Interrelated casework processes of mother and father in six child guidance clinic treatment cases

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INTERRELATED CASEWORK PROCESSES OP MOTHER AND FATHER IN SIX CHILD GUIDANCE CLINIC TREATMENT CASES

A Thesis Presented to the Faculty of the School of Social Work The University of Southern California

In Partial Fulfillment of the Requirements for the Degree Master of Social Work

by Rachelle Pinkham June 1950

UMI Number: EP66357

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iso T h is thesis, w r it t e n u n d e r the d ir e c t io n o f the ca n d id a te ’s F a c u lt y

C o m m itte e a n d a p p r o v e d

by a l l its m em bers, has been p re s e n te d to a n d accep ted by the F a c u l t y o f the G ra d u a te S c h o o l o f S o c ia l W o r k in p a r t i a l f u l f i l m e n t o f the r e ­ q u ire m e n ts f o r the degree o f

MASTER OF SOCIAL WORK

Dean

Them of,

BACHKELB P3MKHAM

Faculty Committee

....

3X_.£.Jf.£ Chairman

u£ljfl y

TABLE OF CONTENTS CHAPTER I.

II.

III.

PAGE

I N T R ODUCTION ....................................

1

B a c k g r o u n d ....................................

1

Present trends .............

5

Problem and s c o p e ...........................

8

Organization and method

.....................

9

S e t t i n g ....................................

11

Selection of materials .....................

12

CONDENSATION AND ANALYSIS OF C A S E S .............

16

The Andrews c a s e ..............................

17

The Baker c a s e ................................

30

The Conner c a s e ..............................

44

The Dodd c a s e ................................

57

The Eldridge c a s e ............................

73

The Ferguson c a s e ............................

86

SUMMARY AND C O N C L U S I O N S .......................

98

B I B L I O G R A P H Y ....................................... A P P E N D I X ................................................

108 Ill

CHAPTER I INTRODUCTION I.

BACKGROUND

The unit of attention in child guidance clinics has been an integral part of the history of this type of service for children.

This history has evolved out of the impact

between the problems presented to the clinics and the developments in the professional disciplines responsible for their services. The beginnings of the child guidance clinic have been described by Dr. Helen Leland Witmer,^ M . • • as growing out of the convergence of two somewhat independent lines of research and practice.”

On the one hand there was the

development of the mental hygiene movement, and on the other there were the studies of Dr. William Healy, of the offenders coming before the Chicago Juvenile Court.

His studies of

individual children led to the conclusion that delinquency was due to a complex set of physical, psychological and sociological factors.

When the first clinic was established

in 1910 as a result of his studies, psychiatrists, psycho­ logists and social workers were employed to work as a team

1 Helen Leland Witmer, Social Work (New York: Farrar and Rinehart Inc., 1942), p. 459.

2 in the study of these various factors as they affected a particular child.

The unit of attention was on the individual

child. The method by which child guidance clinic practice was carried out at this time was based on a complete study of the child from these various aspects.

After such study, a

diagnosis of the child’s problem was made and a treatment plan was formulated.

This plan usually provided that the

psychiatrist continue treatment with the child and that the social worker explain to the parents, school or recreation workers changes that should be made in the child’s behalf. Dr. Witmer

has said of the thinking of this period, ’’Parents

were regarded as being, in the main, sensible, rational people who would want to do the best for their children.” This approach to treatment was discovered through experience to have certain limitations.

It was often found

that parents had feelings and problems of their own which interfered with their using the advice given.

In addition to

the observation of these personality problems, developments in psychological knowledge brought an awareness of the part of early family relationships as an important contribution to children’s problems.

It began to appear that the solution of

the parents* own psychological problems, would almost by itself

2

• P. 463.

3 dissolve the problem of the child.

The parents ’ own psycho­

logical problems overshadowed consideration of other psycho­ logical and sociological factors.

This brought a new phase

in child guidance clinic practice which occurred first in the early 1920’s.

In this phase, the parent, usually the mother,

became the center of attention for treatment.

This treatment

was usually offered to the parent by the social worker.

The

psychiatrist during this period acted as the consultant to the social worker.

The psychiatrist further made a psychi­

atric examination of the child and contributed to the diagnosis of the problem. This practice continued for adding

over a decade, and although

greatly to an understanding of

the problems ofparents

as disturbed individuals, it was not found to be too effective in treating the problem at hand— the present trouble between parent and child.

To many clinics, there seemed a need for

further developments.

Changes in the theory and practice of

social work and psychiatry about this time provided the stimulation for new developments in child guidance services. These changes were in the direction of a case work and psychotherapy that made greater use of a person’s own capaci­ ties for solving his problems.

These changes in the psychology

of helping were also based on an emphasis on treatment within the present realities.

Dr. Lawson

G-.

s

Lowrey

said ofthis

3 Lawson G. Lowrey, ’’Trends in Therapy,” American Journal of Orthopsychiatry. October, 1939.

emphasis, ffIt became increasingly apparent that a knowledge of the past life and of mental mechanisms was important, but not basic, for therapy*

The therapeutically important point

is the present situation and its management,” This orientation included help for the child as well as for the adult.

Increasing knowledge about the child’s

own capabilities for adjustments and change had led to in­ creased practice in the direct treatment of the child.

The

direct treatment of the child, in fact, developed first and added to the changes in the practice of casework with parents .■ 4 Dr, Witmer spoke of this development, . • . the shift to direct treatment of young children, however, led to changes in work with parents. The wisdom of attempting to treat parents for their own psycho­ logical difficulties came to be questioned, and social workers began to maintain that parents should be accepted in the role in which they present themselves to the clinic; not as mere informants, nor yet as patients, but as individuals who are troubled about a social and personal relationship in which they are involved. The program in child guidance clinics gradually moved toward providing psychiatric treatment for the child at the same time the parent received casework help.

This casework help

was geared toward the parents 1 relationship with the child, not with their own total adjustment.

Rose Green

5

has said of

4 Helen Leland Witmer, Psychiatric Interviews with Children (New Yorks W. W. Norton and Company, Inc., 1946), P * 13, 5 Rose Green, ’’Treatment of Parent Child Relationships American Journal of Orthopsychiatry, 28:442-46, July, 1948.

this development, nThe present emphasis, then, is built on the realization that the treatment of either parent or child is not as effective as the treatment of the relationship between them*”

The unit of attention became that of the

parent and child together, that is of the relationship between them. II.

PRESENT TRENDS

With greater acceptance of the parent-child unit of attention in child guidance clinics, structure and practice developed for working with this unit.

However, in the

struggle around focusing the treatment on the child or the parent or both, not much emphasis was placed on which parent would use the service.

The literature about child guidance

clinics referred rather vaguely to the parent or parents as being involved in the service.

Historically, probably for

cultural reasons, the parent most frequently using the clinic service was the mother. This lack of concern about which parent used the clinic could not persist for long, due to its inconsistency with the reality of the forces in the child’s life. Allen

Dr. Frederick H.

in describing the function of the family in the child’s

growth said, 6 Frederick H. Allen, Psychotherapy with Children (New York: W. W. Norton and Company, Inc., 1942), p. 31.

6 • . • in its (the family fs) functioning a setting is provided for the definition and conservation of human difference and is given objective form in the different but related roles of father-mother-child, the basic roles in any culture. Changing patterns within the American cultural life have further brought attention to the role of both mother and father in the child!s life.

Margaret Mead

7

has written

that, ". • • there is a trend in the contemporary American family for young fathers to do more for their children than fathers have ever done before."

This conclusion was attested

by statements in the child guidance literature of recent years.

A report of the American Association of Psychiatric

Clinics for Children

8

revealed that, child guidance clinics

have become increasingly aware of the interest and partici­ pation on the part of both parents, whereas previously the mother was generally accepted as the person responsible for the continuing contacts. Others in the field have pointed to the clinics * responsibility toward including in the service both mother and father.

Beatrice Greenfield

9

has said of the thinking

7 Margaret Mead, "What Is Happening to the American Family," Social Casework, 28:323-30, November, 1947. 8 Mary F. Carswell, Secretary, Minutes of the Social Workers Meeting of the American Association of Psychiatric Clinics for Children, April, 1949. 9 Beatrice Greenfield, "Counseling in Parent-Child Relationship Problems," Jewish Social Service Quarterly, 14:225-33, December, 1947.

7 at the Children^ and Youth Services of the Jewish Community Services of Queens-Nassau, A child has two parents, both responsible for him in differing degrees* It follows then that in disturbed parent-child relationships, both parents would be in­ volved in treatment to the same extent they are involved in reality. Hose G r e e n ^ has also mentioned the importance of both parents * roles in the childfs life, 11In our culture, when mothers and fathers function normally in their own roles, they provide the essential support and direction which a child requires for his own growth*,! From the standpoint of both the applicants f wishes and the professional purposes of the clinics,

the focus on helping

the parent and child together had begun to be broadened to include mother, father, and child.

Miss Green‘d

has stated

about this, A more significant acceptance of parents, in the role of parents, may affect clinical practice more vitally, gaining impetus and motive power throughout the process, from the dynamic of what brings the parent to the clinic in the first place* It has been an hypothesis of this study that this trend was a constructive one for more effective service*

The problem was

for this trend to be used most helpfully by the facilities of the child guidance clinics.

^

Green, op * cit*

11 Loc* cit.

8 III.

PROBLEM AND SCOPE

The trend toward offering casework service to both parents in child guidance clinics presented many consider­ ations for agency policy and casework practice.

The

additional services needed were not just those for an additional client of the casework staff. was not a separate one.

This new client

He (as the new client was usually

the father) was closely related to a second client with whom he was asking help for a third person, the child.

All three

had a mutual problem--that of their relationship to one another, which relationship problems they had chosen to focus on the child they brought for help. This additional service posed several questions for the social worker.

Should the two parents have the same or

different caseworkers?

What should be the focus of the case­

work service with each parent? service be provided for each?

To what extent should the And what are some of the

special reactions of clients sharing and working on a mutual problem with an agency?

The answering of these and many

related problems will be a gradual process in the field of social work.

This study was not intended to provide specific

answers for them.

It was an attempt to consider this situ­

ation by looking at what had happened when the phenomenon of both parents coming to a child guidance clinic occurred

9 through a family's initiative, rather than through a pro­ fessional conviction as expressed in the clinicfs procedure. This was a study of the social work process in situations where both parents used casework help in an agency that made a conscious use of the focus on the parent-child relationship as the unit for treatment. The purpose of this study was to describe and analyze a limited number of situations in which both parents made full use of agency service. process was considered.

Not every aspect of the clinical

The worker's part in the process,

the interrelationships with the child in therapy, and the parents * movement in the use of service were all important parts of the process.

This study was limited to the inter­

relationships that occurred in the processes of mother and father as they used casework service in a particular agency setting.

It was also limited to the description and analysis

of the interrelationships that developed when both parents used the services of the same caseworker, as this was the practice in the locale of this study. IV.

ORGANIZATION AND METHOD

The presentation of this study has been divided into two sections.

The first section was devoted to a description and

analysis of six case records.

This has been carried out for

each case record by a division into seven parts.

The first

10 six parts consisted of condensations and analyses of the case material in each of the initiating, continuing, and processes of the case. These processes represented

ending . the

logical, though merging and non-compartmenta1 parts of the total casev/ork process.

The seventh part of each case study

was a general analysis of the interrelated processes of the parents as seen in the movement from interview to interview. The condensations of the cases were presented from selections made from the original case material.

The emphasis

was on the recorded activities of the parents in the casework situation.

It has been assumed that the caseworker

responsible part

had a

in the process, but analysis of her activi­

ties was considered to fall outside the scope of this study. The analysis of the interrelated processes has been carried out by the use of a schedule prepared for each part of the process.

The questions asked in the schedule for the

initiating process were geared toward an analysis of the parents1 activities during the several interviews in which they were becoming involved with the Agency, and were coming to a decision about whether or not to use the Agency service. The questions asked in the schedule for the continuing process included those about the parents1 greater consideration of their relationship with the child.

The questions asked in

the schedule about the ending process were aimed toward dis­ covering the part of the parents in their ending with the

11 Clinic and planning to take back the problem to themselves. Copies of these schedules have been included in the Appendix. The second and final section of this study was devoted to summary and conclusions.

These were based on the collected

findings from the individual case studies. The setting of this study was the Long Beach Mental Hygiene Clinic.

This Clinic was an independent voluntary

organization, supported by the Community Chest of Long Beach. It offered psychiatric services for both children and adults, who were living or working within the community of Long Beach.

The services for adults and children were carried out

as two separate facilities of the organization.

This study

was made only from the records of the Child Guidance Clinicservices of the Agency. The Clinic was staffed by a psychiatrist, who was the Director, two psychiatric social workers and a psychologist. They operated not independently but as a team.

In the child

guidance clinic services the parent was offered casework help by the social worker, while the child was offered psycho­ therapy by other members of the team. It was the understanding of the Clinic that not every one can use this type of service.

In addition to having a

problem, there must have been some readiness on the part of the applicant to work with the Clinic on his problem.

Persons

who were able to make payments for the service were expected to

12

do so*

Pees were based on a sliding scale according to income* The plan for treatment was that child and parent were

seen simultaneously by their respective workers*

They might

be seen for an indefinite number of visits, which generally occurred on a weekly basis.

As stated above, when both mother

and father used the casework service, they were seen in interviews with the same worker* The selection of case material was aimed toward getting a picture of the two-parent situation*

It was also aimed at

locating a representative number of such situations which occurred within a certain time period. selection certain criteria were set up*

To achieve this The first criterion

was that of locating cases in which both parents made con­ sistent use of service.

This was done by the arbitrary

selection of those cases in which each parent was seen at least three times. The next criterion set was that concerning good use of services.

In order to be able to study the phenomenon of

interrelationships in the casework process, it was thought desirable to study "successful” cases and not to be side­ tracked by the factors that might have contributed to a "poor” use of service.

Cases were further screened by a review of

the closing summary of each case for a statement about the use of service. In order for the study to have some validity, even

13 within the limitations of the above criteria, care was needed to select representative cases and not just those that might have revealed certain characteristics*

For this reason, a time

period of three years was chosen, and all cases.coming within it and meeting the above criteria were used for this study. The three-year period selected was that of the last three fiscal years of the Agency, the fiscal years being chosen as Agency statistics for these periods facilitated the selection of cases. During this period (November 1, 1946, to October 31, 1949), there were a total of three hundred sixty new and re­ opened childrens* treatment cases.

Each of these cases was

reviewed to learn the frequency and use of service made by both mother and father.

It was found that of this total •

number, there were seventy-eight cases in which both mother and father came at least once for an Interview.

Of this

number, there were eleven in which mother and father each had three or more interviews with the case worker.

It was

discovered that of these eleven cases, two had been closed without a planned ending, two more had not been considered to have made good use of service, and one was still open at the time this study was made. cases used for this study.

The remaining six were the

14 V.

DEFINITIONS OF TERMS

Terms frequently used In this study have been con­ sidered to have the following definitions. Interrelated.

