she was not improving, they took her to several "nerve doctors." Mrs. Fox stopped, unable to continue talking. I said that it was awfully hard for her to relive so much pain in talking with me, a perfect stranger, especially since she had had one ordeal right on the heels of another. I thought that she and her husband certainly were having to bear a great deal as parents. Mrs. Fox made no reference to her husband's feelings, in response to this, but talked, instead, about how she and her son were affected, saying that they could not believe what was happening to Lillian. They kept urging her to snap out of it and to control her feelings, since after all, isn't this what they had had to do? When they saw that this had no effect whatever, they decided that their only recourse was to take her to a nerve doctor. The family physician had pooh-poohed this; but they were desperate. They also had a problem in relation to the financial expense, since Mr. Fox is only a working man and her son had not had a chance to settle down to doing anything. As a matter of fact, he still hadn't, because of the way Lillian's condition upset them all. With some bitterness, she brought out that after all, he had really deserved something better after what he had gone through. In spite of the dangers that he had been exposed to, he had been able to come through with a medal and several citations for bravery. I recognized how much this gratified her, but I also recognized that it baffled her that her children were so extremely different in the way they coped with difficulties. She said eagerly that they had, of course, always been very different. Her son

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had been a much more self-reliant person practically from birth; but on the other hand, Lillian had always been a wonderful daughter, extremely responsible and devoted. Other mothers had always envied her because Lillian was so good about everything. Mrs. Fox had felt that she could share things with her because she was so sensible, even as a child. I could see how much more of a shock this had been to her, in view of her past experience with Lillian. By this time Mrs. Fox was weeping and making apologies to me for doing so. I told her that I felt that she had real reason to weep, and I did not know why she needed to be superhuman about this. She was able to go on to tell me about her experience with the nerve doctors, which she described in a very general way, not seeming to know what the diagnosis was. Lillian had been treated by one of them, whom I recognized as a distinguished neuropsychiatrist. He had given her several shock treatments in his office last spring, but then had discontinued because he felt that Lillian should be hospitalized. Mrs. Fox was entirely unable to afford the fees of a private sanitarium, and under no circumstances would she consider letting Lillian go to a state institution. She waited to see how much improvement Lillian would show after the shock treatments; but even though she had seemed to come out of her depression, she showed no evidence of returning to her old self. In June, Mrs. Fox took her to another neuropsychiatrist, who also recommended shock treatment and sanitarium care. Since this was still out of the question, Mrs. Fox concentrated on building Lillian up physically, hoping that in this way she would bring her "up to par." Although there is no doubt that Lillian is much improved over the way she was when she first became ill, she still isn't able to return to school or take a job, and Mrs. Fox is finding it increasingly difficult to cope with her. I wondered what Mrs. Fox had in mind in coming to our agency. She brought out, in a fumbling way, as though she herself were questioning her purpose, that she thought we might suggest a convalescent home where Lillian would have to be active and get out of herself. I told Mrs. Fox that although we know of convalescent homes, our agency could take responsibility for such a plan only if we had reason to believe, from our observation and from medical opinion, that Lillian was convalescing. From what she was telling me, I did not know whether Lillian was still ill, in which case she would not be acceptable to any convalescent home; nor did I think that Mrs. Fox herself would want her to go to a place that couldn't help her. Mrs. Fox said hesitantly that she herself doesn't know and asked, with a certain amount of eagerness, whether I would talk to Lillian myself. I thought that, in some way, Mrs. Fox might welcome this; on the other hand, it might also be up-

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setting to her to have me talk with Lillian. Mrs. Fox choked up and after a pause, said that it hurts terribly to see Lillian acting the way she does; but after all, she must do something for her. I agreed that it was this that made it possible for her to come here in the first place. I asked Mrs. Fox whether Lillian knew why she was here. She hadn't told her about it until they were on the subway, when she explained that she was going to find out about a country club. Lillian became furious and in fact, almost unmanageable; but finally she was persuaded to accompany her here. I thought, then, that Lillian probably doesn't seem to think she needs help of any kind. Mrs. Fox responded impatiently that Lillian is so unreasonable, that she felt it best not even to discuss this with her. She is certain that she needs help, since no real improvement has shown itself, even though so many months have gone by. I put out that the time factor is now beginning to worry her, and she replied, with some desperation, that maybe things have been delayed too long, and she doesn't want to waste any more time. I could understand this, but wanted her to know that I couldn't be sure that the agency could give her the kind of help that she had had in mind in coming. I could only assure her that we wanted to help her consider what Lillian really needed now. After explaining to Mrs. Fox that we set aside an hour for appointments, and that I could therefore spend only a little time with Lillian this time, leaving a few minutes to talk with her again briefly, I went to get Lillian. Mrs. Fox remained in the waiting room, looking very scared. When Lillian began to giggle in a silly way, she showed extreme annoyance. By the time Lillian sat down, there was no trace of laughter left in her face. I remarked that I had kept her waiting some time while I talked to her mother, and I thought she might have been pretty upset and curious about what we were discussing. She relaxed at this, and began to talk very rapidly, throwing questions of a personal nature at me but not waiting to get any answer. Only at points did she relate in a relevant way. For the most part, she was unrelated and agitated. She brought out that she considered the whole family ill and that she is constantly worried about this. She mentioned that she had had a nervous breakdown. She had felt horrible then, but now she is perfectly happy. Couldn't I see how well she was? I said gently that laughing did not always have to do with feeling happy. I could accept that it was better than the way she had been feeling, but still she was not able to do things that she herself would probably prefer. Despite her denial, I sensed also a reaching out to me. She said that she liked being here and thought that social workers are pretty important people.

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I said that her mother would be coming back next week, and would she like to come in again then, too. This recognition of her produced a different kind of material, and she began to tell me about her student experience in college. When I asked whether she would like me to help her and her mother to see what they could do about getting help, so that she would feel as well as she did during her college days, she began to draw back a little, telling me that social work was a pretty dangerous kind of profession. Wasn't there real possibility that a person like myself, who has to listen to so many troubles and worry about so many people, might not also break down? I said that I knew that she had had very serious things to worry about and that other people, too, w h o had had upsetting times during the war, had gotten ill and needed help. I realized that she might be angry at me for thinking that she needed it, but I did want to help her. Her response was again more in terms of reaching out. With some relief, she said she was glad to hear that I knew of other people who had broken down and that she was not the only one. She thought she would like to come back. I saw Mrs. Fox briefly, telling her that I would like to see her and Lillian in a few days. I urged her to try to get Lillian here, b u t to come herself in any event, if Lillian should refuse. I thought this was possible, since Lillian seemed to me to b e really ill, but I hoped not too ill to be able to take a little part in working out plans for herself with her mother and me. I could not be sure of this, but I thought it was worth trying. Mrs. Fox's response was, "Then she really is sick?" putting this both in the form of statement and question at the same time. I said that she knew this, but was naturally finding it hard to realize and I would like to help her with this. She then agreed readily to come in, and an appointment was made for 10/16. W e discussed fee, and Mrs. Fox told me that her husband works in the needle trade on a seasonal basis, averaging $60 a week. Her son provides for most of his needs through unemployment insurance, but the family still has some responsibility for maintaining him. On the basis of the combined income of about $80 a week, we arrived at a fee of $1.50. This was quite agreeable to Mrs. Fox, w h o said that she certainly would not like to take up the agency's time without some payment. After Mrs. Fox and Lillian left, I learned from the office secretary that while Lillian was in the waiting room alone, she kept singing a popular song called "I'm a Big Girl Now," showing little awareness of the people who came in and out of the waiting room.

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Second Interview, 10-16^i6, Mrs. Fox and Lillian: Mrs. Fox and Lillian in for appointment. Mrs. Fox was holding herself aloof from Lillian, who began to talk to me in a loud, agitated voice. Mrs. Fox then began to scold her impatiently for being noisy. This increased Lillian's excitement, but when I asked her whether she could again bear to wait a while, indicating that I would see her before talking to her mother if she could not wait, she relaxed and said that she would wait. She had a lot to think over. I said that I would be just as interested in knowing what she is thinking as I am in talking with her mother. I mentioned that I would be seeing them together after seeing them individually. Lillian greeted this with positive delight, while Mrs. Fox looked a little apprehensive. When Mrs. Fox was alone with me, I commented on my feeling that it had bothered her that I was planning to see them together. At first she denied this, but then said she wondered about it. I told her that I knew how hard it was to get together with Lillian, because she is a sick girl; but I thought that if she could get together with her, just in relation to what next step needed to be taken, both she and Lillian would feel better about it. She said that she couldn't do this by herself, but thought I could help her. She then went on to tell me that Lillian is very much worse since I saw them last week. Actually, the information Mrs. Fox gave me about her behavior during the week corresponded very much to what she had told me originally. I brought this out, saying that maybe she is beginning to see Lillian's difference from other people, and from the way she used to see it. She nodded wordlessly in response and then began to talk about getting immediate help for Lillian. She wondered if I knew of any hospital which they could afford, other than the state hospitals. They would be only too glad to pay for private treatment, but the expenses of private care are out of the question under their circumstances. I told Mrs. Fox that there were one or two places that she could accept and be better able to manage than the private places. However, I was not a doctor and could not say just what was needed. The place I had in mind has an admission psychiatrist who examines the patient to determine whether hospitalization is needed and whether it is the type of condition that their hospital can undertake to treat. I made it clear that the agency has no authority or control over the hospital, but has a respect for the work they do. Mrs. Fox wanted me to refer her immediately, expressing fear that any further delay in treatment might hasten the changes she is now seeing in Lillian. I agreed that we would not want to prolong the situation unnecessarily. On the other hand, our

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agency, in helping a family plan for the treatment of a sick youngster, could undertake to do this only if we could arrange for this with both parents. If this was all right with her and her husband, I could see him in a few days. I really did not think that she had to feel that a few days could make so much difference, or that even a few weeks would, since there was a possibility that if Lillian was accepted at the hospital, there would be some kind of waiting period. Mrs. Fox said that she did want to continue with us, but wanted to assure me that her husband would agree to any plan we made. Both she, her husband and her son now realize that Lillian is getting worse, and want to do everything they can to help her. I accepted that this was so, but wondered why she had to carry the whole burden herself. She put it on the fact that her husband, after all, has to carry his job. The situation has upset him so that she doesn't know what will happen to him. She therefore feels that it is up to her to relieve him of this responsibility as much as possible. I questioned pretty directly whether she could really spare him in this way. Did she think that he left his concern about Lillian behind when he went off to work? Mrs. Fox then began to talk about what a devoted father he is, and how he and Lillian have always been very much attached to each other. H e has been so proud of her. She is sure that he cannot get it off his mind, and that he would be glad to come in. She is only worried about how long it will take. I told Mrs. Fox that I knew only how to take one step at a time in such a complicated situation, and that the next step of seeing her husband and then talking with them together, and with Lillian, too, if she could come along, could be taken on 10/21. If she could not bear to wait, she could go herself, of course, to the hospital with Lillian. The hospital does see people not referred by agencies. However, we could refer them only if we could talk with both of Lillian's parents. Mrs. Fox said unhesitatingly that she would rather work this out with us than go directly to the hospital, because she feels that I am helping her and certainly a few days could not make so much difference. Recognizing how much guilt Mrs. Fox was having about the delay, I said that I thought we had already accomplished a great deal in a short while. I wondered why she needed to blame herself so because Lillian had not been in the hospital during this period. No parent who cared about a child found it easy to place her in a hospital. She had all the memories of the years that Lillian was a well and healthy girl, which neither a doctor nor I could have. I could easily see that whenever Lillian temporarily behaved like her old self, it was natural for Mrs. Fox and her husband to feel that she was going to change back

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again to the way she had been. There had also been the doubts that her son had had, and that the family physician had expressed, and the very real limitation of money in connection with the places that had been suggested to her. She had had no way, after all, of knowing of other possible places through her own experience. Mrs. Fox was crying at this point and, opening her purse, pulled out pictures that she had brought with her. She said that what I had said about her memories is just right. She has been going over all the snapshots of Lillian, looking to see if she could have been mistaken, and if there was anything that she had overlooked in the past. I realized that as a mother she must be thinking back over their whole relationship and what her responsibility was in Lillian's condition. The fact was that Lillian had been functioning in such a way for years that neither at school nor at home nor in any of the other innumerable situations that she had been in had anybody had any question about her. I did not understand why Mrs. Fox had to take all this upon herself. The whole family had just lived through a severe crisis and each one had been deeply affected; but they did each have different individual ways of coping with problems, and for Lillian it had apparently been too much. I thought she was making it harder for herself by trying, at this point, to look for all the shortcomings she may have felt in herself as a mother; that parents are human and they do make mistakes. Nevertheless, children generally have the health and strength in them that enables them to grow and thrive in an imperfect world. Lillian's condition was something beyond this, and I thought that if Mrs. Fox and her husband could mobilize the strength that is in them to help her now, ño more could be asked of them as parents. Mrs. Fox relaxed visibly, and told me that after all, her son, too, had gone through a terrible ordeal, and had been able to cope with it; nor had she and her husband been broken by it. She guesses that there are those differences in people, but she had never suspected that Lillian could be broken by any trouble. She had always seemed so strong to her. I thought that the strength that Lillian had in her was what gave hope to her getting better. It would be this that would enable the doctors to help her. I brought out that Mrs. Fox keeps talking about hospitalization as an accomplished fact. I was inclined to think that this would be necessary; but actually all we could gear ourselves to at this point, was the examination. I thought that this in itself was a pretty big step for them and for Lillian to take. For that reason, I wanted to help them prepare her for this and help Lillian myself, as much as possible. I thought that we needed her will too, to get better, and her participation in this step to the extent that she was capable of it.