’’Interrelated” is a term which refers

to a state of being mutually and reciprocally connected,

this

connection is further considered to be one of a multiple nature• Process.

In this study the term ’’process” refers to

the dynamic interaction and development which takes place between the caseworker and client from the time the client first comes to the Agency to the time he leaves.

The plural

of the term refers to the processes of two clients with the caseworker.

The processes are further considered to be made

up of three parts, the initiating, the continuing, and the ending processes. Initiating process.

The ’’initiating process” is con­

sidered as applying to that group of interviews in which the client or clients put out their problem to the clinic and are involved in coming to terms with an acceptance of agency service for help with this problem. Continuing process.

The ’’continuing process” applies

to those interviews in which there is a fuller working on the problem.

15 Ending process.

The ’’ending process” applies to that

group of interviews in which the client or clients and the Agency bring to an end the use of service, and in which the clients plan to take back the responsibility for working on the problem without the Agency. Child guidance clinic.

’’Child guidance clinic” is an

agency using the integrated professional services of a corps of specialists to provide psychiatric services for parents and children, primarily around the child’s behavior problems. Ambivalence.

The term ’’ambivalence” applies in this

study to those emotions of opposite and dualistic character which a client brings in dealing with his problem with an agency. Movement.

In social casework the term ’’movement”

applies to the changes and psychological shift in the client which results from his use of casework services.

CHAPTER II CONDENSATION AND ANALYSIS OP CASES Before presenting the six cases selected for more detailed study, it seemed appropriate to present a factor observed in the larger group of eleven cases, wherein both mother and father had three or more interviews at the Clinic* In this larger group, as well as in that selected for this study, there was found to be a correlation between the age of\^ the child and the amount of participation by both parents. In one half of the cases in the larger group' the ages of the children were between four and nine years.

About these

children, the mothers came to the Clinic for an average of eight interviews; the fathers for an average of three inter­ views.

In the other half of the cases the ages of the

children were between ten and seventeen years.

About these

children, the mothers came for an average of five interviews; the fathers for an average of five interviews. This participation as already noted arose out of the natural interest of the parents rather than of planned pro­ fessional procedure.

It appeared that a more active partici­

pation of the father occurred with the older child.

This

factor coincided with the naturally more active role of the father in the older years of the child*s life. Because of this correlation, the eases selected for

17 more detailed study, were presented in the order of the age of the child. THE ANDREWS CASE Family Pictures Problem: Races

Patient, Dan, age 4

Aggressions to other children

White

Occupations

I.

Father, age 31 Mother, age 29

Religion:

Protestant

Father, Insurance Salesman Mother, Housewife

Condensation of the Initiating Process:

Referral: 6-7-48 Mother telephones, she has been referred by her physician. States problem concerns her four-year-old son who has temper tantrums and cannot share with other children. Mother says that she has had a nervous breakdown and child has also had much illness. Initial Interviews 6-28-48 Mother discusses problem of son at once. He has had a lot of physical illness, was on a diabetic diet for two years, also had anemia and scurvy. His present problem, mother continues, is that he fights with other children and always wants to be the center of attention. She says, ffhe is spoiled.” Mother tells more about Dan. His eating habits are poor. Because of his former diet there has been much concern that he get enough to eat. Dan talks back to mother and father, when they try to help him. Mother wonders if she may have pushed him too much. Others have told her this. After a further recital of the problem, mother pauses and says, ’’well, I guess I have told you ahout how it is.” Before worker can respond, mother adds, ”oh yes, I was separated from him for about a year.” She had returned to being with Dan last December. Mother feels there has been too much interference from grandparents. They spoil Dan and offset her discipline. She indicates Dan visited grandparents 2 or 3 times a week, but added, ”we have stopped this now.”

18 Worker comments on mother1s mention of own illness* Mother explains that she had surgery (gall bladder) and this was followed by a nervous breakdown* She elaborates little on this • Mother continues that Dan is affectionate, and she has never turned away when he wanted affection. Mother says of father that he is a kind, gentle person, but not one who would kiss the boy. Mother indicates that father fears Dan is going to be a sissy* Mother asks about inheritance. Mother tells of a sister’s child who is spastic, and there has been discussion in the family a'bout inheritance* She comes back to what a trouble­ some child Dan is* He pulls hair, and he scratches* To mother he seems violent. Worker talks of coming to Clinic to discuss this. Mother is agreeable and talks to worker about bringing child to Clinic. Mother mentions that child fears separation from the parents. Second Interview; 7-8-48 Mother brings Dan to Clinic. She tells of his response to coming. She had told him of their doctor sending them because Dan did not get along with other children. He had responded, ”how did doctor know about that.” Mother does not talk much after this. Finally says, Dan is aggressive and she just c a n ’t stand it. She is sure he doesn’t like'her. Then mother says it is the attitude of her friends that bothers her. They have said something should be done about Dan. But, she adds, these friends d o n ’t have children. Tells of father and herself not taking Dan with them when they go out, wonders what worker thinks of this. Mother says that when another adult takes care of Dan, he gets along beautifully. But as soon as mother arrives, Dan starts picking on other children. Mother says, ”at times Dan stops me.” She had told him she was planning a birthday party, but that it was not going to be fun if no one came because Dan doesn’t get along with them. Dan had replied, ”1 will1 eat the cake all by myself if no one comes.” Before leaving this interview, mother tells of her period of separation from Dan. She had been suffering with an ”anxiety neurosis.” Now her heart bothers her, she has palpitations at night and will get up and play solitaire until she gets control of herself. Third Interview; Clinic with Dan.

7-13-48 Father, without plan, comes to He is quiet in manner, but listens

19 to worker. Worker talks of seeing mother and of the first visit with Pan. Father says of Dan that he is quick tempered and so are parents. Father thinks that time will be a factor in D a n ’s adjusting. He speaks of Dan being only child on maternal side and of grandparents keeping Dan on a pedestal. Father knows mother worries about Dan. Father states motherTs illness did occur because of many problems: D a n ’s illness, financial reverses for father, and frequent moving. He tells of mother’s sister being more neurotic than she. Mother still receives psychotherapy at intervals. Father is generally protective of mother in dis­ cussing Dan, although he states that mother expects too much of a little boy. Father says he is not worried though. Thinks Dan will turn out all right. In talking of Clinic, father seems accepting as long as mother wants it. He smiled about the Clinic’s work with Dan, appeared more interested in mother using service. Fourth Interview: 7-15-48 Mother brings Dan to Clinic and has interview. Worker tells of D a n ’s visit here. Mother listens but has no questions. Mother brings her concern about an incident that occurred that day. Dan, playing with a seven-year-old girl, took a knife and drew it down her face. M o t h e r .spanked him. Dan sought mother’s love after this, which she gave him. Mother speaks of her fear of having Dan with children his own age as he might hurt them. Mother tells of Dan wanting to come here. He has asked, ’’why d o n ’t you do some of these things with me.” Mother wonders if she h a s n ’t had fun with. Dan. She tells of her doctor telling her that she pushes Dan too much. She asks worker if getting an erector set would be pushing Dan. Mother Is attentive to worker’s talking about toys for different ages. In leaving, mother tells again of D a n ’s insistence on having his own way. He kicks and bites his parents if he doesn’t get it. 7-22-48 Mother telephones that Dan is ill. She wants to know if she should come without him. She is advised it is not necessary.> but she can come if she wishes. Mother elects to cancel appointment.

20 II.

Analysis of Interrelationships in the Initiating Process: 1*

Evidences of Joint Decision to Use Service:

The

first contact is made by the mother, who speaks then of only seeking service for herself and child*

In the subsequent two

interviews, mother does mention the father*s concern about the child*s problem*

However, there is no mention of his

coming, until he arrives, without plan, for the third interview. 2*

Participation in the Initiating Process:

Both

parents do play a part in this process, mother in the first two interviews, father in the third and mother in the fourth* The second parent*s coming, although seemingly a matter of convenience, also may be an indication of the parents * wish that both have a part in the acceptance of the Agency service* As mother has spoken of the father*s relationship with the child, this also may be an indication of her wish that he be involved in the changing of the family relationships. 3.

Acceptance of Clinic Service:

This seems to occur

after both parents have experienced the service, and yet also have expressed some reservations and doubts about it.

These

doubts are shown indirectly by mother*s mention of the un­ helpful advice given by friends, and in her wondering what the worker will think of her if child does well at the Clinic* Father shows some hesitancy by being slow to enter into his interview*

He gives an indication of their joint acceptance

of service when he tells of wanting it ”if mother wants it.11 The acceptance of the Clinic seems to be fairly certain when mother calls to ask if she should come even though child does not come for a particular interview.

The planning for future

interviews appears to be with mother only, 4,

Peelings About the Problem:

Both parents see the

child as hot-tempered and relate this to his having been spoiled, particularly by the grandparents.

Differences in

ways that parents see the problem are seen in the mother’s emphasis on the serious nature of the b o y ’s behavior problems, whereas father sees them as unimportant and something the child will outgrow. 5, Child:

Evidences of Closeness to or Separateness from the

Mother tells clearly of her identification with the

child even though she had been separated from him for a year. Mother sees both herself and child as having had much illness. She has great concern about his behavior and indicates con­ siderable involvement with them.

Father, on the other hand,

shows little worry about the s o n ’s behavior difficulties, sees the problem more as being in the mother. III.

Condensation of the Continuing Process:

Four Interviews with Mother - Fifth to Eighth: 7-29 to 10-12-48 There is one month without appointments during August because of Agency summer vacation. During these interviews, mother talks freely but seems more thoughtful about her relationships with her son. Although

22

she does from time to time tell of her exasperation at D a n fs destructive behavior, she seems to have much less need to cling to them. Her discussions of D a n ’s problems change from complaints about his getting along with other children, to more discussion of how he is with her. She talks of their struggles around eating and of his violent reaction when she trys to discipline him. Mother takes hold of discussions with the worker about being firm in spite of this reaction. Mother reports that she believes Dan is doing better. She indicates too that she is more comfortable with him. From Dan's therapy interviews, worker brings up the matter of nursery school for Dan, It is thought a possibility for one of his energies. Mother at first thinks family cannot afford it. Later, as father changes to a job with a higher salary, plans are discussed for this. Mother talks little of father during these interviews, except to indicate that he is supporting her efforts to be different with Dan. She implies that father is understanding of her difficulties in this. Ninth Interview? 10-19-48 Mother brings out in this inter­ view that there are two new things she would like to speak of. One is that now when Dan feels out of sorts, he will deliber­ ately wet all over the bathroom. Mother handles by having him clean up with her. Mother wonders if he may have done this in response to something she may have done. She at once decides against this. Mother discusses dirtiness of this habit. The other matter is that there are not so many temper tantrums now; she believes she knows better what to do about them. They do happen once in a while but no longer puzzle her. Mother then tells of Dan not wanting to wash his hands. Father has been joining Dan in the bathroom and then Dan finds it fun. However, mother feels that father is easily angered at times about Dan. He shows this. Mother says she would like father to come in next with Dan. She says father makes fun of Dan. Mother tells of father being an athlete in high school, and both parents regret they did not go to college. They are anxious for Dan to have this opportunity. Father has already picked out college. Mother says father is a very positive person in what he does. Says father becomes angry when sees Dan afraid, calls him a sissy. Wants to rough house with Dan, but Dan is terrified. Mother then tells of D a n ’s playing. He can ride a whole block on his tricycle* She wonders about his getting hurt. She tells of many injuries in her childhood.

23 Tenth Interview; 10-26-48 Father is in office* He comments that worker wanted to see him. Worker tells of mother having spoken about talking to father of how he is with Dan. Father accepts this, but indicates he feels pretty comfortable in his way of being with Dan. He feels that Dan is responsive to him; it is mother’s anxiety about it that needs exploring* Father brings then, his concern about mother. Speaks of the cost of her medical care. Says it is all right, but he does want to see an end to it. Father says mother was brought up meticulously, that there was never dirt or disorder. Father gets mad once in a while when mother must have Dan so clean. Father wants Dan to be a real boy. Father concludes that mother is doing better and tells of her being less concerned about D a n ’s eating. Father tells of moth e r ’s concern about her sister who is neurotic. Worker tells father about the adult psychiatric service at the Clinic. Father is interested, thinks worker should talk to mother about it. 11-2-48 Father telephones to- say family not able to keep appointment. Eleventh Interview: 11-9-48 Mother is in office. It is apparent she is disturbed. Brings new content about father. She is near tears but struggles for control. Mother says that father is drinking. She indicates he has always been a heavy drinker. During an interval such as now, when he is between jobs, he drinks a great deal. Mother even thinks of separation. Says her doctor knew about this and one of the reasons she was at a sanitarium last year was father’s behavior— his drinking and the marital relationship. She tells of her own family and that she could live with them. Mother says she cannot let Dan go with father to the home of paternal grandparents. Yet if she didn’t they might go to court and try to point to her as an inadequate mother, with a history of nervous breakdowns. Mother weeps. Worker is supportive in discussing this. Mother says she would like father to see a psychiatrist, but he Is not a person to ask for help. Mother tells how father belittles her, blames her for his inadequacies. Mother feels he has great need for money and success. Mother is quite upset and worker offers extra appointment before Dan comes next week. Twelfth Interview? 11-16-48 Mother telephones stating father would accompany Dan as she is not well. Says father not informed of mother’s interview with worker.

24 Worker talks to father of parents and Dan coming here and of how long plan is to continue. Father responds by saying that Dan is playing better* He is sure he will get along all right now. Father thinks mother ought to go talk with someone every three months* She is better after sho has. Father states that he understands that mother is not always well now, and how hard it is for her at these times. He states too that when mother is sick, Dan is sick too, as boy worries. Father tells of motherfs intense worry over polio. Worker speaks to father directly about this making him angry. Father says he is not a person to be angry, rather he may be silent for a couple of days. Father says he doesn’t worry as long as he can pay the bill. Father tells of incident that lead to mother’s going to sanitarium: she had taken an overdose of a bromide. Father gives no indication of pending separation, although he shows some irritation about mother’s frequent illnesses. He is planning to have mother help him in his new store when it opens, believes it would help to keep her busy. IV.

Analysis of Interrelationships in the Continuing Process: 1.

Focus of Interviews for Each Parent:

During these

interviews with mother, the focus is at first on the motherchild relationship, for a period almost no mention is made of father.

Mother slowly brings more about the father-child

relationship.

In one intense interview, after one with the

father, she brings out all of her feelings against the father and even talks of separation. With father, the focus is also generally on his re­ lationship with Dan.

He relates most of the trouble, however,

to mother and her illness. the costs of her illnesses.

He talks of his annoyance with

25 2.

Feelings About Self as Parent:

herself as a concerned but unsure parent#

Mother talks of She sees herself

as close and affectionate to the boy, but not sure of how to be mother to him.