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W e then talked about Mrs. Fox's fears about handling Lillian. Since she has been expressing so much hatred towards her mother and fighting her in everything she suggests, she thought that it would really be up to me to help Lillian, and that Lillian did seem to respond to me in an entirely different way. I said that Mrs. Fox had a right to feel resentful, at this, when she was given so much, that I who can only play a very temporary part in their Uves, should have less trouble in getting across to Lillian. Mrs. Fox quickly replied that she does not resent this at all; she is very grateful, because she would not know what to do without it. I said I thought she could trust herself much more than she does, and that it is not the knowing that is involved, b u t the difficulty for her of beginning to approach Lillian as a sick child, when all her life she has been accustomed to treating her as a well one. After all, I was not Lillian's mother, and did not have that problem to contend with. As for Lillian, I could assure her that she needed her now more desperately, if anything, than she ever had, and that neither I nor the doctor could ever take her place. It was not Lillian's lack of need for her that made her so upset at her, but her overwhelming need of her, which at this point was the need of a sick person and could not come out the way it had when she had been well. Mrs. Fox said that she noticed that I did not try to reason with Lillian, and she has tried to stop doing this because it is that kind of thing that always precipitates the worst difficulties. I thought it was much harder for her than for me to do this, both in terms of her feelings and their relationship, and in terms of the special experience that she could not expect herself to have. I did think, though, that she could trust herself more than she has done with Lillian, if she could blame herself less. W e talked about the fact that I would try to help prepare Lillian for this next step, and that she and Lillian and I would get together briefly to talk over Mr. Fox's coming after I spoke to Lillian. When Mrs. Fox and I entered the waiting room, Lillian began to complain to me that her mother had ordered her to do the ironing at a certain hour when she wasn't ready to, appealing to me to tell her whether it was right for her mother always to make her do things the way she wanted them done. I knew that she and her mother had been having a pretty hard time together, and I thought they both wanted to make each other feel well, but it was hard to do this when they were upset. Lillian came along with me, but not before she turned to her mother and said, "Mrs. Brody is going to talk to both of us, isn't she?" Mrs. Fox said she would like that, too, at which Lillian turned to me and asked whether I didn't think she had the nicest mother in the world and also the prettiest one.

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After Lillian was seated in my office, she remained quiet for a while, looking around the room and stopping to examine or comment on each detail. She then said that this is the kind of place where you could say what you feel, even if it seems very petty, because petty things can be very important. I was glad that she felt this way, but I thought that she also knew that we were talking about her, and that she was very important and not petty at all. Lillian was glad that her mother had come here, because she seems to feel so much better since she has been here. She is starting to look young again, although for some time now she has been looking old and ill. I knew that it has upset her to think that her mother is worrying about her. I said that her father, too, was concerned and that he was going to be coming in here in a few days. I wondered whether she would like to come along, and then I could talk to all three of them together. Lillian became quite excited and interested, saying that her father is the most wonderful man, but he has been looking very bad, too, lately, and that has worried her a lot. She would like to come because after all, their family is like a team and if one is separated from the other, or they are not all pulling together, then they all become sick. I thought that they, too, missed not being able to get together with her like a team, as they used to when she was quite well. It was because of that I was seeing her and them, too, so we could all decide about how she could become quite well again. When she said nothing, I asked whether she wondered what I meant by this. She laughed, saying that I must be talking about going to a doctor. She hadn't liked the doctor who gave her shock treatments. She realizes that he must have helped her, because she began to feel better after seeing him. She would have no objection to going to see somebody else, since it is always possible to be better than you are. I said I felt sure that she did not want to prolong the way she is feeling, even though she might be a little afraid of going to see a doctor. I said that after her father came, I would talk to all three of them about the doctor I had in mind, and they would then decide about it. Today, however, I was going to see her and her mother together. Lillian began to laugh at this uncontrollably, and when I returned with Mrs. Fox, we found her still giggling and talking to herself. Although Mrs. Fox began to get tense, she was able to look at Lillian, turning from her to me alternately, as though she was comparing us and at the same time studying what brought us together. Lillian began to say that social workers are awfully important people. Many individuals do not realize this, but social workers really can settle problems that come up between different countries. I wondered if she felt that I had something to do with the way she and her mother

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are getting along, and with bringing them together here today. She replied very earnestly that she thinks they get along much better since they have come here. She then began to talk about how immature and young-looking her mother is, while Mrs. Fox began to squirm. She told Lillian not to say such silly things, which made Lillian turn excitedly to me, asking if I thought that was silly. This is the very thing that has been confusing her all this while; she really has never known just who is who. Sometimes it feels to her as though she is the mother and Mrs. Fox the daughter. While her brother was away, for example, she was much more worried about him than Mrs. Fox, just as though she were his mother. Even when she was a little girl, Mrs. Fox didn't do very much for her. She always felt like the responsible one. I thought that she had had a great deal to contend with when her brother was away, and it was for that reason that her mother, she, and I were together here, to talk about getting help to make her feel better. Mrs. Fox began to look very apprehensive and Lillian promptly told her that she does not know why she worries so. If Mrs. Brody thinks they ought to go to see a doctor, then she will go. There is no reason to go around worrying and crying over such a thing. She knows that she feels much better and that she is in her right mind, although she realizes that she is still nervous. Mrs. Fox addressed her gently, saying how glad she is that Lillian will go. Lillian, however, told her impatiently not to go around with such a long face. I remarked to Lillian that she probably wouldn't like it at all if her mother weren't concerned about the way things go with her. She then began to laugh uncontrollably again and after a while said that it is funny about families and how they get on each other's nerves. Her brother is getting on her nerves too. She thinks that he really needs help. She does not like the way he talks to her. She is beginning to conclude that many people are very jealous about the fact that he managed to come home unharmed, when so many other boys did not return. With increasing excitement, which made Mrs. Fox squirm in her seat, Lillian explained that nobody really understands what she went through. Her brother doesn't understand it either, even though all through the war she was flying right in the plane with him. After I talked with her quietly, saying I thought she was entitled to a much easier time than she has had and that a doctor could help her with this, she subsided. I then reminded her of our next interview, when her father would be coming and I would be seeing her and her mother too. Lillian laughingly said that the whole family would be together then, and she thought this was very funny. After all, her brother is back now, and they should all be happy and pulling together. Instead, all of them are unhappy, except herself. I said that I, too, would look forward to seeing them all, but today our

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time was up. Lillian was continuing to talk with great excitement and was having difficulty in leaving. I made no attempt to handle this, saying to Mrs. Fox that I would leave it to her to help Lillian leave. Mrs. Fox turned to Lillian in a very patient way, saying to her that she wanted her to come along with her because they were going to have a nice time that afternoon going to the movies together, and that they had better not leave the office too late. 10-18-46: I had talked over with Mrs. Fox, in the interview of 10/16, my purpose in talking with the neuropsychiatrist that had seen Lillian, explaining that it would help us and the hospital to know whether they should be seeing her for possible admission. Mrs. Fox was quite willing to have this done, and pleased that I would do this before she and her husband came in. From both doctors I received the same diagnosis: schizophrenia, hebephrenic type, with the recommendation of shock treatment, hospitalization and psychotherapy. There was no indication from their observation, that there was any hazard in our helping Lillian in this, on the basis of their past experience and what I could tell them about her present behavior. Later I talked with the admission psychiatrist at the state-endowed hospital to which I was referring Lillian, describing her present condition and the conclusion of the two doctors who had examined her. The psychiatrist was willing to consider Lillian, and an appointment was arranged for the afternoon following our next conference. Third Interview, 10-21-46, Mr. and Mrs. Fox and Lillian: Mr. and Mrs. Fox and Lillian in early for appointment. When I greeted them, Liliian was laughing and giggling, much to their embarrassment, and asking whether they, too, did not think it was funny for all of them to be here together. She sobered up quickly when I said it was awfully important for her and for them to be together in anything concerning her. Mrs. Fox, who was remaining behind with Lillian while I was seeing Mr. Fox, was able to turn to Lillian with some ease, suggesting that they both sit down and read while they are waiting. Mr. Fox is a short, thin man with a worn, harassed look, who seems considerably older than Mrs. Fox, although in actuality there is just two years' difference. He sat down timidly and could not venture any comment. I said I knew how concerned he must be about Lillian, and that I had been eager to see him, since I was really not able to help Mrs. Fox plan for their daughter without his being part of it. He said eagerly that he was relieved when Mrs. Fox told him about the ap-