She is also fearful he may get hurt#

Father believes he is comfortable with his son# 3#

Feelings About Other Parent as Parents

Mother

believes father is short tempered and rough with son, that he terrifies boy#

She indicates vaguely that father does

not help her much with the discipline#

Father sees mother

as being an ineffective parent because of her anxiety and illness#

He sees her as too particular about D a n fs cleanli­

ness and too fearful about him# 4.

Evidences

of Working onthe Parent-Child Relation­

ships as Expressed in Ambivalence About the Child:

Mother

tells of her interest in the boy, and yet of her extreme annoyance with his behavior# of worry about the boy#

Father tells mostly of his lack

He does mention though that he

believes the child has been spoiled, and is not the "real boy11 he would wish# 5#

Reports of Changes in the Parent-Child Relationships:

As interviews progress, mother tells of being more comfortable in disciplining child.

She tells of fewer temper tantrums

and states she knows

better how to

has felt problems of

boy lay in the mother-child relationship,

reports improvement in the latter#

handle them# Father who

Father does not speak of

26 changes in his own relationship with boy although he does show changes in his attempts to have understanding of mother. V.

Condensation of the Ending Process:

Thirteenth and Fourteenth Interviews: 11-30 and 12-7-48 Mother seen in both these interviews is much calmer. Ending is discussed with her again, and mother begins to plan for it. In reference to the interview about marital problems, mother states ’’there are ups and downs like this.” Mother discusses with worker sending a friend of hers to Clinic who is also having trouble with child. In the last interview, mother talks about herself and Dan. She believes coming to the Clinic has helped. Friends and relatives see Dan as better and mother as less concerned. VI.

Analysis of Ending Process: 1.

Part of Each Parent in Planning Ending:

is first discussed with father.

Ending

He states boy is playing

better now, and apparently believes ending is indicated.

He

has some question about mother leaving, and believes she ought to see someone every three months.

Ending is discussed

with mother, who accepts it in a positive fashion.

She talks

of sending friend to Clinic. 2*

Confidence in Going on Own Without Clinic:

Mother

believes things are going much more smoothly with child and herself. marriage. child.

She states though there are ups and downs in the Father believes things are better with mother and

27 3*

Differences from Beginning in Expressions About

Parent Roles:

Mother talks of her greater confidence as a

mother and of being less concerned about child’s behavior. Father does not talk of his being different with his son, although his more frequent visits to the Clinic toward the end of the contacts may indicate he is taking a more active role in his responsibilities

to his family*

VII.

of the Parents as Seen in the

Interrelated Processes

Movement from Interview to Interview: The initiating process begins with mother speaking of the problem as a l l b e i n g in her child.

She stresses his

fighting, his illnesses and all of the problems his being in the family presents.

She excuses herself for having much

part In this because she has been ill.

By the second inter­

view, mother continues in the same vein but she does begin to think of her relationship with the boy and to speak of her own emotional problems about being with him.

In the

third interview father comes

to the Clinic without plan.

It

is as though mother wants to

continue with the Clinic but

is

unable to face the facts she has begun to discuss in her second interview.

Perhaps by sending father, mother hopes

that he, too, will work on some of his part in the relation­ ship with the child.

Father does not do this, although by his

coming he does sustain the family’s coming to the Clinic.

Mother’s next visit, shows some reaction to father’s not assuming any responsibility and she again blames most of the difficulty on the child*

Mother does take on a small part of

her own responsibility as she asks worker about the kind of toys she should give her child.

In this small way she asks

for help in her relationship to her child* In the continuing process, mother is more free with the worker in thinking of her relationship to the child.

She

works hard on this, expressing her feelings about the child, and begins to think about her responsibilities to him. Mother follows this with reports of progress in the relation­ ship between herself and her child.

For five interviews,

father does not come to the Clinic, but he is apparently sustaining mot h e r ’s coming.

As mother reports progress

between herself and child, she begins to talk more of father and herself and their different ways in child rearing.

Mother

is feeling more comfortable in her relationship with the child and is beginning to wish that father would also work on his with their son.

Father does come to the Clinic for the

seventh interview.

He enters into the interview and sustains

the clinic work but again does not see much difficulty in his own relationship with the child. the one that needs help.

He states that mother is

Following this, mother comes to

Clinic and reacts to father’s failure to work on his part by an outburst of anger at father.

After this interview, mother

telephones that she is ill and will not be in*

Father keeps

next appointment, and although he reiterates mother’s need for help, he does begin to talk of his responsibility in helping mother with her problem. In the ending phase, mother comes again to Clinic. She is calmer and apparently has accepted;that father will not be working on his relationship with the child.

She

accepts some of her own responsibilities in the child's,care. Mother has been helped in this acceptance through the father’s giving some support to her.

THE BAKER CASE Family Picture:

Problem: Race:

Patient, Eve, age Brother, age 2j% Sister, age 1

6

Hair pulling; fearful at night

White

Occupation:

!•

Father, age 32 Mother, age 28

Religion:

Protestant

Father, Mechanic at Aircraft Company Mother, Housewife

Condensation of the Initiating Process:

Referral: 3-31-49 Mother telephones Clinic. School teacher has suggested Clinic as E v e ’s habit of pulling out her hair disturbs the other children. Mother asks numerous questions about the Clinic, particularly in terms of what the examin­ ations are. Appointment planned. Initial Interview: 4-19-49 Mother is at office early. Mother finds it difficult to talk, but slowly tells of the numerous physical examinations Eve has had. Mother had thought Eve may not be receiving the proper vitamins. She has been told, however, that Eve is in good physical health* Mother tells more about Eve, although she cannot give infor­ mation easily. Eve is about average in her general behavior. She does not sleep well, however, and mother wonders if the stories other children tell her are frightening her. The hair-pulling habit began when Eve was two years of age. Mother suddenly mentions that Eve was a thumb sucker when young, and of other people counseling mother to stop it. Mother appears frightened. She tells of using medicine and Eve stopping thumb sucking in two days. Mother wonders if this might have caused the hair pulling. Mother tells of the family situation at the time these events took place. Father was away in military service, and mother lived with his parents for about three years. There were many adults in this home. Mother believes that although they were trying to amuse Eve, they really excited her and gave her too much attention. She says however, that Eve was not spoiled. Mother was working most of this time. Mother states that Eve has been living with just mother and father now for

31 three years though, and she should be over the habit. Worker talks of coming to the Clinic to talk about these things now. Mother tells of what she has done to date. Most of the hair pulling occurs at night, and mittens have been used. But this does not help. Mother says with feeling, that Eve does want to have hair and really is ashamed. School has told of day­ time hair pulling. Mother has tried praise, but there i s n ft much chance to do this. Mother stops and cannot go on. Worker asks about family at present. Mother tells of a boy, two and a half, and a baby, one. There was another pregnancy this year, but mother miscarried. Mother says miscarriage worried Eve and she asked questions about it. Mother says both she and Eve are worriers. Mother tells of father. He loves Eve, often holds her and reads to her. Mother knows Eve is more readily hurt when father punishes her. Mother says Eve is generally happy, gets along well with playmates, and likes pets. Mother then says with feeling that Eve likes to watch bugs and worms in the garden. Father lets her. Mother doesn’t like this. Mother wonders if she may have been too strict. Just before leaving, mother mentions that she has been told E v e ’s habit might be a sexual expression. Second and Third Interviews With Mothers 4-27 and 5-3-49 Mother brings Eve to Clinic on these dates. She raises many questions about how Clinic might help Eve. ”How can you know about the hair pulling, Eve might not do it here.” Mother talks further about referral by the school and the fear this has given mother. Eve likes school and is doing well; however she is an excitable child who loves to sing and play imaginary games. The doctor at school had wondered if Eve is given enough to do. Mother speaks of being mother to three children and how busy this keeps her. Yet she does not believe Eve felt displaced by the new babies. Mother and father are with Eve a lot. Mother wonders if she is strict enough. Others tell her so. Mother tells too of her fears about the hair pulling. ”Will her hair roots be destroyed?” Worker relates these questions to mother's coming to the Clinic. By the end of the third interview, mother brings up the matter of father coming in. It is arranged that the next interview will be with father.

32 Fourth Interview; 5-9-49 Father eomes to Clinic* He seems self conscious* Worker comments on his knowing of the Clinic through mother* He indicates they have been discussing it* He said it was all pretty new to him, but he felt it was all right* Father talks then of his being aware that mother gave Eve a lot of attention when he was away* He believes, too, that living in a house of females as they did then, meant that a lot of attention was given to E v e ’s hair, t!as girls do.” He wonders if this didn’t fix E v e ’s mind in this way* Worker asks about problem now* Father tells of present living arrangements* They are in a housing project. He thinks there are too many demands on children to fit in at a housing project* Father talks then of his little boy, and also of how he was as a boy* Further about Eve, father says that Eve never blows up* The other children, particularly his boy, will hit the ceiling occasionally* But not Eve* Then he tells of her pulling her hair last week until she made another bald spot* However, he says he i s n ’t worried about it, believes Eve will outgrow it* Father does believe, though, that mother is worried, not only about the' hair but what kind of character the child will have* In answer to worker’s comment that three children must tie down this couple, father tells of their not going out much. He hopes when the children are a little older they can do more together. Father says though, that he enjoys his work, likes ^tinkering with motors,” believes he has a pretty full life. Worker asks father about coming again to Clinic* He states he talks to mother about things, but he doesn’t know quite what else he can do* It is left that father will come in if he and mother wish it* As father is standing to leave, he tells of Eve often crying when the brother is punished. He also says that Eve never has a chance to do things, "like pulling up the neighbors’ flowers.M Fifth Interview? 5-11-49 Mother is in office* Worker speaks of father having visited. Mother is silent at first* Later tells of discussing it with father* Mother seems un­ able to say anything beyond, "he agrees with you I guess.”

33 Mother then tells of Eve reminding her this week about a spanking mother gave her two years ago* Mother cannot under­ stand how Eve could remember this--she must be sensitive to discipline* Mother proceeds to tell why children need disci­ pline. Mother tells of Eve taking change from a store. Mother wonders what kind of a child Eve will grow up to be. Mother tells of her own growing up on a farm. She did not play with other children, but she cannot remember doing mischievous things. Suddenly mother tells of her present living in a housing project with many children around, many backgrounds, fears what might happen 1 Sixth Interviews 5-25-49 Mother in office, mentions they almost did not make it today. An accident occurred the pre­ vious night in front of their home. Parents were away but an aunt was with the children. Eve saw the accident and was terribly upset. This morning Eve vomited. Mother feared she might not want to come, but she did. Mother tells with feeling that Eve ’s hair pulling is worse. With tears, she tells of their being sores and bleeding. ,fIt has never been so bad.” Worker asks mother’s feelings about coming under these circumstances. Mother says that before she was confident that Eve wanted to stop, now she wonders if she even cares. Mother tells of an aunt who tells Eve, ”you promised me that you would stop, you disappoint me.” Mother asks if aunt does right. Worker is understanding of mother!s discouragement. Following appointment cancelled because Eve has measles. II.

Analysis of the Interrelationships in the Initiating Process r 1.

Evidences of Joint Decision to Use Service:

first contact and initial interview requests

are with mother.

help for herself and her child.

The She

There •is no

mention of the father’s wish to use the service.

Mother does

speak of the father-child relationship and of his taking part in the child’s daily life.

34 2•

Participation in the Initiating Process:

At the

end of the motherfs third interview, she asks if father can come to the,Clinic* interview*

Father does take part in the fourth

His participation occurs after mother has asked

many questions about the Clinic and has tested her own decision to use the service.

Fatherfs participation appears

to be that of his giving endorsement to motherfs somewhat questioning decision to use the service* 3.

Acceptance of Clinic Servicer

At first, mother

shows a decided wish for help and a concern about the problem. The questions raised by an outside authority may be adding to her concern.

It takes a number of interviews before she

is comfortable in her acceptance of the Clinic.

It is in the

sixth interview that mother is free enough to give vent to her intense feelings about the problem.

Fatherfs acceptance,

although giving an endorsement for mother and child to come, is a somewhat half-hearted acceptance.

Father does not

indicate a wish to participate in the future, and planning for interviews is with mother. 4.

Feelings about the Problem:

Both parents recog­

nize the fact of the problem and that it may have something to do with the childfs life in the family.

Mother is much

more upset about the problem than the father.

She wonders

about its implications for the child*s character.

35 5. Child:

Evidences of Closeness to or Separateness from the

Prom the beginning, mother indicates considerable

closeness to the child*

Part of this is related to a physical

closeness caused by father’s absence for a period because of military service, even though mother needed to work during this time.

Mother tells of a close identification with the

child in describing them both as being "worriers•

Father

states that the child’s problem does not worry him particu­ larly, but he implies that mother is too strict with the girl, and that there may be a problem in the mother-daughter relationship. III.

Condensation of the Continuing Process:

Seventh Interview: 6-8-49 Mother is in office. She talks of Eve 's measles. Mother is more eneouraged about Eve at this time. States Eve does not whine at her aunt so much. Says defensively, though, that aunt does provoke Eve. Then mother wonders if she should stop Eve from whining at aunt. Mother states she is "all mixed up . . . everything she does worries m e ,'1 Mother is much more spontaneous in bringing to worker her concern about Eve. She tells of her disappointment in Eve not being dainty like other girls. Mother speaks with fondness of her own mother, of thefun they had together. Mother does not feel she can be like her own mother. She worries so if children play and jump. Her own mother never minded. Following appointment cancelled as mother has measles. Four Interviews With Mother, Eighth to Eleventh: 6-22 to 7-31-49 Mother is generally more cheerful in her manner during these interviews. She asks worker more directly for help in her relationship with her daughter. Mother is still interested in the therapy sessions of her daughter, but is less fearful about them. She states, " I ’d like to know-maybe it would help me understand more."

36 Mother also talks of father during these interviews. She tells of his wanting her to be less careful with Eve, She also tells of father's scolding Eve and how this upset mother. During this period, Eve visits the farm of the maternal grand­ parents, Mother tells of her feeling when Eve was away. She thinks separation was good for them both, but tells of her pleasure that Eve was happy to return. Tells of the happy time Eve had at the grandparents' hqme. Says worker would like farm too. Mother tells of her leaving home and marrying father when she was 21, A few months after the marriage, father was drafted and mother wentto live with his parents. Eve was born when father was away, he was in combat, and all in all it was an unhappy anxious period for mother. Although there is little change in the symptom of hair pull­ ing, mother does seem less upset about it. She states, too, she is more comfortable in the discipline of Eve, At the end during the

of July, plans are madefor treatment to be stopped Agency's vacation month of August,

Twelfth Interview; 9-12-49 Mother and Eve return to Clinic, They seem happy to be back, but mother is slow to begin again. Most of the talk is about the symptom. Mother believes there is little change, although Eve is happier. Mother tells of father having humiliated Eve recently by commenting on the scarf she wears on her head. Mother says proudly that she herself h a s n ’t said anything to Eve about it lately. /

Next appointment cancelled as worker is out of town. Thirteenth Interview; 9-26-49 Mother again moves slowly in interview. She comments that father wonders about their con­ tinuing. Worker asks how mother feels about It. Mother says she wants to continue, because she feels there isn't anything else to do. Plan is made for father to come to Clinic next visit. Mother tells of how much better Eve Is doing, even though the hair pulling continues. Mother tells of previous day and of how good a day It was for the family. They went on a picnic. There were no scoldings, everything was fine. Yet Eve pulled her hair as they drove home in the car. Mother talks of the problems with her other children. She tells of father losing his employment in the near future

37 because of the closing of his place of employment* Mother thinks this may really be a good thing* It may give them the spurt to go out and do the thing they have always wanted to do--buy a farm* Father is already inquiring* Mother says she is looking forward to this kind of life again. IV.

Analysis of Interrelationships in the Continuing Process: (Only mother was seen during this period) 1.

Focus of Interviews for Parent:

The interviews

with the mother are focused on her relationship with her child-where the greatest disturbance in parent-child relationship appears to be.

There is an occasional reference, however, of

this relationship to that of the mothers with her own family* Mother occasionally talks of father, but usually in regard to his criticism of her* 2.

Feelings About Self as Parent:

Mother talks of

her fears and inadequacies in being a parent*

She speaks of

not being as good a parent as her own mother*

Yet she

believes she has tried to be a responsible mother* 3*

Feelings About Other Parent as- Parent:

Mother

first speaks of father as being loving to the child.

As she

moves into the continuing process, she tells tentatively of his being critical and humiliating to the girl* 4*

Evidences of Working on Parent-Child Relationships

as Expressed in Ambivalence About the Child:

During this

period, mother tells much more of her anger at her daughter, the girl whines, she no longer even seems to care about the

38 hair pulling.

Mother tells too of her disapp.ointment that

girl is not a dainty child.

She tells, on the other hand,

of Eve seeming happier and of doing much better generally* 5.

Reports of Changes in the Parent-Child Relationship:

Little change is reported in the symptom, but mother is less upset about it.

Mother tells of not having to talk to her

daughter about the symptom. about discipline.

She tells of being more comfortable

She is happy, top, that girl has a pleasant

vacation away from home, yet was glad to return.

Mother re­

lives some, through Eve ’s visit, her own rather sudden break from her own family. V.

Condensation of the Ending Process:

Fourteenth Interview; 10-3-49 Father is in office. He is pleasant but slow to talk. Worker mentions motherrs talking of how long family wanted to continue here. -Father talks of their plans to move to a farm. In about three months, he may be so busy planning move that he will be unable to bring mother and Eve to Clinic. He is bringing them on his day off now. Father says the hair pulling is the same. He believes she will outgrow it sometime. He speaks of her getting older, fla girl you know ,*1 and believes this may help. Father thinks mother gets upset when other women and relatives give her advice. He finds it difficult to talk to worker. Worker shares with father the thinking of a conference she has had with therapist for Eve. The therapist believes Eve has shown progress in her general adjustment. In fact she seems as happy and expressive a child as one could expect for her age. However, the symptom does persist. It is the Clinic*s belief that Eve should continue for treatment, with­ out parents needing to participate as often. Father agrees with this plan and arrangements are made for Eve to continue with weekly appointments, with mother and father coming monthly.

Two Interviews With Mother, Fifteenth and Sixteenths 11-7 and 12-12-49 Mother talks easily during these interviews of her day to day life with Eve* She feels Eve is extra happy. Mother has not seen Eve pull her hair for a long time during the day, although it still happens at night. Mother indicates that Eve no longer cries at night* Mother also tells of Eve *s talking back to her. In response to worker1s question of how mother felt about this, mother laughs. Says she knows how it is, because she needs a place for her feelings too. Mother tells of family1s continuing to plan their move to a farm. Laughs as she tells of father buying a wagon that was much too big. Seventeenth Interviews 1-9-50 Father is in office without appointment. He is shy at first, but finally says that family thinks that they should not bring Eve in longer. Worker tells of wanting to plan with family about ending. Father says, ,!that is fine.” He is agreeable to bringing Eve for two more visits. Father states he is sure Eve has improved. When as a little child she was only with females and somehow got off to this problem. Eighteenth Interview: 1-25-50 Mother is in with Eve for the last appointment. For the first time since Eve came to the Clinic she is not wearing her bandana. Her hair has been curled. Both mother and Eve are beaming with pride. Mother and worker talk about this being the last visit. Mother has some question about it being right to end. Mother says that while she was coming to the Clinic, she lost most of her anxiety about Eve. But today as mother was coming for her last visit she felt a twinge of worry again. Mother smiles then as she tells .of Eve saying she is not sure she wants to come any more. Mother says she believes the hair pulling is almost gone. Tells of Eve asking to come today without the bandana. Eve had told mother though that she would wait 11a little about the bandana at school.n Mother smiles at this and sees Eve as gradually changing. In leaving mother says she can see now how as a mother. She laughs and tells how she feelings now. When she gets mad she makes herself, but of course she doesnTt deliver

exacting she was handles her angry up speeches to them.

Mother is warm in her farewell to the worker VI.

Analysis of Interrelationships in the Ending Process: 1.

Part of Each Parent in Endings

Father takes an

active part in bringing about ending, although he tells of it being something that ’’family" wishes. agrees to ending.

Mother hesitatingly

She seems to again, as in the beginning,

need father's help to make the decision about the Clinic. Mother reports the return of a twinge of anxiety in ending, but soon smiles and tells of progress.

Father indicates he

is pleased to be ending and shows, although shyly, that he is now putting his foot down about it. 2.

Confidence in Going on Own Without Clinic:

Mother

has some doubts, but speaks of her assurance that problem is gradually changing.

Mother tells of. Eve being "extra happy."

Mother talks, too, of her own greater confidence in knowing how to take care of her own feelings when with her child. Father still has confidence in girl's growing out of her difficulties.

He implies that now that he, father, is in the

home things will be better* 3.

Differences from Beginning in Expressions About

Parent Holes:

Mother tells of being more comfortable in being

mother to child.

She knows better how to handle specific

things such as discipline and the symptom.

Mother tells, too,

of her own feelings and sees them as being handled in a manner

41 that does not always Include the child.

Father talks of his

role similarly to his beginning description.

However, his

shy though firm ending with the Clinic, may show greater responsibility in his taking part as father in the family, VII,

Interrelated Processes of the Parents as Seen in the Movement from Interview to Interview: In the initiating process, the mother begins slowly

in talking about the problem with her child.

She can only

think of it at first as a physical problem, even though she has been told the child is in good health.

Mother speaks

positively of the child although she wonders if the symptom may be a sexual expression.

She wonders if father and other

adults may have stimulated too much.

After the first

interview, mother talks a little about her relationship with her child.

She soon remembers, however, that she is terribly

busy in her own caring for three small children.

After this,

mother brings up the matter of father*s coming to the Clinic. It is as though she both wants father to sustain her coming and to participate through his work in Clinic on his part in the family situation.

In father*s coming he does give his

permission to mother and child to continue at the Clinic. Father talks too of the child in the home but he places the problem mostly in the relationship with the mother. Motherfs interviews following this are crucial ones

42 for her.

Fat h e r ’s coming has helped her to face the fact

that she can no longer project the problem on him. expresses much pain about facing this. problem with the child is worse. coming in, but she does.

Mother

She reports the

She tells of almost not

Difficult though father’s coming

has been in her having to face her own part, it has helped her to reaffirm her need for clinic help. The continuing process shpws the mother coming for regular and hard working interviews.

She is more relaxed and

talks easily about her relationship with her child and of the problems she has had in starting and establishing a family. She gradually brings reports of the daughter being happier at home.

Mother talks too of her own childhood and of her sudden

break from it.

Her daughter’s visit to the grandparents' home

during this part of the process helps mother to discuss her early life, and to think through her beginning with her own family.

Mother is able to begin thinking of her own feelings

and how she will handle them.

Mother talks of herself and

husband moving to a new life.

With this she talks of ending.

Mother, having taken a step toward ending, finds it difficult to complete the break from the Clinic alone.

Again

father comes to strengthen mother’s b e l i e f that she will be able to work on the problem on her own.

Fat h e r ’s two visits

toward the end of the process help mother in accepting the ending with the Clinic.

Mother and daughter in the final

43 interview show the progress they have made.

Even though the

mother has a little anxiety, she affirms their confidence in the improvement in the problem, and in their future ability to handle it themselves.

44 THE CONNER CASE Family Picture: Problem.: Race:

Patient, Joe, age 7

Bedwetting

White

Occupation:

I.

Father, age 36 Mother, age 35

Religion:

Protestant

Father, Photographer Mother, Housewife

Condensation of the Initiating Process:

Referral: 1-29-47 Father telephones for appointment, school doctor had referred. Receptionist advises that Clinic is for mothers and children. Father makes appointment for mother. Initial Interview: 3-14-47 Mother in office, is tense and ' does not talk spontaneously. She seems interested, however, in description of the Clinic. Mother tells of the problem being bedwetting. A sister-inlaw has gone to another child guidance clinic, and mother had thought of coming even before the school doctor referred. She indicates that school doctor was not even sure they need come. But, mother states, she and father are not the kind to just let a problem go. Mother says that Joe goes to the bathroom frequently in the day, so she wonders if problem is "all emotional." Still doctor has said he is o.k. physically. Mother is silent. She tells of Joe giving up daywetting when 2, but night wetting continues. Parents have tried everything. Mother doesn't think Joe is at all embarrassed by the wetting. He seems to want to get over it, "but does he want to badly enough?" She pauses again. Later mother says spontaneously, "I am kind of neurotic and so is father," "I have kept him a child in spite of not wanting to." . Mother says that Joe and father are closer now than in the past. States she is happy about it. Father, she described as a rather immature person, so that he and Joe cannot get

45 close. She believes this is the age fathers and sons should get closer together. Father is also inclined to use corporal punishment. Mother criticizes father for this and he criti­ cizes mother for raising her voice. Mother smiles at this. She goes on in a more relaxed way to tell of Joe and father having more projects now. Mother tells of another problem around piano lessons. Joe hates to practice, although piano teacher insists. Mother wonders' if she may have dominated Joe in past. She thinks though that lessons are all right as Joe is a child that learns easily. Mother talks of school, J o e Ts being the best reader in class. Mother would like a morning appointment so that Joe w o n ’t miss school. Second Interview; 3-21-47 Mother and Joe are prompt for their first visit together. Mother is again slow to speak. She does tell of J o e ’s response to coming to Clinic. He had seemed eager as he knows his cousin goes. However, on way to the Clinic Joe said, "now I d o n ’t have a problem." It was true that the night before was a dry one. Mother thinks something is already happening. Mother wonders if she is at fault in suggesting so many things for Joe to do. She says, father doesn’t have to spend so much time with Joe as she does. Mother says that father is firm, but it is hard for her when she is with boy 7 or 8 hours in comparison to father’s 2 or 3. Toward end of interview, mother mentions father coming. is decided he would visit soon. 3-28-47

It

Mother cancels appointment as Joe is ill with flu.

Third Interview? 4 - 4 - 4 7 Mother is again slow to talk. After a while tells of Joe having two dry nights. Joe also has talked to her, said, "I can stop when I want to." Mother is not sure if he believes this, because it has long been her idea too. After another pause, mother says perhaps she has not told all of J o e ’s problems. She talks of his negativism. He does not listen to her statements, wants to find out for himself. Worker asks if he seems to be asserting himself. Mother states she had not thought of this, "it helps me think of it that way." Mother thinks she may have spoiled Joe as it is not easy for her to discipline. She feels too much anger when she should discipline. Mother talks of how having a child is different from working.

46 Mother tells of sometimes feeling that she and father have resented being tied down. They are not too happy as they d o n ?t have the money they had hoped so they might travel and do things. At end of hour, mother tells of being disappointed in Joe lately* Joe was unpleasant and aggressive when his cousin visited recently. The d a y Ts activities had not turned out well and Joe had blamed mother for this. Mother could not talk much after this. Fourth Interview; 4-11-47 Mother relates further improve­ ment in J o e 1s symptom. She and Joe feel good about this. After this mother asks about their continuing to come to Clinic, Worker asks if mother is thinking Clinic can do more. Mother says she would like Joe to come longer. Worker asks if mother feels uncertain about coming herself. She denies this, smiles, and says it helps to come. Mother asks worker about a matter she had suggested briefly before, that of her plans to return to work. Mother says that father endorses it, although she is not sure she is physically able to do it. She and worker discuss further. Mother then talks of father and his vocation. He is a person that changes jobs frequently. Mother would like him to stick to one job. She speaks vaguely of adjustments in marriage as the hour ends. II.

Analysis of Interrelationships in the Initiating Process: 1.

Evidences of Joint Decision to Use Service:

first contact, by telephone, is made by father.

The

Through a

misunderstanding, the receptionist (not a professional person) mentions- that the Clinic

is for mothers and children.

Mother comes for the initial interview and for subsequent ones during the initiating process.

The decision to use the

Clinic appears to be a joint one, even though father does not participate during this period.

47 2.

Participation in the Initiating Process:

As

stated above, only mother participates during this period. She speaks often, however, of the father-child relationship. At the end of her second interview, she inquires about father!s coming in. come in.

Although worker encourages, he does not

Mother’s wish for him to participate may be that

she wants him to be helped; she often tells of the child’s trouble with father. 3.

Acceptance of Clinic Service:

Mother keeps

regular appointments although she is slow to enter spontan­ eously into the interviews.

In the second interview, mother

shows evidence of some withdrawal from the process, in her thinking that there may not be much of a problem after all. By the fourth interview, mother talks directly to the worker about continuing.

This bringing out of her question signi­

fies her emotional acceptance of going on with the Clinic. 4.

Feelings about the Problem:

the latter part of the case) similarly.

(Father’s taken from

Both parents see the symptom

Neither seems overly concerned about it.

Mother

sees problem differently from father in her belief that son is negativistic and critical of her.

Father talks of boy

being an only child, as though he wonders if he and mother should have been parents, and if so should there be more children. 5.

Evidences of Closeness to or Separateness from the

48 Child:

Neither mother nor father indicate much closeness to

child.

They express some resentment at not having more life

together because of child.

They frequently speak of their

own interests rather than their relationships with the child. III.

Condensation of the Continuing Process:

Two Interviews With Mother, Fifth and Sixth: 4-25 and -5-2-47 In the first of these interviews mother reports improvement in Joe. Also states she is not as worried about his problem as before. She talks further about herself and of completing plans to return to work. She feels it will be good to be mingling with others and "having some stimulation." In the second interview, mother talks almost entirely of father. She speaks of his being ill and wonders if it could be "psycho-somatic." Mother has been reading of this. Worker wonders if mother has been thinking further of father coming to Clinic. Mother believes father will come to Clinic with Joe for the next several visits, as she may be working. Mother does not seem sure if she wants father to come. Worker talks of father coming as father to Joe. Mother seems more relaxed, and talks further of father and herself. Thinks they are serious rather tense people. Mother makes appoint­ ment for father for next visit. Seventh Interview: 5-9-47 Father comes to Clinic. He is quiet, reserved and very courteous. He does not bring material easily. He tells of Joe, growing up alone with him and mother* Describes problem similarly to mother. Father adds that he and mother are happily married, although there is a normal "number of disagreements." These occur in terms of Joe and frequently around discipline. Father thinks they have pretty well worked this out now. He thinks though a little more disciplining around bedwetting would help. Father shows some difficulty in entering into interview and worker is not sure he will return. Eighth Interview: 5-16-47 Father explains mother is working so he comes. He adds she is getting quite a kick out of working. Says shyly that he thinks it helps all around because mother at night has more interesting things to talk about.