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pointaient. The thing preys on his mind all the time; his health is being undermined. He is not even sure how long he can continue working. He talked a little about his son and the strain they had gone through because of him. I recognized that they had had one severe blow after another, and thought it was pretty remarkable the way they had been holding up and going ahead with making plans to help Lillian. Mr. Fox said that he had felt for some time that Lillian needs to be in a hospital, but that Mrs. Fox was reluctant to take this step. He feels this is the only solution, and wants me to help them arrange this. I agreed that it was very likely the best solution, but nevertheless an exceedingly painful and difficult one. Mr. Fox's eyes filled with tears. He said that he was becoming desperate and that if this continues, they will all fall ill. He had a lot of confidence in me because of what his wife had told him, and felt that I could help them get Lillian into a hospital. I was glad that he could feel this way, but the fact was that it was he and Mrs. Fox who would be the ones to have to take Lillian to the doctor for examination and then to the hospital, if she was to be accepted there. That I could not do for them. Mr. Fox said that nevertheless I could make it easier for them to go through with this. He knew that Lillian liked me and was more likely to go if I encouraged her. I thought I could help with this, and that often a trained person outside the family has to help along, not because they are helpless but because Lillian really is ill. They would not be here if they were helpless, and my encouraging Lillian would in itself be fruitless without their having the courage to go through with the difficult step of getting her to the hospital. Mr. Fox said that somehow he and his wife feel that if we all work in this together, they will be able to accomplish this. I was glad that I could be of help to them in this way, because I thought that the part they had to take, even with help, was by far the most difficult. Mr. Fox said slowly that after all, they are the parents, and it is their responsibility to help Lillian. At this point, I suggested that I ask Mrs. Fox to come in, so that we could all three discuss what is involved in the next step of getting Lillian to the hospital for examination. When I came into the waiting room, Lillian looked at me very expectantly. I told her that I thought she was being very patient and wondered whether she could bear to wait a little longer while I talked to both her parents. We would then want her to join us. She said as long as it did not take much time, she would wait. I told her we would be ready for her in about fifteen minutes. Mrs. Fox, immediately upon coming in, began to tell me that something had come up that convinces her that Lillian should be in a hospital. In response to her glance, Mr. Fox said that he had been

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unable to tell me about this because it upset him too much. Mrs. Fox proceeded to tell me that Lillian had gone down to do some shopping for her the previous Friday night, but had failed to return. She stayed away all night. They had had the police looking for her and were frantic with fright. She turned up Saturday moming, and all they could get out of her was that she had been walking with a friend. Mrs. Fox realizes that whereas she had thought it would be a good thing for Lillian to have some duties such as light shopping, it was entirely wrong for her to expect Lillian to take such responsibility. Since this episode, they have not let Lillian out of their sight. Mrs. Fox mentioned that she remembered my having said that it was important for her to be with Lillian all the time, even though it was very hard; but somehow she had not taken this so seriously. I thought that it was terribly hard for her to realize fully that Lillian is ill. Mrs. Fox then said that she has been realizing it gradually, especially after she started coming here. Apparently she had not fully grasped it until this experience. She then asked eagerly about the hospital and what information I had for them about this. I gave Mr. and Mrs. Fox all the factual details, answering some of their questions about the kind of hospital, the auspices, the fee, etc., reminding them again that I had no way of assuring them that Lillian would be acceptable to this hospital. The probabilities were that she would be; but if there was any difficulty, we would then have to find another place. We talked primarily about how they would get Lillian to go to the hospital. They both looked a little panicky at this, saying that she becomes so negative at anything they suggest, that they would prefer if I tell her about it. I agreed that Lillian's condition makes it impossible for them to talk with her normally. I wondered how they would feel about my bringing this up when she joined us. They said that would be the ideal solution. Mrs. Fox said she did not quite know why, but she felt that Lillian's hearing it from me while they were present, and then their all talking about it a little, would be right. I reminded her, however, that I would not be there tomorrow when they have to take Lillian to the hospital. Actually, I did not think I needed to be there, if Mrs. Fox could trust herself more than she does. I know how much she wants Lillian to get well, but I thought that maybe they were not realizing that in spite of how sick she is, there is some spark in her, too, of wanting to get well. Mrs. Fox said that she had noticed that Lillian mentioned during the week, for the first time in a long time, that they would all feel better if she could get a job; and it had made her feel a little more hopeful. I thought it was very hard for them not to know what the outcome of all of this would be;

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and yet, we could not. The only thing we could do was to have convictions about its being right for them to place Lillian in a hospital where she could get the help she needs. Apart from any help I could give them in gaining some cooperation from Lillian, their conviction that they were helping her is what, in the end, would make it possible for them to take Lillian, while the spark in Lillian that wants her to get better would permit her to go along with them. I wondered if we were ready for Lillian to come in now; and when they agreed, I suggested that Mrs. Fox might want to get her. She hesitated at first, b u t when I said that I thought Lillian needed to feel that they were including her, rather than that it was I, Mrs. Fox agreed readily, saying that she would not have thought of it in this way; but she, too, feels that it would be better. Lillian began to giggle when she came in, and referred to the "secret council that has been going on." I said that her mother had brought her in because they did not want this to be a secret from her, nor did I, since it was about her. She interrupted by flinging her arms around her father, talking about how much she loved him and how badly he looks. Mr. Fox was almost rigid in his chair. He was unable to look at Lillian, so great was his distress. I said it was because they loved her that they were here talking with me about getting help so that she could feel better. Mrs. Fox followed this up in a very natural way, saying that I had suggested that they take her to a doctor for examination and he would be able to suggest the best thing. Lillian took this easily and asked about the doctor. I explained where he has his office and that he sees people in order to find out what is bothering them and if there is any way in which the hospital can help. Lillian wanted to know if she would have to stay there after he saw her. I assured her that she would certainly be going home after the examination, but that I did not know whether the doctor would recommend that she come back. Mr. and Mrs. Fox were quite tense during this exchange between me and Lillian, who suddenly turned on them saying that she did not know why they had to look so solemn. She was perfectly willing to see this doctor because she knows that anybody can feel better. She suddenly wondered who would be going with her, saying it would be nice if both her mother and father went, so they would all be together just like it was here. Mrs. Fox demurred, mentioning the loss of pay involved for Mr. Fox. For the first time, he asserted himself, saying to Lillian and Mrs. Fox both that this is something they could all decide the next day at home, and Lillian quieted down. In leaving, she talked about how glad she was that I was helping her "mom and pop." I thought she was helping them too, and herself as

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well. She said they always like to treat her as a baby, but she is much more mature than her mother. I thought they were all depending on her, and that they could, to keep the appointment at the hospital the next day. On leaving, Mr. Fox shook hands with me and with great difficulty and agitation, told me that I could not know how much I had helped them all today. I said that it was ten days ago that Mrs. Fox first came, and I thought that in that time we had gone as far as was humanly possible. 10-22-46: Mrs Fox telephoned to say that she had had no trouble in getting Lillian to go to the hospital. It had not been necessary for Mr. Fox to accompany them, since Lillian had not raised this. Unfortunately, the psychiatrist was called to court before he could see them, and they therefore had to return the following day. She was, of course, disappointed, but quite confident that she could get Lillian to go again the next day without any special struggle. She mentioned our appointment for 10/28. I thought it might be pretty far off for her today. She thought she could manage until then, but wondered if she could call me after they saw the psychiatrist to let me know about the decision. I assured her of my interest in hearing. This enabled her to terminate the call. 10-24—46: Mrs. Fox telephoned to tell me that the psychiatrist had accepted Lillian after some hesitation. He had told her that there would be a waiting period of from one to two weeks. In Lillian's presence, he had mentioned that she is suffering from schizophrenia. Lillian seemed to recognize the word from her psychology course. Mrs. Fox was quite relieved at Lillian's good behavior throughout the examination, even though she talked about a lot of irrelevant things. She had even asked the doctor whether she could have the treatments at home, or whether she would need to enter the hospital. When he had told her that it would be easier for her in the hospital, she had not protested. I told Mrs. Fox that it was possible that Lillian might get pretty upset within the next few days, and that she should not be too surprised if this happens. Mrs. Fox thought that a week or two was not too dreadful to contemplate. She was arranging for her son to remain with Lillian on 10/28 so that she could come in for her appointment here. Fourth Interview, 10-28-46, Mrs. Fox: Mrs. Fox immediately began to talk about the changes in Lillian since her visit to the hospital. She

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has again taken to bed and will not dress or wash. Mrs. Fox has been having trouble getting her to eat. Lillian's response to any discussion was violent denunciation of everyone, especially of Mrs. Fox. She knew that this was due not only to the examination, which made Lillian realize that she was ill, but to a dreadful incident that had occurred during the week-end. A young man had suddenly appeared, announcing his purpose to take Lillian out. Mrs. Fox said that he not only appeared feeble-minded, but she thought he needed to be in a hospital himself. His appearance and manner frightened her. It developed that this is the young man that Lillian had walked with all night. Lillian had insisted on going along with him, and Mrs. Fox had to resort to physical force, literally pulling Lillian back into the apartment and threatening the young man with police if he did not leave before she could get him out. In her efforts to keep Lillian from going out, she had bruised Lillian's arm, and this had had a very disturbing effect on the girl. She had talked about nothing else but Mrs. Fox's beating her ever since then. I thought that the visit to the hospital and the psychiatrist's recommendation had been a shock to Mrs. Fox as well as to Lillian. With this incident following upon it, she must be wondering how she can manage the next two weeks. It was precisely this that Mrs. Fox wished to discuss, wondering about possible interim plans whereby Lillian could be out of the home until hospitalization. I knew how frightened she must be now at seeing Lillian behaving this way, and how intolerable a strain it was for her and for the others in the family. Yet I wondered how she would actually feel about placing Lillian elsewhere for these two weeks, since she was bound to have to stay in the hospital for an awfully long time. However, if she felt that she could bear to go through with two changes, we could discuss some possibilities. Mrs. Fox thought that she might or might not use the alternatives, but would like to know what they were. I had talked with the psychiatrist at the hospital before Mrs. Fox came in, raising with him the question of possible hazards in the waiting period. He had thought that if Lillian's symptoms became alarming, or if the strain was too intolerable for Mrs. Fox it would be all right to arrange for a temporary stay at a private sanitarium, or even in Bellevue, if they would agree to keep her until the hospital was ready to admit her. If the problem was Mrs. Fox's strain, rather than Lillian's condition, there was a possibility of a psychiatric nurse at home to relieve her for part of the time. I outlined these possibilities to Mrs. Fox, who was inclined to dismiss the private hospital and the private nurse on the basis of

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expense, and Bellevue because she could not bear the thought. I suggested that there was emotional expense involved in any of these alternatives. Mrs. Fox then said that she did not want to get rid of Lillian, but simply wanted to safeguard herself and the family. I thought that this was a very important consideration, but that she also had to consider that she might regret sending Lillian away in the interim. Mrs. Fox began to cry and said that she really could not do this unless the situation became desperate. Actually, the only thing that she really could consider was the possibility of a psychiatric nurse. This she would need to talk over with her husband because of the expense involved. She would then let me know their decision. Her husband and son tried to relieve her as much as possible, but since Mr. Fox is away at work all day and her son is out looking for work most of the time she is with Lillian alone. If things get much worse, she would not feel free about leaving the house anyway, so that she is not sure whether she could use a psychiatric nurse. We agreed that Mrs. Fox would call me to arrange about another appointment, since she had this problem about leaving the house. I assured her that she could feel free to call me at any time during this period, because I thought that it was far too difficult to be alone with it so much of the time for anyone, no matter how strong a person they were. Mrs. Fox was tremendously relieved at this, but said she would only do this if she could not come or if the situation became too unbearable. I thought that she did not need to wait until it was too unbearable. She was entitled to any help that I could give her, for one thing; and for another, we could not know in advance what developments would occur in Lillian's condition during the waiting period and whether, regardless of how determined Mrs. Fox was to stick it through, it might not be necessary to consider some other plan. Mrs. Fox expressed her relief at knowing that she could call on me during this time, saying that it helped her live through this period to have me to talk to. Summary of contact from 11/1 to 11/15 Mrs. Fox was confined to her home throughout this period, but telephoned almost every other day. I was maintaining regular contact with the hospital during this period, and had to inform Mrs. Fox of the fact that it might be three weeks, rather than two, before Lillian could be admitted. Mrs. Fox described Lillian's behavior as increasingly worse. She was using foul language, refusing to see anybody, and was completely unmindful of her appearance. Mrs. Fox was especially upset by Lillian's refusal to take food, fearing that she might become physically ill. I sensed that she had had