49 Father then talks of Joe and himself beginning to do more things, together. Are talking of going fishing.Father seems pleased but adds, ”it is going to be a bit of aburden onme, I see.” Father asks worker, ”have you ever gone fishing.” He laughs for first time and talks about fishing. Father then talks of his own hobbies and his plans for a vacation. He tells of his hobby of collecting clippings. He has theory that a lot of crime is related to economic in­ security. He tells then of his own experiences during the depression. At end of hour, father comments he will possibly be coming in a few more times, he and mother will share in coming to the Clinic. Ninth Interview? 5-23-47 Mother is in Clinic. She opens by telling of bedwetting being worse. She discusses and ends with, ” 1 know he can stop.” Worker mentions father’s visit. Mother responds by telling of sister’s recommendation that father see a psychiatrist for self. Mother says knows father is different than other people. He is serious and reads a lot. Mother tells of father’s feeling that the normal person would commit suicide in these times. Mother ple_ns to talk to father further about seeing psychiatrist. Mother tells of Joe playing more with other children. She wonders if she watches too carefully, but later explains why it is necessary to watch him. Tenth Interview? mother being 111. physical. Father to work. She had he endorsed plan, people.

6-6-47 Father seen in office. He tells of He believes it is as much emotional as says it was a strain on mother to go back done it as a security measure. Father says as feels mother wanted to mingle with more

Worker brings up subject of Joe. Father says at this point he believes coming a few more times will be enough. He talks of thinking Joe should have more supervised play. Father looks at worker shyly and says he supposes Joe doesn’t get much kick out of just helping father in the backyard. Father tells of his own growing up. He lived in a female dominated environment. Laughs and says it d i d n ’t give him 'much feeling for the female. Things were pretty well dictated to him. He was a person who did n ’t get into vigorous competi­ tive play. He tells of his pleasure now in working in the garden.

50 As interview ends, father mentions mother again. Carefully says that he supposes that mother worries as other women do about having another child. He says they use contraceptives but these may not be fool proof. He concludes that it may be better they go along with just one youngster, .because of the kind of people they are. ‘ IV.

Analysis of Interrelationships in the Continuing Process: 1.

Focus of Interviews for Each Parent:

For both

parents, the focus evolves around the parent-child relation­ ship, although with both, the discussion is centered largely on their own efforts to find their own roles in the family. Parents mention vaguely some marital difficulty although such is not discussed directly with the worker.

Parents mention

these difficulties too as occurring around their being with their son. 2.

Feelings About Self as Parent:

Mother1s statements

about herself as mother show considerable ambivalence.

At

some times she talks of believing that son is spoiled, finds it difficult to discipline as she gets too angry.

At other

times mother "wonders if she dominates son too much, watches him too frequently.t Father sees himself as trying to be more friendly to Joe, more of a pal to him.

He also has some

question about this and wonders if child needs more supervised play away from father. 3.

Feelings About Other Parent as Parent:

Mother

believes father and son were not too close in the past but doing better now.

Mother thinks fatherfs personality problems

make it difficult for him to be closer to son. father to seek psychiatric help.

She wants

Mother thinks father has

easier job as parent as he doesnft have to be with child as constantly.

Father talks of his belief that mother should

have more discipline with boy.

In his questions about the

size of their family, it may be that he questions if he wants mother to be a mother person. 4.

Evidences of Working on Parent-Child Relationships

as Expressed in Ambivalence about the Child:

Both parents

tell of being disconcerted by the demands the child makes on them.

Mother feels that the child»s problem is something he

can handle himself if he wants to.

Mother in the beginning,

tells of s o n ’s good qualities and his abilities, but she mentions few of these in the continuing process, except to report from time to time the problem is improving.

Father

talks of the boy needing recreational activities, and of his wish to provide them for him.

It Is only in a later inter­

view that father tells of his being angry with boy. 5.

Report of Changes in the Parent-Child Relationship

Parents report a gradual lessening of the b o y fs symptom. During this period parents are working chiefly on the readjustment of their own roles in the family.

Mother

returns to work and although it is difficult for her, both she and father are happy about it.

The relationship with

the child Is a happier one, as parents are happier in

52 their roles.

Father continues working on his efforts to be

closer to boy, although he talks of this being a burden on him. V.

Condensation of the Ending Process:

Eleventh Interview: 6-13-47 Father in interview states mother is working. Says she feels better, althoug she had a digestive upset for a few days. He does not comment further on this and is somewhat quiet during the interview. Worker talks of father’s comments about ending. He says it has been a helpful experience for him and mother. He and worker agree on one more visit. Then father poses question, "what do you think of a father that flares up at his child?" He says he was thinking of the other day when Joe kept him from getting off to work. Father was angry about it. He. and worker discuss this. Father concludes that his expectations of the child are too great. Father ends by telling of help he §.nd mother have received. Not too sure he wants to end now. Mother to come for last appointment• Thirteenth interview: 6-20-47 Mother is seen for last appointment. She is rather quiet as in first interviews. Mother smiles when worker tells of J o e ’s contacts here. She says his report card is better.- The marks were always good she says, but the remarks about his relationships with other children are better. Mother says, "the general trend is up." Says the bedwetting is better, shows little concern about this now. Mother says thoughtfully, "oh yes, that was why we came, w a s n ’t it?" Mother says it has been helpful to come to Clinic. "It helped to clarify some ways I thought." " I t ’s different than the way I was brought up." She mentions specifically attitudes about aggression. VI.

Analysis of Interrelationships in Ending Process: 1.

Part of Each Parent in Ending:

Father is first to

mention ending, although when it arrives he has some question about it.

Mother accepts fatherTs decision in this and seems

to be comfortable in ending.

Both parents mention the help

that has been received for all of thorn. 2.

Confidence in Going on Own Without Clinic:

speaks of the general trend being up.

Mother

She barely remembers

the problem of bedwetting and ^appears, more interested in working on problem where it really is in motherTs and father1 respective roles in the home.

Mother tells too of child*s

relationship with other children being better.

Father in

last interview talks more of his relationship with the child and less of his own problems.

He is able to tell of his own

anger at Joe and of his thinking that his expectations may have been too high. 'Father has some hesitations about ending 3.

Differences from Beginning in Expressions About

Parent Roles:

There is considerable evidence during the

progress of the case that parents are active in working on changing their own roles in the family.

Mother, who had

apparently resented staying home and being mother, carrys out a plan to go to work.

Father who talks at first mainly of

his avocational interests and of seeing child as being con­ nected with these, talks in ending of more interest in being with his child, and of his supporting mother in her plans for work.

54 VII.

Interrelated Processes of the Parents as Seen in the Movement from Interview to Interview. Initiating phase begins with mother telling of s o n ’s

problem, she is able to say rather soon, however, that the problem may have something to do with the family relationships, specifically the father-child relationship. herself and father that they are "neurotic.”

Mother says of She also tells

at once of how this may affect the relationship with the child. In the second interview, mother reacts to her rather quick facing of the relationship problem by withdrawing somewhat. She begins to wonder if there is much of a problem after all. Mother continues to come, however, apparently with some support from father who had made the first contact.

In the

third interview mother talks more of herself and her son. She tells of his blaming her for things that have gone wrong. She also asks if she has told worker all of his problems, and although thus projecting the problem on her son, she begins to talk more directly of the parent-child relationship.

After

this, mother talks to worker about her own adjustment as mother, and her plans for going to work.. During the continuing process, mother works on more ways of finding her own satisfactions and yet being mother at the same time.

She speaks of father endorsing her plan to go

to work and then talks of believing that father should come

to clinic.

It seems that mother wants father to sustain the

contact with the clinic, but also that she wants him to have help for himself.

Mother shows some hesitation about father's

coming perhaps because clinic had first been described as being for mothers and children.

She may also fear that he

will not show to worker the type of problems as a father, she has described.

Two interviews do follow with father, in

which he begins slowly.

He may be sensing that mother had

wanted him to come to work on his own problems.

It is father's

second interview, before he begins to think of his relationship with his son, and then only briefly.

When mother next comes

to Clinic, she tells of problem being worse.

She may be

fearing that worker does not accept her projections on father. She talks directly of father needing psychiatric help.

After

expressing this, however, mother can think again of her own relationship with her child.

Father comes for next interview.

He and mother, during this time, show an active working on the adjustment of their roles in the home.

As they work on

this, improvement in the child's problem is reported and father mentions ending. In ending process, father is rather quiet and it seems as though he and mother are ready to end, having worked as much as they can on their relationship problems with their son.

After ending is set, however, father asks of worker

questions of how he should be as father, and expresses some

56 feelings of how he may have erred.

Mother comes for last

contact and shows an awareness of how she has wanted father to be helped.

Although the change and activity of parents

in Clinic interviews is not too obvious, the movement they show in adjusting their own roles as parents is considerable. Mother talks of this adjustment and concludes by mentioning that she believes she has changed in her own attitudes.

57 THE DODD CASE Family Picture: Problems Races

Poor school adjustment;

White

Occupations

I.

Father, age 34 Mother, age 36

Patient, Ed, age Brother, age 8

12

sibling rivalry

Religions

Catholic

Father, Intermittent Employment Mother, Secretary for Business House

Condensation of the Initiating Process:

Referrals 7-10-48 Mother telephones to inquire about Clinic service for her 10 year old son, Ed, On learning that the Clinic will be closed for the month of August, she decides not to plan for an appointment, 3-1949 Two page letter received from mother, in which she asks for a Clinic appointment. She describes problem in detail. She writes that Ed is ’’confused, frustrated and un­ happy; 11 further that his ’’relationship to his parents is unevenly balanced as he is fond of his mother and afraid of his father.” Laters

Letter sent mother offering appointment.

Initial Interviews 4-8-49 Mother keeps appointment. She tells of having written, as she believed it would save time for both herself and Clinic. After worker’s description of Clinic, mother asks about the tests that can be given. She tells of Ed's drawing well although some of his drawings are bizarre. She would like to know if he has ability and if he should be encouraged. Mother talks of the family situation. Mother has worked most of the time since Ed has been in Kindergarten. She thinks he got along well, but recalls that he was ill about 30 per cent of the time. She then tells of herself being hospitalized with active t.b. when Ed was seven. At that time, Ed and his brother had been placed in a farm foster home. The foster parents were young but they had great difficulty with Ed. Mother does not believe they showed favoritism to younger brother, although they had wanted to adopt him. They found Ed hard to manage. Boys were returned home when mother recovered, in about a year. However, she subsequently needed

58 convalseent care, five months in an home after this. mother would want

and boys were placed again, this time for orphanage. Ed was better when he returned She remembers that he seemed just as him, but it did not last.

Shortly thereafter, family moved from Ohio to California as there were openings for workers in the war plants. Ed entered another new school. Here he was noted by teachers to daydream. He began having trouble with other children, and in one instance struck another child. At present time, Ed is in the 6th grade, has a man teacher and there have been no troubles, but mother fears he will have a rough time going to junior high. Worker talks of m o t h e r ’s wish to come to Clinic. Mother says that at present Ed worries about himself. She has found him crying and saying, ”1 am worried.” Mother believes Ed will come to the Clinic all right, although he is nervous when he faces a new situation.Mother talks of father, tells of his coming from a large family with strict ways. He is strict with children, believes parents should have absolute authority. He endorses Clinic only because he feels something should be done. He feels mother has spoiled children, that she spends time in arguing instead of. action. Mother thinks he may come to Clinic. Worker talks of regular appointments for both, and mother agre es* Second Interview? 4-15-49 Mother and Ed are seen at Clinic. Mother comments about Ed having seemed so well as a child, although she realizes now that underneath there was tension, in his first foster placement, a marked twitching was noticed. Father was sent for, but he believed that Ed was simply nervous• Mother talks of father again. Believes he was a good father when children were small, but now that children are older he thinks they can amuse themselves. Ed c a n ’t do this however, he do e sn’t get acquainted with other children and spends a lot of time in the house. Mother tells of wanting father to come to Clinic* Plans for this are made. Worker asks mother what she wants in coming to Clinic. Mother tells of how it seems that Ed is always resisting her* He does not want to take care of his hair, or teeth or bathe. Mother says she may have been a perfectionist about these things, but she has changed now. She adds that father is even more critical than she. He even makes comparisons

59 between Ed and other children. Mother says he.r younger son is better than Ed, but he too is becoming resistant. The two boys argue constantly. She fears leaving them together. Mother concludes that Ed does seem lonely. She believes she is changing in trying to help with this, but believes father needs encouragement* Plans are made for father to come when Ed has psychological test. Third Interview? 4-18-49 Father brings Ed to Clinic. When worker meets him he seems ready to leave. After worker explains appointment with him, he smiles and comes in. Once started, he talks easily, took full interview time. Father begins about moth e r ’s having gone to school many times for Ed. Father has never gone, but mother has relayed their belief that father is at fault. Worker tells of Clinic as different from school. Father is more at ease. Says he believes Ed is brighter than school says (low average I.Q.). Father tells of E d ’s many interests in music, photography, etc. However, he and mother are discouraged at E d ’s short time of interest in anything. Father tells of jealousy between his two boys. Younger one always receives attention easily, even when an infant. But he is rather selfish now, and in fact father believes 75 per cent of the fault lies with the younger brother. Worker asks father about coming to Clinic again. He does not reply, .but proceeds to tell of his own problems. He has a glandular imbalance and frequent drowsy, sleepy feelings. He also has little self confidence. Father says hesitatingly that he wants to tell of something that has often been on his mind. An incident occurred when Ed was about 4 years of age. Father had come home, exhausted from work, in those days he was also doing the housework, and he fell asleep on the couch. Ed had come up and hit father* Father awoke suddenly and beat Ed. Since then Ed has with­ drawn from him. Does not want to go places with father any more. Ed wants to stay home, yet father dislikes leaving boys alone with mother because they fight so. He knows children raise ’’hell with mother.” He makes a few more comments before leaving about Ed quitting easily and fearing he will not be liked. To worker's invitation that he come to Clinic again, father says he will want to.