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a revival of tremendous guilt about the many months in which she had ignored recommendations for hospitalization, and was feeling any delay as a threat to Lillian's recovery. I therefore told Mrs. Fox that I could not responsibly plan with her during this period without a medical opinion as to what waiting for hospitalization involved for Lillian. I thought that they were both entitled to this and that neither she nor I could gauge the seriousness of delayed treatment. Mrs. Fox responded eagerly to the suggestion for a psychiatric home visit, and was fully prepared to pay the minimum fee of $15.00. She thought that Mr. Fox and her son would also be relieved to have an opinion. I subsequently arranged for Dr. Smith to visit on 11/9. He informed me that Lillian was obviously in need of hospitalization but he was able to assure Mrs. Fox that there was no danger to her recovery in terms of her remaining at home for another week or two if necessary. He also found Lillian's physical condition fairly good, although she was somewhat dehydrated. He had advised Mrs. Fox not to press solid foods on her, but simply to insure that she had nourishing liquid food. In my telephone conversations with Mrs. Fox following Dr. Smith's visit, it was obvious that she had been reassured by him; and although she was under tremendous nervous strain, she felt she could go through this period without any change in plans. What frightened her was the prospect of taking Lillian to the hospital, since she really felt unable to manage her at all. I wondered how she would feel about having Dr. Smith's nurse, who is a psychiatric nurse, visit on the day of hospitalization and accompany them to the hospital if necessary. Because of Mrs. Fox's feeling about having neighbors know what was happening, I explained that the nurse wears ordinary clothes, not a uniform, and that she could be prepared to give Lillian an injection which would quiet her, if this should be necessary. Mrs. Fox felt that the expenditure of $5.00 for this purpose was negligible in proportion to the help it would be to her. I raised the question of who was going to accompany Lillian to the hospital besides the nurse and herself. Mrs. Fox had not given this a thought and at first had planned to go alone. In response to my question, she stated that she had not yet talked to Mr. Fox about this. I had raised the question of whether he could really go to work that day, just as though it were any ordinary day. Apart from this, I wondered why she had to undertake this all by herself, mentioning that she would be returning home alone, and her possible reaction to so much strain. I felt that even with Mr. Fox accompanying her it would take all her strength to go through with this. Mrs. Fox readily said that she really did not want to be alone in this, and that if she were alone, it would mean that

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Mr. Fox would also be, which was probably more than either of them could bear. She was quite certain that he would want to accompany her and that this would be the best way. On 11/14 I called the hospital and learned that Lillian could be admitted the following day. I suggested that the registrar call to inform Mrs. Fox. Shortly afterwards, Mrs. Fox called me. She had made all preparations, and wanted now to conclude arrangements with the nurse I had suggested. I had already been in touch with the nurse, and told Mrs. Fox how she could reach her. Commenting that I was sure that she could facilitate the whole process, I mentioned also that in spite of her eagerness, for Lillian's sake, to have her hospitalized, both the trip and the aftermath would probably be pretty upsetting. Mrs. Fox said that she had just realized this when the registrar called, even though up to this point she has only been thinking about what a relief it will be when Lillian is away. I thought it would be good, in that case, if she could come in to see me again after Lillian's admission. Mrs. Fox eagerly made an appointment for 11/18. She wanted to ask all kinds of questions about what she should do in connection with taking Lillian to the hospital. She was able to leave this when I suggested that in making arrangements with the nurse, she could work out the details of what there was for each of them to do in getting Lillian ready. Fifth Interview, 11-18-46, Mrs. Fox: Mrs. Fox was in promptly for appointment. Although she was looking fatigued, there was a kind of serenity about her. I referred to how different it was for us to be getting together now that Lillian was in the hospital, and was wondering how she was finding it. Mrs. Fox replied that the presence of the nurse had been a tremendous relief and Lillian had responded to her just as she had to me. The nurse had not even had to use the injection. Mrs. Fox went on to say that she simply feels tremendous fatigue, now that it is over, and also considerable relief. She and her husband have already visited Lillian. They had been fearful that she would be hostile and reproachful and would beg to be taken home. To their surprise, she appeared to be quite settled and content, praising the nurses and the general surroundings. I was sure that this felt good to them, but at the same time they were seeing Lillian for the first time among other mentally ill people, which must have been terribly hard. Mrs. Fox began to cry quietly, saying that it had been a dreadful ordeal for herself and her husband, and they were both practically ill after it was over. Lillian had introduced other patients to them. This had felt very queer, since she was behaving as though this were like any other social situation. One young girl, after talking with them for a few minutes,

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suddenly sat down on the floor and stretched out, paying no further attention to anybody. First Lillian had commented that the girl was acting, but after she continued lying there, she suddenly told her parents that she thinks the girl is really mentally ill. In a way it was a relief to her that Lillian was able to differentiate behavior and recognize that there were people sicker than herself. When I said that painful as it was to have Lillian in the hospital, I thought that apart from the treatment it afforded Lillian certain advantages which they could not have given her at home even if they could have afforded private treatment there, Mrs. Fox said thoughtfully that she could see it was easier for Lillian to be surrounded by sick people than by well people. I agreed, and thought also that it was good that Lillian could see that there were people in worse condition than she, and to feel that she wanted to get better, rather than to feel hopeless about being able to be as well as those around her at home. This could be much more encouraging to her than being at home with people whose difference from her could be very discouraging. I talked about how much had been accomplished by the family in a relatively short time. Mrs. Fox said with genuine feeling that I could never know how much I had helped them to see the problem and to start doing something about it. I was glad that she felt this way, but I felt also that unless they had had the courage and will to help Lillian, I could not have done anything by myself. Now that Lillian was in the hospital, I wondered if Mrs. Fox knew about the social service department there, and that they would be working with her. Mrs. Fox had already been seen by an intake worker, but knew nothing about what to expect. When I described the purpose and method of their working with her, Mrs. Fox was very pleased. She said, though, that she wished it would be possible to go on with me. I recognized that it was hard to talk with a new person, but pointed out that I was sure she would feel better about this, too, after she started, since I could not stay close to Lillian and her hospital experience, as the worker there could. She and I had had something together while Lillian was at home with her. I knew that she would want to continue to help the hospital help Lillian, and that they could help her to do this because Lillian was there. There might be a little delay in their getting in touch with her, since I knew they were awfully pressed. In that case, she could feel free to call me if she was troubled by anything that came up, and I could see her until the hospital was ready to begin with her. Meanwhile, she might have some access to the doctor, in which event she might not feel the need to get in touch with me. Mrs. Fox expressed relief in this, and went on to ask questions about the meaning of Lillian's illness.

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In looking back, Mrs. Fox has been remembering certain incidents and thinking to herself that if she had only known somebody like me to talk to when they came up, maybe this could have been avoided. When her son was about five, he was still talking baby talk, even though he was very well developed in every other respect. She therefore went to consult somebody in the clinic, and he got over it. When Lillian was about eleven, Mrs. Fox began to feel that she was too dependent on her and needed companionship of girls of her own age. She therefore suggested a summer camp. She was quite astonished by the vehemence of Lillian's reaction. Even when she told her that she did not have to go unless she wanted to, Lillian kept asking for reassurance. Mrs. Fox seemed to be groping for a connection between these two episodes, in terms of the different ways she had handled her children, which seemed to me to be related to her difference in feeling and her sense of guilt towards Lillian. I commented only that it was easier to think in terms of seeking help for something that she associated with a physical problem than with a way of feeling. In this respect she was like most people. In addition, there was the fact that Lillian's general functioning and behavior were perfectly satisfactory to everyone, including her teachers, the family doctor, and other relatives. Mrs. Fox eagerly told me how all the other mothers used to envy her because of Lillian's maturity. It was almost like having a younger sister with whom she could share things and on whom she could rely. Lillian had always wanted to be very good and grown-up; and, referring to something I had said in a previous interview, she said that she could see that maybe Lillian had needed to be too good. I said that it was hard to know why she had such a need. But it was hard for me also to see why Mrs. Fox felt that she was responsible for Lillian's condition entirely. Lillian, after all, was a person in herself, just as her son was. They were different from each other and from the parents, from whom both received a great deal, at the same time bringing something of their own. Furthermore, the nature of Lillian's illness was such that it could not be explained by any one incident such as she had cited, or others like them. The fact was that the complete basis for schizophrenia was not entirely understood by doctors, many of whom thought that there might be some organic basis for it. In any event, every person has a real struggle to find himself, but not everyone becomes mentally ill in the process, and for that difference in Lillian she really could not take full responsibility. This recalled to Mrs. Fox that a neighbor had told her a few months ago about a conversation Lillian had had with her. She had said a lot of confused and irrelevant things, in the course of which she kept re-