60 Fourth Interviews 4-25-49 Mother asks at once about the psychological examination. Seems interested as worker describes, but makes little response. Mother does not bring other content spontaneously. Work e r ’s comments are dropped, except as mother brings up that troubles at home continue. Their living is crowded. It is so small that children are always close and they cannot enjoy themselves. Mother states this affects parents too, living so close to one another and to neighbors too. Mother speaks of father not ever being able to enjoy a game with the children. She elaborates on this and tells too of his having worked seven days a week during the first ten years of their marriage. Worker mentions m o t h e r ’s success in working and perhaps father is trying to keep up with this. Mother states she had never thought of this. Says though, that father has never been able to praise boys. In talking of future appointments, mother asks that father also come at times. 4-30-49 Mother calls to cancel appointment, as father is taking an examination and needs car. Fifth Interview: Later Contrary to above, father and Ed come to Clinic. He says his plans were changed. Father talks about jobs but does not bring content spontaneously. Father finally asks if f'you are informed how Ed and brother are spitting at one another." He tells how he has to put up with a lot from the boys. Yet frequently boys come in yelling, ’’mama, I did this.” They never call daddy’s attention. Father then tells of mother receiving a promotion on her job. He tells of how he and mother d o n ’t have much time together because of the boys. He ends the interview by telling of how Ed has at times played with fire. Ed seems to have fear that father will punish, yet father does not believe he has punished severely. Somehow they c a n ’t get together. In leaving, father says he will be continuing to come to Clinic. II.

Analysis of Interrelationships in the Initiating Process: 1.

Evidences of Joint Decision to Use Service:

contact is made by mother.

First

From the beginning, mother tells

61 of the poor father-child relationship.

She talks in the

initial interview of father having entered into the decision to use the Agency,

He endorses Clinic, she says, but only

because he believes something should be done*

She believes

he will come in, 2.

Participation in the Initiating Process:

In

mother’s second interview, she talks of father coming in. It appears that the purpose for the father’s coming is the m o t h e r ’s belief that he needs help in his relationship with his son.

Father is aware of mother’s feeling in this too.

His coming occurs after mother has made some acceptance of Clinic service. 3.

Acceptance of Clinic Servicer

Mother shows con­

siderable impetus toward asking for help, by making two applications.

There was some withdrawal from the first

application, when she did not re-contact the Agency for some time.

Father shows unsureness in beginning.

On the other

hand, he stays for a full interview in spite of his lack of planning for it.

He also shares a good deal of his problem

with the worker.

The acceptance of the Clinic service and a

working through of* hesitations about it, seems to occur at the time mother cancelled an appointment for father and he c ome s ,anyway• 4.

Feelings About the Problems

Both parents see the

problem as a school one, of behavior problems at home, and of

62 the boy being a fearful lonely child. ently, however,

Parents see it differ­

in that father emphasizes the sibling rivalry,

whereas mother talks of the b o y ’s nervous characteristics and his physical problems* 5* Child:

Evidences of Closeness to or Separateness from the

Mother is apparently quite involved in the child's

problem, doing many things about it.

She sees most of the

difficulty, however, as being something in the child.

The

fact that the children have been physically separated from the parents for long periods of time, and yet their returning to them as soon as possible, seems to show a mixture of parents' closeness and separateness.

Mother, whose illness

had brought about the separation, seems to be overcompensating in her activities by being controlling of the children. Father is frank about his lack of closeness, and starts to work much sooner on his relationship with his son. III.

Condensation of the Continuing Process:

Two Interviews With Father, Sixth and Sevenths 5-7 and 5-21-49 There is telephone call from mother in between these interviews. Father begins in both interviews by stating that he came instead of mother because she is tired. He seems embarrassed about stating this. He could not get her to come, "she just wanted to sleep." During these interviews, father talks further of troubles with Ed at home. He expresses some fear of what Ed's behavior is leading to, but his main concern is around how he can be closer to his boys. He says with difficulty, "I would like to find out my kids' feelings to me." He indicates that boys

63 might grow to like him if given a chance to do so. He tells of how mother reaches out to boys and how he feels they lap it up. He does not believe mother is sincere though. Father says he knows he is not effective with the children. Father then tells worker that he believes he and mother should not have married. Were it not for the children, he would have left. He tells with feeling, that not long ago mother was out six nights a week at girl scout meetings. He also tells with difficulty of mother going to Ed's room at night, of her closing the door and talking. He adds quickly, "maybe she doesn't mean anything by it,’1 After sharing this with worker, father seems embarrassed. Worker encourages both mother and father to continue coming. Mother's phone call in between these visits was about the advisability of a physical examination for Ed, Worker advises it would be helpful to Clinic too, 5-26-49 Mother telephones Clinic again to discuss Ed's going to a school camp, Ed has said he didn't want to go but keeps bringing home literature about it. Mother would like therapist to encourage. It is suggested that both she and Ed talk of this at Clinic, Eighth Interview; 5-28-49 Mother and Ed are in office. She talks of Ed's physical examination and of the continuing problems in the home. Ed does not want to eat sweets as the doctor recommended. Mother tells of an accident in which Ed was supposed to have knocked down a little girl. Her parents are asking for damages. Mother says she doesn't know just what happened, but parents have not scolded Ed. They were understanding with him that it may have been an accident. Mother mentions that she believes father's coming here has been of significance, although any change has been slight. Worker talks of different roles of mother and father with children and brings rather directly to mother about her adequacy and what this may mean to father. Mother is agree­ able to discussing this. Laughs and tells of her own mother telling her she is a person who never walks but starts running. Mother tells of passing second in an examination of 300, and of how father learned of this, made no comment to her. But mother learned he had told a friend about it. She realizes he cannot share this with her but is proud of her.

64 Then mother tells of father and Ed at home. The other day Kd came asking for a stool, saying happily, "I am helping dad.” Mother adds though that this expression is infrequent. Ninth Interview: 6-4-49 Parents come to Clinic, suggest they would like to talk to worker together. They begin by discussing their daily activities, errands, etc* They are planning for boys to go to summer camp. They talk of E d fs problems although they do not seem as distressed about them as formerly. Talk of E d Ts unwillingness to undress. Parents do not feel they are overly modest and d o n ’t quite understand. They tell of the family struggle about getting him dressed in time. Both parents thought that Ed put himself in a position of needing pushing. By end of interview parents begin talking to one another. Mother brings out father’s inability to praise. Father feels Ed never earns it. Worker enters and brings up the problems in it for all. Mother does then include herself In the problems when she talks of where she may contribute to some of the conflicts in the home. Tenth Interview; 6-18-49 Father seen in office. He brings E d ’s report card, which shows good grades and also teacher’s comments on Ed's making friends. Father tells though of their considering sending Ed to military school to avoid the home squabbles. Ed is sick about it, he cried all night when told. Father understands how a boy might not want to go. Parents are worried though about supervision of boys during the summer months. Worker talks of other possibilities. Father did not think any of these would work. He indicates mother is in favor of military school plan. Thinks even if she were not working mother might want it. Father tells of his own efforts to be with the boys, but he is not doing so well. Believes boys do not. want him. Father tells of an every evening occurrence. Mother arrives home first. Boys meet mother at door, ready to tell on one another. When father gets home fifteen minutes later things are in a turmoil. Mother thinks boys should not do this, but father thinks should overlook. Mother says she is a good mother, everyone else tells her so. But he feels mother is not. Worker asks if he is concerned about her feeling for children. Father says he would not like mother to be as frank here as he has been. He wants her to continue coming, though.

65 Eleventh and Twelfth Interviews; 6-25 and 7-2-49 Mother is in Clinic* Worker encourages more participation of mother as she has not been here in some time* Mother feels it has helped father* Mother talks of the military school plans. After parents saw how boys felt about it, they withdrew application* Boys have made plans with parents about what to do after school instead, and things are going to-be much better. Mother says, "why is this working,” because therehhas been less bickering with boys all week. Worker mentions then the matter of how long family wishes to come to Clinic, and of wondering if mother wants to think about it further. Mother then says directly that she cannot stand routines of housework. She must be employed. There is a discussion of how this being so, family life is affected. Mother is aware she wants father to be more successful; of how she has tried to encourage but he feels it as criticism. In m o t h e r ’s second interview, she again faces frankly that she is not maternal, but does not feel badly about it. She had not wanted children but is happy once she had them. She thinks she can give children affection even if she works. Worker comments on mother’s honesty in discussing this. IV.

Analysis of Interrelationships In Continuing Process: 1.

Focus of Interviews for Each Parent:

During this

period the focus for father gradually moves from that of the parent-child relationship to that of his conflicts with mother.

Father discusses more of his feelings about being a

husband and father.

Mother’s interviews continue to be on

the parent-child relationship, although she too discusses the father-child relationship a great deal.

She never talks of

the marital situation as such, but does discuss frankly her lack of wish to really be a mother.

In the middle of this

66 process of actively working on their roles as parents, there is an interview with the parents together.

In this, some of

their disagreements with one another are discussed with the worker. 2.

Peelings About Self as Parentr

Mother tends

to

see herself as the one affectionate parent to the boy, and his defender at school .and in the neighborhood.

Later,

however, she can tell her lack of wish to be mother.

Father

tells of his lack of closeness to the boys and of wondering about what their feelings are for him.

He states, frankly

too, his belief that he cannot be close to the boys.

He

tells of his guilt at having once severly slapped Ed. 3.

Feelings About the Other Parent as Parent:

Mother

puts a large part of the problem on the father-child relation­ ship.

She sees him as being strict with the children, of not

wanting to do things with them. his lack of praise Father does

She talks particularly of

for them. not speak as directly, but

every bit

as

feelingfully of E d fs problem being with the other parent. She thinks she is the good parent, he says, but he does not think so.

She does not allow children to be close to him.

He suggests that she would not want to be a mother person even if she were not.working.

She also spends too much time

away from home. 4.

Evidences of Working on the Parent-Child Relationship

67 as Expressed in Ambivalence About the Child: dramatically in this case.

This is shown

On the same day that father

brings Ed*s improved report card, he tells of family’s plans to place boys in a military school.

After family start to

make plans for this placement, they are then able to see how unhappy the boys are about it, and can make other plans to have the boys at home. Mother talks of the troubles boy had in growing up and indicates some understanding of it.

She also tells of annoy­

ance of living with children in close crowded quarters. Father tells of the boy being brighter than he is said to be, but he also tells of his annoyance at the noise Ed makes, and of the boy not liking him. 5.Reports of Changes ships:

in the Parent-Child Relation­

Toward the end of this period, mother talks of the

improvement in the father-child relationship.

She discusses

too her own lack of feeling for being mother, yet concludes that she will be able to give affection to children even though working.

After working through the plan about' the

military school, parents begin to make more constructive arrangements for the boys to be at home.

Mother says after

this that things seem to be fine and boys are squabbling less. During this period father changes from his thinking that Ed does not like him, to

more consideration of

difficulties in being close to the boy.

his own

68 V.

Condensation of the Ending Process:

Thirteenth and Fourteenth Interviews; 7-9 and 7-16-49 Two interviews occur with father. Plans are made for 3 more before ending. He is pleasant and cheerful although he indicates how he feels there is little change. He believes that mother makes more of issues than need be, yet he recognizes his own loss of patience. Father discusses relationship to mother again. He knows she is probably brighter than he. Yet he thinks in some ways he can match mother. Worker tells of mother’s facing honestly her not being maternal. Father states that the last year of marriage has been better, he and mother share more. He brings some difficulties though, and asks if mother ever shared with worker her background as a child, her father, her whole way of life. In fatherfs last interview he speaks of employment plans. He would like a salesman job. He is fearful about locating new job though. In leaving, father states he thinks Ed is the same at home, but believes he is getting along better with other people. Fifteenth Interviews 7-23-49 Mother is in for last interview. She is responsive and pleasant. Believes Sd is playing more with other children. She thinks Ed is some less afraid of father although she feels there i s n ft much reaching out from one to the other. Mother tells then of E d fs becoming interested in puppet shows. He has become very busy at playground with this. She wonders though if he is spending too much time on one activity. Mother in ending states that coming helped us all. She says with a smile that she had wanted father to come as much as Ed. She knows she wanted father and children to be as adequate as she. She decides herself that in future she w o n ’t go to school as much about Ed. VI.

Analysis of Interrelationships in Ending Process: 1.

first with mother.

Part of Each Parent in Ending:

It is discussed

She accepts the plan to end, but after

69 this brings out some material that she has not talked of before— that of her lack of interest in being mother.

When

father discusses ending he agrees to it but reports then that there has been little change.

A s .ending approaches,

however, he tells of improvements with the child* 2.

Confidence in Going on Own Without Clinic:

tells in ending of how Clinic helped them all.

Mother

She tells of

E d ’s better relationship with other children and of his en­ joying outside interests.

She is able to recognize in ending

that she had expectations that Ed and father be as adequate as she.

She implies she now has some acceptance of them as

they are, and she can go on more comfortably on this basis. She believes that father and Ed get along better, although they still do not reach out to one another. Father in ending tells of E d ’s doing better.

Both

parents see that there are still problems at home, but they no longer focus these on the child. 3.

Differences from Beginning in Expressions About

Parent Holes:

Mother in ending faces her own feelings about

not wanting to be a housewife.

She is able to talk of how

she can be mother in her own way.

She tells of having a

lessened need to manage things in her child’s life.

Father

in ending speaks with more confidence of his comparison with mother, and for the first time talks about his job.

Father

shows less conflict about his dependence on mother, he tells of this last year being better than former ones.

70 VII.

Interrelated Processes of the Parents as Seen in the Movement from Interview to Interview, The initiating phase begins with mother’s letter to

the Clinic ; in this she outlines the child’s problem and states definitely where she believes the problem lies. Mother says the child is fond of the mother and afraid of the father.

Mother’s first interview carries this further and

she describes the child’s problem in great detail.

She is

aware that her own illness has had a part in the problem but she does not see any problem in the child’s present relation­ ship with her.

In the second interview, mother discusses

more of the child’s relationships in the home.

She sees the

difficulty as mostly with father, and she begins to talk about his coming to the Clinic.

After this is planned, mother

does talk of her relationship with the child but quickly con­ cludes that she is doing better.

Father comes in hesitatingly

and it appears that he is aware of mot h e r ’s wish that he work on his relationship with the child.

With encouragement from

the worker he does enter the interview and begins to talk about his son.

He shows interest in coming again.

Mother comes in after father’s interview, she is slow to comment and apparently wonders if worker sees the problem in the father.

Mother speaks of father’s difficulties again

and suggests that he return to the Clinic.

Mother does not

consider her part in the parent-child relationships but she

71 sustains the family's coming.

Mother, however, cancels the

next appointment and perhaps Is beginning to realize that it is something that both she and father will have to work on together.

When father keeps this appointment, in spite of

the cancellation, he talks of the difficulties between himself and wife. With this movement of the parents to a consideration of their roles as parents, and their relationship to one another, the continuing process gets under way.

Father is

first to work actively on the difficulties in the total family situation.

He expresses his feelings of resentment of

the mother's closeness to the boys, and of his own feelings of jealousy at being left out.

Father speaks of his in­

adequacy in comparison to his wife and the difficulty this causes in his wish to be closer to his boys.

Mother continues

her contacts with the Agency by telephone calls about the boy's physical condition.

She again sustains father's coming

and his working on the matter.

When mother keeps an appoint­

ment, she reports improvement in the father-child relationship. She begins to consider more her feelings about being mother in the home. together.

After this, both parents come to the Clinic

This coming together seems to signal a greater

coming together in working on the family situation. This is followed, however, with the parents * starting to carry out a part of their rejection of their children, by

almost placing them in military school*

They do work this

through and there follows a more positive planning toward taking responsibility for the childfs welfare and happiness* After this active period, there are reports of improve­ ments in the child's problem.

Worker speaks of the length of

time the family wishes to come to the Clinic. for ending.

Mother plans

She then talks honestly about her lack of interest

in being mother, and recognizes how she had wanted father to take over some of this role.

Both mother and father in their •

interviews before ending work actively on the matter of their roles in the home.

They show greater acceptance of themselves

and the other parent for the part that each can play in the family.

THE ELDRIDGE CASE Family Pictures Problem: Racer

Patient, Al, age 15

Sex offense with 5 year old girl; trouble at school

White

Occupation:

I.

Father, age 55 Mother, age 55

Religion:

Protestant

Father, Unemployed; Electrician by Trade Mother, Housewife

Condensation of the Initiating Process:

Referral: 1-20-47 Local physician telephones Clinical Director. Parents of a 15 year old boy are asking help. The boy has been involved in sex play with a 5 year old girl. It Is suggested that parents call social worker. Father calls later and is given an appointment for that day. Initial Interview: 1-20-47 Father, quite distressed, is seen by the intake worker. He states he has a lot of confi­ dence in his family physician, and therefore had gone to him about this matter involving his son. He has confidence in the doctor's referral here. Father begins to tell his story, quietly at first. -Al has been exemplary in all of his conduct until he entered high school some four months ago. Father adds, "of course there were one or two Incidents when he was mischievous as all boys are." Lately, however, there has been a sudden change, Al has been ditching school and taking things that do not belong to him. Then Father talks, with difficulty, of Al's beginning to go with girls. He Is sure Al never molested any little girl before. Yesterday, the incident occurred which has made Mother and Father "crazy." Father says hurriedly, "he took down the pants of a five year old girl." The girl did not suffer any harm, and her parents are not pressing action. What alarms Father now, is a conversation he had with Al. Al had said he probably would have gone further If someone had not stopped him. Al does not show remorse. Father tells of events that preceded this incident. Al is excellent in athletics, which Father has encouraged. However,

74 after an incident at the flY ff a week ago, father had taken away Al's privileges• Here.father is upset, saying Al had been resentful* The school Dean had recommended taking away these privileges, now father believes it d i d n ft work* He does not know what to do* He wants to check this, "nip it in the bud.” Worker tells of Clinic and how it might help both parents and child in this# Father then tells about the family, of Al being the only living child of the couple* Two other children died in infancy. He speaks with feeling, of Al becoming resentful and mean to mother. She cries about it* Mother is ill at present, but she will be able to come to the Clinic. Worker talks to father about presenting Clinic to Al. Father has no question that Al will come. He again tells of A l fs athletic success* He wonders if A l ’s trouble might be due to the crowd at high school. In talking about the next appoint­ ment, father asks for an after school time, says mother may come in for the next appointment. Fee is discussed, and father tells of being unemployed at present. He is a radio electrician by trade, but his last job was too exacting for one of his age. Plans to return to former employment. Second Interview; 1-25-47 Both parents and Al at Clinic, are introduced to the regular worker and therapist. Parents have made no plan as to which would see worker. After dis­ cussion of this, mother sees worker. Mother begins talking about the happenings of the past few weeks. She concludes, "we have been talking to Al, but we feel he has not been telling us the truth.,T "He tells us what he wants us to know.” Mother tells of the school principal talking to father about their home life, asking if there was something there that led Al to react as he does. Mother tells of their happy home life, of parents being happily married for 27 years, of no trouble, only a few "ordinary disagreements.” Mother speaks of A l fs birth when she was 39 years of age, the loss of the two other children, and how much she has put into being mother to Al. She states slowly, "this happening makes me wonder If I have failed somewhere." Worker relates this to her coming to Clinic and Al coming too. Mother tells of what a lovable child Al used to be, of his saying to mother, "you are the only girl for me." Mother

75 says Al lias always had such a nice, clean look about him. Recently he has been going around with a rougher crowd, he has been "on the gofl a lot, and he seems to have lost interest in the old things* She is puzzled that- change came so suddenly. Mother feels that some of this was to be expected, she doe s n ’t want him on her ’’apron strings." She tells of an incident at a movie. Al had left parents to join other boys. She had remarked to father, " h e ’s outgrowing us." Worker brings up how coming to the Clinic might help mother to think about all this. Mother says, "she would like the doctor to feel Al out," and see where the blame lies. "How she and the mister are at fault." Mother tells of she and father growing up in the old school. Her own mother died when she was 13 and there were five younger children that she raised. She was taught that there was a right and wrong, no in-betweens. Mother thinks that this generation might be different. To worker, "you are a young person who would see this easily." Mother smiles and wonders what it is like to be coming to a "psychiatrist." Mother asks worker if she should let Al go out more. Then mother smiles, says she probably knows the answer, but wonders about being right. Worker mentions dis­ cussing this in interview-s here. Mother indicates that father will be coming in mostly. Her church duties plus her housekeeping keep her busy. She wants to cooperate and will come in "anytime you want me." Third Interviews 2-1-47 Father is serious during this inter­ view. He talks of both he and mother coming to the Clinic. States mother wants to come too, although she is in poor health this day. Worker asks father how he sees coming. Father smiles and says he might have something to learn, "Maybe i t ’s me." Father tells of his not being as alert as mother in seeing that these changes were coming about. Father feels that the incident with the little girl has been a thing of Al asserting himself. Father has restricted Al, and sees the incident as revenge against it. Father talks of wanting to leave Al more on his own now. Has told Al he is going to "turn him loose." Sunday school, staying out late, etc. is up to son. He tells of A l ’s reaction to this new advice. Al seems puzzled, as though not wanting so much freedom all at once. Worker mentions that father may be wondering what Al is going to do with this freedom. Father replies that watching him did not work.

76 Father tells of another incident that Al has recently told him. Al and another boy had sex play with .a girl their own age. Her father had come home unexpectedly. Boys had not been caught, but Al has worried about it. Father told Al he should have come to him earlier and saved worrying. Father puzzles further about s o n ’s need for freedom, although is optimistic about the past week. Wonders if s o n ’s trouble is the company he keeps rather than himself. ‘Father is also pleased with A l ’s changed attitude to mother. He is no longer short and sullen with her. Father brings out that mother did control Al until 15, now it is up to father more. Later worker discusses mother coming to Clinic next week, and appointment is made. Appointment subsequently postponed by worker one week. II.

Analysis of Interrelationships in the Initiating Processr 1.

Evidences of Joint Decision to Use Servicer

From

the first contact there are signs that both parents want help for their son and themselves.

The doetor who calls for the

first contact speaks of parents wanting help.

In the initial

interview father tells of both he and mother wanting to come to the Clinic even though mother is ill. 2.

Participation in the Initiating Process?

After

father has initial interview, both parents come to the Clinic for the second.

Both parents ’ coming occurs as a part of the

impetus to do something about the problem, a time when the trouble is most acute. 3.

Acceptance of Clinic Service?

Both mother and

father show some hesitations about using the Agency service, although neither talk of It directly.

Father tells of having

received advice elsewhere and its not having worked.

Father

77 also wonders In his second interview if the problem may have been due to the s o n ’s crowd rather than anything in the family.

Mother raises questions about the w o r k e r ’s age.

An

acceptance of the Clinic seems certain by the third interview when father begins to consider more of the problem about which he came and less about whether or not to use Clinic service, 4,

Peelings About the Problem?

about the problem in ”w e ” terms.

Both parents talk

They are both aware of the

school difficulties and of the incident of sex play.

They

both talk of the problem as having something to do with the amount of freedom and restraint they provide son.

They both

talk of wondering if they had something to do with the problem. The parents feel differently about it in that the father emphasizes putting a stop to it, controlling it.

The mother

talks of a greater wish to understand the boy and his growing away from her, 5, Child?

Evidences of Closeness to or Separateness from the

Parents themselves talk of this matter.

son has been close and devoted to her.

Mother says

Father talks of things

having been all right until recently, but implies that he was comfortable in a somewhat distant relationship with his son. It appears that the problem of the son and his changing age are forcing upon the family a need for a realignment in their ways of being with him.

78 III*

Condensation of the Continuing Process:

Fourth Interview: 2-15-47 Both parents come to the Clinic with Al. Sitting in the waiting room there is no conversation. Father looks especially tense. Parents indicate they would both like to t alk to worker. Each is seen for an half hour. Mother is seen first. She sits on the edge of her chair during the interview. Says, "things are not so good, we turned him on his own and it did not work out." The day before, the Juvenile Bureau had called about Al driving a car without a license. Mother says Al had taken her in his con­ fidence about this incident. Mother says she has taken this in her stride better than father, who is really shaken by it. She tells of fatherrs concern that there is something wrong with Al mentally. "That he is showing a bad streak.” Mother brings out her disagreement with father to turning Al on his own. She has told father to "take his head out of the sand," "to be boss and take A l ’s freedom away." Mother says she has done her best, doesn’t know where to turn. Worker asks if it is hard for her to think of her son doing these things. Mother smiles, says she is an old fashioned person, raised differently and it is' hard for her to under­ stand "this younger generation." Mother asks worker if she has any children, so that she can understand how a mother feels• Mother tells of at school. But the car may get had her way she

there being improvement at home for Al, also mother is concerned that the incident with Al expelled from school. Mother.says if she would have read him "the riot act."

Father comes into office, strains for control. He repeats several times that a normal boy would not do these things. Father says he is mad. He has tried kindness but it does not work. He tells of the many things he has done for Al. Has gone out of his way to be with him, sat through basketball games, etc., has done things he h a s n Tt cared about himself. "The more I do the less appreciation I get." Father is going to try a different procedure. Al has not come to him saying, "Dad I'm sorry--he has gone to mother." Worker asks father what he had expected freedom to do. Father burst out that he had not expected stealing ears. Father says his head is so full of thoughts he just c a n ’t think anymore. He has been told so many different things, that he is just going to use his own judgment.

79 Fifth Interview? 2-22-47 Mother, father, and Al are at Clinic early* Al has to get off to a basketball game. All seem to be in better spirits. While waiting father jokes with Al. Mother says she is feeling much better than last week and asks that father be seen, "he can tell you every­ thing.11 Father in office, smiles and says, ,fhow do I look." He tells of past week being better. f,I have cracked down on him a little more.” Believes Al is responding to this better, "maybe I eased up on him too much.11 Father tells of learning that Al does not like to comehere. His chums have kidded about, "being off his rocker." Also Al has told parents "they can stand investigation." How that father has learned from worker that doctor has said Al is mentally all right, he is relieved. Now he feels he has only "to hit the right procedure with Al." Worker wonders about her helping with this. Father says he has been talking to neighbors with greater benefit. "There is one thing I d o n ’t understand, why d o n ’t you people tell us what to do." Father says he doesn’t feel that coming here is doing them any good. Father leaves saying he will be in next time unless he calls first

.

IV.

Analysis of Interrelationships in the Continuing Process: 1.

Focus of Interviews for Each Parent:

For both

parents, the focus is on their present relationship with their son.

At no point are other problems of the family brought up.

Both parents do reflect briefly on their own lives in a family but only as it related to their own way of being with their son. 2.

Feelings About Self as Parent:

Father talks of

his needing to be the parent that should discipline son now that he is older.

He talks of trying to do things with his

son, such as going to basketball games and other activities

80 that he really does not enjoy himself.

He tells of being

very interested in doing what is right for his boy.

Mother

talks of herself as being an understanding, and devoted but perhaps an old fashioned mother.

She 3tates she does not

want her son "tied to her apron strings."

She sees son's

growing away from her as being somehow connected with his being -of the younger generation. 3.

Feelings About Other Parent as Parent:

talks of mother being close to the boy. may have fostered this too much.

Father

He implies that she

Father is uncomfortable

though about son being "mean" to mother in his growing away from her.

Mother talks of father as being too upset about

the son's adolescent activities.

Mother talks of father as

having his "head in the sand," of his not being firm enough in the discipline. 4.

Evidences of Working on Parent-Child Relationships

as Expressed in Ambivalence About the Child:

Father talks

at first of son being a fine boy, of his success in athletics, of his model behavior until recently.

Father wonders too if

son may have gotten into trouble only because of the crowd he is in.

Later, after another incident has occurred, father

speaks angrily of his disappointment in the boy, thinks he may be mentally ill.

He talks too of his resentment in the

boy's confiding in the mother rather than him. Mother speaks mostly of her fondness for her son, of

his nice, lovable ways.

She does tell though of her belief

that he is not telling his parents the truth.

Mother talks

of his having lost interest in the old things, and of his being a part of an ununder 3 tandable ’’younger generation.” 5.

Reports of Changes in the Parent-Child Relationship

During this phase of the case, the discussion of both parents changes from that of the problem, to how the parents and child are getting along together.

There is considerable struggle

shown by the parents in working out their own methods for having the proper amount of discipline.

By the end of this

period, father tells of his having worked out a way with Al which is more successful.

He is being more firm with him and

thinks he may have "eased up on-him too much,"

He believes

Al is responding better to this, and the reports of a happier household seem to bear this out. feeling much better.

Mother talks also of

She asks that father only talk to the

worker as he can tell her everything. V,

Condensation of the Ending Process:

Sixth Interview: 3-1-47 Father seen in Clinic, He states mother is not feeling well and had to remain in bed. Things have been pretty well. Father continues to be firm and Al is responding to this. Father does sense that Al is not telling him everything, but feels he is doing his best as father. Worker talks of the different ages way of looking at things. Father laughs and tells of his setting fire to a barrel of straw in his youth. Thinks in his day this was as serious as what Al is doing now. Father speaks of mother, says she is high strung, believes she is constantly wanting to know where Al is. Feels that

82 this got on A l !s nerves. ”1 told her to release some of the pressure.*1 Worker asks about father!s feelings in having' to set limits. Father tells of wanting to work further with the Clinic on this point, although he knows Al wants to stop coming. Seventh Interview: 3«8-47 Both parents are at Clinic with Al. Each is seen for part of an hour. They first discuss with worker their decision to make this their last visit. Mother comes in first. She feels things have been o.k. Al is attending glee club regularly, mother laughs about his voice changing. He is back with his former friends, is attending Sunday night church regularly. Mother raises question of what did happen to him. She talks with worker about what is involved in growing up. Mother says that in her growing up, things were pretty definitely either right or wrong. She recognizes things are changing. She adds it is **hard for me to try this in-between stuff.11 Father is jovial during his interview. Feels things are "pretty well in hand.” He asks though, if Al is going to be all right in the future. He and worker talk about being un­ able to predict. Father says he is more aware of what is involved in A l rs growing up and their living together. In ending, father wonders about returning should further need arise. Both parents express thanks to worker in saying goodbye• VI.