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peating that she was searching to find herself and somehow felt lost. I said that by getting Lillian into a hospital, she was making it possible for the doctors to work with her and help her find herself if she could. Mrs. Fox expressed anxiety about the length of time Lillian would have to be there. I told her that the doctors could certainly not tell so quickly; there might be times when she would even appear worse before she could appear better. In any event, it was certainly a matter of months. She would be discussing this with the social worker in the hospital as they went along, and when the time came that they would be thinking in terms of discharging Lillian, they would help her in planning for this. At this time it was premature to think in such terms. Mrs. Fox replied that it helped her to have an idea, though, of what is involved. She is determined to do all she can to be of help and to be ready to take Lillian home when she is better. Mrs. Fox began to talk about her son, and the fact that he has not made any kind of adjustment. Now that Lillian is away, she is beginning to see what has been happening to him. She expressed a lot of feeling about her neglect of him during this period. Again I told her that I did not understand why she felt that she should have been able to do more than she did. Joseph had come home into a difficult situation and naturally must have been affected by it, as well as by his own experience prior to coming home. I felt that the fact that, so quickly after Lillian's hospitalization, she could begin to relate herself to him was remarkable, considering what she has been through. Mrs. Fox said that she knows that Joseph hasn't been successful in getting into a school and is thinking in terms of work until he can succeed in enrolling somewhere, because he wants to finish college work. Meanwhile, he has been told that his unemployment insurance will be discontinued. I wondered if she was telling me this because she might be thinking of how she could help him. She replied rather shyly that she wants to help him more than any other thing, but wonders whether an outsider like myself might not better be able to do this. I told Mrs. Fox that our agency frequently helps returning veterans and their families in relation to very similar problems; but what I really wondered was whether she was giving herself and him enough of a chance. Lillian had just gone into the hospital, and I thought they might need some kind of breathing spell. The fact was, that this illness had come to one child should be no reason for her to distrust herself and Joseph to work out something satisfactory. I thought, on the other hand, that she was quite right to feel that she would not want to see him continuing this way indefinitely, and if she could trust the changed situation a little while longer and see what they can do with

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it, would she not know better, then, whether she would really need to have our help. Mrs. Fox said with great relief that she is glad that I have brought this out. Actually she thinks that Joseph is a very capable young man who has been held back by the situation. She knows that he would feel better about working it out himself, too, if he could. However, if things did not improve fairly soon and he still seemed to be mixed up, then she would like to call me. In response to my question, she said that she had not suggested this to him as yet, because she first wanted to talk with me about it. When I mentioned that he knew of us as the place that had helped to get his sister into the hospital and might connect us with sick people, Mrs. Fox said that this had vaguely passed her mind and she would want to think about the whole thing more thoroughly if she should need to consider coming in with him. I told her that I would be glad to consider it with her in such an eventuality. Mrs. Fox said that the fact that she could think of us in this way was very reassuring, even though she recognizes that it is her discouragement with herself and the situation at this point that made her think in terms of coming in now. I said that I knew that she would prefer to be without us if possible, and certainly I could understand this. My saying this seemed to relieve her of some guilt about being ready to separate from us, since she remarked that she knows we want people to be able to get along on their own. It was very hard for Mrs. Fox to leave. She sent me her husband's thanks, reiterating that I had made it possible for them to 'live through hell." Again I acknowledged my role in this. At the same time, I expressed my conviction that it was the way they had carried the whole thing through for and with Lillian that had been the most important and most difficult thing to do. In leaving finally, Mrs. Fox said that she hoped some day they could send me an announcement of Lillian's wedding. Later: Telephoned the hospital and talked with the social service director briefly and about the situation, emphasizing Mrs. Fox's sense of guilt and her need to take a part in Lillian's hospital experience. The hospital was glad to know about this and would consider it for earliest possible assignment. 12-9-46: Request for summary of the contact received from the hospital in connection with assignment of case to a worker. It is difficult to say anything about this record because it speaks for itself so perfectly, yet its very perfection and apparent sim-

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plicity rest on a skill that depends for its sureness and direction upon a genuine identification with the purpose, policies, and procedures of this family agency. Here we have an identification no longer maintained by conscious effort but so much a part of the worker's professional equipment that she is able to utilize every aspect of structure helpfully at the right moment. At no point in this record, can one discover the harshness, the inflexibility, the mechanical operation, which are sometimes attributed to functional casework; yet in every interview, we see Mrs. Brody gradually differentiating herself and the responsibility that belongs to agency from that which has to be taken by Mrs. Fox, by Mr. Fox, and by Lillian, in so far as she is able. Mrs. Brody's relation to the parents, and even to the obviously disturbed daughter, is at no point determined by an overt diagnosis but by a progressive exploration with the applicants, of the nature of their request, and of the extent to which the family can sustain it and agency can meet it responsibly. The warm and immediate response to every aspect of Mrs. Fox's problem, both in her family situation and in her application to a social agency combined with a frank acceptance of Lillian as a person, however disturbed and disturbing, create for Mrs. Fox, and to a degree for Lillian herself, the sense of being understood which makes the differentiating process not only bearable but challenging and helpful. There is no way to take the discomfort out of having to admit the need for help, nor, by any warmth on the part of the helper, to alter the negative aspects of having to discover, at the hands of another, one's own denied weakness or even one's potential strength. It is interesting to note how aware Mrs. Brody is of the underlying duality of feeling and impulse as she accepts Mrs. Fox's request that she talk to Lillian but also admits the possibility of pain in this for Mrs. Fox. Her own less strained relation to Lillian enables Mrs. Fox, already feeling help in the situation, to lessen her fear and annoyance, and one sees the initial shift in relationships which the introduction of a new and powerful focus can bring about in a family constellation. It is noteworthy, also, that the extent to which Lillian is able to take her part in the application is not determined by a diagnostic study nor by immediate judgment, but is uncovered by actual process. Mrs. Brody approaches

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Lillian as she would any other client, with sensitive, respectful consideration for the spot she is in and for the way the immediate situation may feel to her. Sick as she obviously is, Lillian can feel the recognition of herself as a person and can use the worker's accurate response to the way things are for her, even when Mrs. Brody brings out the side that Lillian is denying: "I said gently that laughing did not always have to do with feeling happy." In the beginning of the second interview, while Mrs. Fox has not yet been able to hold to a greater acceptance of Lillian as ill, it is interesting to see how quickly Mrs. Brody's entrance into the relationship alters the focus and calms the excitement. Yet all she does is to express her realization of Lillian's distress by indicating her intention to see her and offering to see her before her mother if she feels that she cannot bear to wait. Then she affirms the importance of Lillian's thinking and says that she will see them together at the end of the hour. Again Mrs. Brody uses her own very different relation to Lillian to help Mrs. Fox to realize herself as separate from her daughter. This is furthered by the agency's policy about having to see both parents in such a situation. Much as Mrs. Fox resists the delay and little as she admits the necessity, the introduction of Mr. Fox into the situation restores a balance in the family relationship that has been distorted by a too complete assumption of responsibility for Lillian's condition on the part of Mrs. Fox, a responsibility which it is a relief to drop once the resistance to change is overcome. The worker's firm assertion of the agency's condition: "We could refer them only if we could talk with both of Lillian's parents" is sufficient to bring Mrs. Fox back to her decision to work this through with the agency's help. Backed by the diagnosis of the physicians who had previously treated Lillian, Mrs. Brody is able to hold to a genuine process in time, through which Mr. Fox also begins to take over his share of responsibility. Mrs. Fox gains the conviction that they really can take Lillian to the hospital and Lillian herself accepts the plan. For the remaining period of waiting for admission, Mrs. Fox uses the agency's support as well as its valuable connection with community resources in terms of immediate psychiatric and nursing assistance. Finally, after Lillian is safely inside the hospital, Mrs. Fox meets the problem of ending with agency. Here the end

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is determined, not by the movement of the helping process itself and not by a prearranged allotment of interviews but by the objective accomplishment of the task and by the entrance of another agency, to whose social worker Mrs. Fox will of necessity be related. In the interest of the reader who longs to know how the case eventuated, the following report is added. Lillian remained in the hospital about two months and was given twenty-one electric shock treatments. She was dismissed upon her own insistence, without recommendation from the doctor. Terrified by this unexpected outcome, Mrs. Fox turned again to the agency for help. Mrs. Brody continued with the family but without involving Lillian, until the situation was stabilized about one year from the original application. During this period Lillian improved steadily, took a job, was able to use the help of an outside psychiatrist, and developed a good relation to her mother, who with Mrs. Brody's help, not only sustained Lillian's progress but herself experienced developmental change that altered her relation to every member of the family. Lillian's growing insight and ability to work steadily and with increasing satisfaction led to her discharge by the psychiatrist as a well girl in October 1947.

CONCLUSION Jessie

Taft

IN THE creative utilization of referrals, such as the Fox case, the helping function of the private family agency is clearly in its rightful province. The kind of responsibility it takes for its relation to other sources of help as well as to the family unit seems to me to mark a new level in professional development as well as a new field for counseling. The fact that in referrals the agency has only information to give, might well lead, and often does, to a purely automatic or mechanical contact confined to the initial interview. It is only when an agency becomes conscious of its responsibility for giving information helpfully that it begins to break up the barren referral problem into the elements of an application process and to make its referrals to other resources dependent upon the degree to which they can be made effectively as the result of a helping process carried responsibly by worker and client. The referral case is particularly important because, since the agency has no concrete service to offer beyond its knowledge of resources, it falls clearly under the category of "pure counseling" and yet, because the client is already directed toward an outside goal, his problem in relation to that goal becomes the environmental focus for the helping process around which both family and individual relationships may be reorganized. Here you have the transitional case between the traditional concrete service of the family agency and the newer counseling service which depends quite completely upon its own psychological helping to deal with a family relationship problem that cannot be solved by any use of community resources. Into this middle category fall those cases that present an acute problem with a conclusion to be reached through handling some environmental situation differently. The case will be focused on help to approach the reality situation in 301

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a new way, and will be terminated naturally as the family is enabled to find a new direction that permits it to conquer the environmental block and move ahead constructively. There is no lack of the psychological in this type of case as, for instance, in the kind of process that goes on with the client who has been ill and has lost his courage to apply for and hold a job. But both the worker and the client have always the family relationship and the realistic objective focus which prevent the too great internalization of interest that may so naturally timi into a pure therapy a one-to-one worker-client relation that loses the characteristic differentiation of social agency and reality problem. Even this middle ground is complicated by the prevalence of the case like that of Dr. Gomberg's Miss Black, where there is no genuine family involvement but an emotional conflict that is purely individual so far as the method of working on it is concerned. The problem of the single person would seem to belong to the family agency only as every individual has within himself the family connections on which his personality has been developed but the fact remains that he is not approached through his place in the family unit. It follows that to give casework help in such instances, one must rely on being able to keep the focus on the reality problem. The difficulty of maintaining objectivity in such cases is increased by the fact that agency has no direct relation to the reality factors on which the client is working so that the pull of the helping relationship itself tends to become greater than when it is shared by other members of the family. In the singleperson cases, then, only the client's genuine interest in the external focus and the worker's skill in utilizing agency structures can keep the worker-client relation from drifting into pure therapy. Often the single-person applicant will prove to be interested only in his own personality problem and will resist every attempt to externalize it forcing the worker into therapy or referral to a psychiatrist. There is no doubt that the lone individual in need of psychological help turns to the family agency because he does not know where else to go or because he prefers a social agency to a mental hygiene clinic. There is also no doubt that a skillful caseworker can often help such an applicant through a family agency service, but it is this type of case that seems to me to present a problem that family agencies might well decide to relinquish since

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there are so many authentic family situations that only they are equipped to meet. Family counseling, even when it is confined to genuine family relationships, presents many new and varied problems for functional helping, not all of which have been conquered in terms of policy and structure. Marital counseling as Dr. Gomberg has presented it indicates the results of continuous specific experience, experiment, and analysis over several years. Here is defined a reliable form and structure that has put reality into the application process, mutual commitments on time and fee into the continuing interviews, and an obligation on the partners to work with each other as well as with agency. There remains a relatively unexplored and uncharted area which is far more difficult to handle as casework than referral or marital problems. I refer to the area of parent-child counseling which is defined and practiced in as many ways as there are family agencies and in a variety of ways often within the same agency, where as yet no policy or procedure has been developed to guide the practice of the individual worker.1 One might say that such problems belong to a child guidance clinic and perhaps they do ideally, but actually parents apply to family agencies for help with the fairly normal problems of children and adolescents. They are seldom ready to go to a psychiatric resource and in most cities, there is little hope of acceptance by such a resource within a reasonable time. Moreover, the family agency can and often does work with parent-child cases helpfully. But there remain many problems of structure and process, which will not be determined without greater concentration, specialization, and experiment than has as yet been generally attempted. Is it necessary to see the child, except perhaps the adolescent, or is it always a matter of reaching the child through the parents? If the child is seen, should it be only for a few times with no effort to "treat" the child? If the child is seen along with the parents, does it become therapy for the child and if so is a caseworker justified in undertaking it? Is casework with a young child really possible on a long continued weekly contact basis? Is it necessary to work 1 The Jewish Community Services of Queens-Nassau, a multiple service agency, under the direction of Herbert Aptekar, has established a separate department for parent-child counseling and is gaining valuable experience through this specialization.

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with the father too, or can contact be confined largely to the mother with or without the child? At what point, may an adolescent be carried independently of his parents? Should parents and child be carried by one worker or should the child have a separate worker? All these questions and many more, which remain to be answered, are met in various ways by every family agency but without enough knowledge or experience on a predetermined experimental basis to draw any conclusions or to provide the conviction that underlies marital and referral counseling. Perhaps another two years will see the emergence of parent-child counseling as a reliable service of the functionally oriented family agency. Certainly it should not be undertaken without a deepened awareness of the responsibility to children that such a service implies.