Analysis of Interrelationships in the Ending Process: 1.

Part of Each Parent in Ending:

talk of ending with the Clinic.

Father is first to

His statements indicate that

this is a matter, however, that all family has considered together.

He expresses some anger at the Clinic around his

being left with the responsibility in changing. does continue toward having a planned ending.

However, he In leaving,

he wonders if they might return should further need arise. Mother goes along with father’s wish to end.

She also shows

83 some question about leaving though in wondering what has happened in the situation, 2,

Confidence in Going on Own Without Clinic:

Mother

shows an awareness of her pwn thinking about how she will be with her son in the future, she tells of knowing that it is hard for her to try this "in between stuff,"

Father in

leaving believes that things are "pretty well in hand."

He

states he is more aware of what is involved in A l Ts growing up and their living together.

His pleasure in having worked

out, on his own, more effective ways of being with Al also shows his greater confidence in the matter. 3,

Differences from Beginning in Expressions About

Parent Roles:

From the beginning of the casework contact,

parents have talked of their awareness of a need for a change in their roles as parents.

However, the emotional

acceptance of these ideas is tenuous and it is this accep­ tance on which they work in their contacts with the worker. In the last interview father talks with confidence of some success in having taken a more active role in the life of his son.

Mother, too, shows some awareness of the fact that

although she has wanted son to be less close to her, she knows now it will be hard, and can thus have a more realistic acceptance of it.

84 VII*

Interrelated Processes of the Parents as Seen in the Movement from Interview to Interview. The initiating phase begins with father coming to the

Clinic distressed about the problem of his son.

He is

inclined to project the difficulties outside the home and the family entirely.

In the second interview, both parents come

to the Clinic, still concerned that son get help.

With both

parents at the office, mother is interviewed, and she talks about the problem having something to do with herself and father.

In the following interview with father, he also

shows a willingness to consider the pare nts ’ part in having the proper amount of discipline with the boy.

Father dis­

cusses further his own need to take a greater part in this discipline now.

Father talks of taking steps to make changes

in the matter of discipline. The continuing process sees further back and forth movement of both parents in working on their relationship with their son.

The first steps taken had not worked out,

and parents go through a period of again projecting the problem outside themselves.

Father thinks boy may be mentally ill,

and mother says that father should have done differently. This expression of their disappointed feeling by both parents is followed by interviews in which both parents and boy come to Clinic feeling much better.

Father tells of his having

found better ways of connecting with his son.

85 In the ending process, father takes further responsi­ bility in his relationship with his son* change in the parent-child relationships*

Mother accepts this In the last inter­

view, both parents come to the Clinic and talk of their comfort in sharing their acceptance of their son growing up, and their new relationships with him.

THE FERGUSON CASE Family Picture:

Problem: Race:

Patient, Ted, age 17 Sister, age 15 Sister, age 11 Brother, age 5

Homosexuality; plans for going to college

White

Occupation:

I,

Father, age 46 Mother, age 42

Religion:

Protestant

Father, Salesman Mother, Housewife

Condensation of the Initiating Process:

Referral: 2-19-48 Father drops in at Clinic, was referred by high school principal. He asks to see doctor about his boy. Accepts seeing intake worker. He presents his problem Initially as one of school. Describes his son as being of ’’good mind, clean and well mannered,” It is only after talk­ ing awhile, that he tells of Ted not being interested in ’’friendships with the opposite sex.” He is then ready to go into some detail. Worker explains about planning for first interview and describes clinic set-up briefly. Father answers that he wants nothing free, wants to pay fee. He continues with problem, talks of the ’’lost sex,” of mot her ’s discovering T e d ’s interests when father, was out of the home on business. Mother was stunned and Is now about to ”go to pieces.” Ted ran away after m ot h e r ’s discovery. Father at a loss, sees home as a happy one. In planning for appointment, father indicates that both he and mother will come. He is not sure, however, that Ted will come. Says confidentially that Ted is a ’’mammas boy,” believes she may be able to get him to come. Initial Interview: 2-27-48 Parents are in office early. Father seems more at ease today. Parents indicate they would like to see worker, and are interviewed together. Parents begin to talk about T e d ’s response to plans to come to Clinic. They have talked to him already. He says he is willing. However, he changes his mind so frequently they do not know if he will. Father talks about Ted. He has a good and brilliant mind, but is temperamental and has no desire to do anything manually.

87 But the thing that parents are coming about is that he prefers boys only. They then mention another problem. Until recently, Ted has been planning to go to college when he finishes high school, and was interested in law or inter­ national relations. Wow, however, Ted is floundering. Father mentions that Ted is thinking of going into the Merchant Marine, Mother smiles and says that he has apparently forgotten this for the moment. Parents tell how school principal has ^seen Ted as a bright boy. The principal has referred them here because there was comment at school about T e d ’s always being so well dressed. Parents have been aware that Ted never mingles with other children. His friends have been like him, neat, non-assuming and soft spoken. Recently, however, Ted has found boy friends who are on the frousy side, rough, tough and older than he. With hesitation, parents then tell of Ted frequenting places known as homosexual ’’hangouts.” Mother comments that parents would allow Ted lots of freedom but are pretty sorry about what he does with it. There is a pause and worker comments on parents T coming too to talk about their concern about the problem. Mother tells her shock on discovering problem, finding some love letters in clothes to be sent the cleaners. She had talked to Ted about it and he ran away. Father was sent for. Police had been notified. Later Ted was located from leads found in letters. Father went for Ted. He told Ted he could talk about it when he wanted to. Father tells of there being a distance between himself and boy. Therefore, it i s n Tt easy for Ted to come to father. Mother tells of her closeness to boy. Parents talk of what Ted was like in growing up. They remem­ bered that he played with dolls as a youngster. Always as a child played alone. He liked school and would never miss a day or be late. Father comments that he felt parents must have been wrong somewhere and if this is true they want to know it. With feeling he comments about the other children and not wanting this to happen again. Father tells his feelings of wanting a ’’real boy.” It is hard for him but he does speak of his disappointment, although perhaps he has given the boy nothing to use. Worker talks of considering these things here. Parents agree. Just before leaving, father comments again on what a fine boy Ted is. *

88 Second Interview: 3-9-48 Mother is at Clinic with Ted. She begins by telling about her being on edge today. There is illness at home. Several weeks ago father and the oldest girl were in an auto accident. It has recently been dis­ covered that father has a broken hack. He is under medical care now and not able to work. Mother does not talk spontaneously about Ted, but indicates her continuing concern. She says that for the last few days family has been close and life seems to have been good. She says that when illness occurs in the family there ’’seems to be a coming together.’1 Mother speaks of Ted's relationship with father. She thinks his business has been a factor in barring his relationships with all the children. There.certainly has been no closeness between Ted and father. Mother brings out that father has criticized her for not allowing Ted to get into fights. Mother smiles and says she doesn't like fighting. On the other hand, she does n’t believe that children are ’’spoiled” in that they are resourceful and the family live and work together. Mother thinks of Ted as a person one handles with ”kid gloves” because of the great swings in his mood. She admits she may have been protective and life won't permit this on the outside. Yet he has always done well in school and good in holding jobs. She speaks of Ted ever wanting to leave home. In fact it was Ted that first came to California with relatives here. He liked it and family came* to live here. Now he wants to leave home again. Mother would like Ted to have further education. She smiles and comments about his being bright at school although she realizes now he never mixed much. Third Interview; Father is at Clinic with Ted. His neck is done up in an elaborate cast. He talks of his injury and says he is glad to come with Ted as he needs to keep active. Father comments that he doesn't know much about psychology, but he would like to give his own appraisal of Ted. He spoke of his job keeping him away, of his feeling that mother always kept a good home. However, sometime in the past when Ted was about 12, father was struck with the feeling that Ted resented father’s ability to travel, go places and be free. Father noticed for some time that a distance and mis­ understanding existed between him and boy. Father sees Ted as ever resentful. Worker wonders about Ted feeling displaced when father came home. Father does not think so, says it was mother who was inclined to make Ted the ’’little boy,” there­ fore Ted never felt displaced when father came home.

89 Father also thinks about how Ted feels about coming to the Clinic, He is interested in the doctorfs strategy, but thinks doctor does notunderstand him. Father tells of T e d !s receiving a letter from a boy whom he had told about going to the Clinic. Boy had written that he had also gone to a psychiatrist once, but only once. Father feels that Ted must be coming here in a challenging way. II#

Analysis of Interrelationships in the Initiating Process: 1.

Evidences of Joint Decision to Use Service:

At the

time of the first contact, occurring when father drops into the Clinic office, he talks of both parents wanting to come to the Clinic. 2.

Participation in the Initiating Process:

At the

time of the initial interview, both parents come to the Clinic. They talk of both wanting to participate further in the Clinic program.

Their joint coming seems to arise out of the impetus

of their concern about the problem and a wish to do something about it# 3.

Acceptance of the Clinic Service:

Both parents

show considerable desire to come to the Clinic and this is carried through their early interviews. interview together, part of the process#

After their initial

each parent is seen once during this Each shows some withdrawal from their

original desire to use the service.

Mother in the second

interview, talks of the problem as no longer seeming so important.

Father, in the third, tells of son coming in a

challenging way, which may be a reflection of fa th e r fs own attitude.

The interviews after the third are more spontaneous

90 and are more concerned with the parent-child relationships and signal a fuller acceptance of the Clinic service. 4.

Peelings About the Problem:

Both parents see the

problem in the homosexuality and the school plans.

They

also believe that the problem might have something to do with the b o y ’s relationships in the home.

Both see the boy as

having been somewhat alone in life and too close to the mother, perhaps connected with father’s frequent absence from the home.

Parents see the problem differently, however,

in that mother sees her son as someone who needs to be handled with ”kid gloves” whereas father sees the problem more in the b o y ’s resentment to him and in f ather’s absences from the home • 5. Child:

Evidences of Closeness to or Separateness from the

Mother speaks directly of her closeness to the child

and indicates that it has existed for a long period of time. Father also talks of his awareness of distance from the boy and of the b o y ’s inability to respond to him. III.

Condensation of the Continuing Process:

Fourth Interview; 3-23-48 Father at Clinic, is in great pain and discomfort. He tells of fearing permanent disability. He talks then of Ted. Both parents have been surprised to note a change in him. Ted is staying home with the family, not because parents have insisted but because he wants to. Ted is also being less critical of the younger children. Father was surprised the other evening when he reprimanded Ted for something. Instead of T e d ’s being resentful, he had said, "why I never thought of that.”

91 Father speaks of T e d ’s never having felt a part of the family. He believes it is because they catered so to his moods. Father tells of needing a ’’right arm” now because of his injury. Ted istaking this part and seems to be helping father readily. Father says he may always need a right arm. Father talks of what his injury may do to his continuing at work, and of his talking to Ted about his going into the firm. Ted had not at first seemed interested, although recently when family were planning a vacation, Ted had said, ’’would I be able to go if I were at the office.” Father talked little of the s o n ’s problem during this interview. Fifth Interview? 3-30-48 Mother accompanies Ted to the office. She talks of a trying week because of f ath er’s illness, of fa mily’s worry about how father will be in the future and what this will mean for his work. She indicates that father will not let others settle these things for him. Mother says there has not been much time to think about other things, although she indicates that Ted has been at home more lately. She says that there is still a deep underlying worry about Ted. She wishes he could mix with both boys and girls. She tells of T e d ’s annoyance when mother did not wait dinner for him the other evening. Yet he did not get home until late and waiting would have delayed the other children. Mother says she would otherwise have waited to keep the peace. Mother speaks of herself as a person who cannot talk out her feelings with other people. But goes along with them keeping peace, ’’maybe at too great a price.” Mother mentions that in coming to the Clinic today, Ted had said this may be the last time, unless the doctor saw a change in him. 4-6-48 Father and Ted at Clinic although worker had had to cancel her appointment with father. 4-20-48 Mother sent a note about Ted participating in a city youth program and cancelling appointment. IV.

Analysis of Interrelationships in the Continuing Process: 1.

Focus of Interviews for Each Parent:

the case, the focus remains

Throughout

on the parent-child relationship.

92 This extended to the past familial relationships as well as to those in the present, 2, there

Peelings about Self as Parent:

beinga distance between himself

Father talks of and his son.

He knows

that it has existed for some time, and that it may .have come about

as he had not given the son much attention in the past.

He believes that his son has resented his ability to travel and that his absence from the home had brought about their misunderstanding.

Mother tells of her own closeness to Ted,

yet it is closeness of catering to his moods rather than one of warmth.

Mother thinks she may have been too protective of

her son and that this has not prepared him for life, 3.

Peelings About Other Parent as Parent:

Mother

speaks understandingly of father but believes that his frequent absences from the home have caused his lack of closeness to all the children.

Mother does mention that father is somewhat

outside the family too, in his decisions about his life and theirfs together.

She talks of father not letting others

settle things for him.

Father is largely protective of

mother in talking of her as a parent. dence in her keeping a good home.

He tells of his confi­

He does tell though of

mother's catering to the boy and of his belief that boy is a "mammas boy."

Father does not tell of it, but mother mentions

that father believes she has not allowed boy to fend for himself•

93 4.

Evidences of Working on Parent-Child Relationships

as Expressed in Ambivalence About the Child:

The parents

speak understandingly of their son although their conversation about him reflects the same kind of distance that is apparently a part of their relationship problem.

Both tell of their

disappointment in their son's not being the kind of a person they had hoped for.

They talk a good deal of Ted's being a

fine boy and of his accomplishments in school and in jobs. The ambivalence expressed about the son is not great and parents seem to be more confused and uncertain about the problem, than having mixed feelings about the boy. 5.

Reports of Changes in the Parent-Child Relationship:

As the case moves from the beginning to the continuing process, parents talk less of the problem and more of the boy's relation­ ships with them and the rest of the family.

They tell of T e d ’s

staying home more, of his seeming to be more comfortable in the family group.

They report he shows less resentment to the

parents and the other children.

Both parenta report that the

family life seems closer, although they relate this partly to the illness that has drawn them together.

Father reports a

greater closeness between himself and Ted, and to father’s need of a ffright arm. M V.

Condensation of the Ending Process:

Sixth Interview: 4-,.6-48 Father is at office with Ted. He understands that this will be the last visit; Ted has talked to the doctor about ending.

94 Worker talks to father of T e d ’s interviews at the Clinic* Ted has not felt he had a problem, that he isa homosexual and accepts it. Father does not comment, but looks directly at the.worker. Finally he states that he would like to make known that he and mother accept this. He continues that there will always be an open door and acceptance of Ted at home. Then father grins and talks of the other children and how well they are doing, especially the youngest boy. Father does think that mother is different with this boy since she lets him go out and get hurt and generally fend more for himself. Father believes that the little boy responds more to him. Father tells of his deep feeling of disappointment about Ted, that is "not necessarily mixed with bitterness," but which is ever present. He tells of how he and Ted talked together several years ago at a time when Ted was planning for his education. Father felt close to Ted then. They had something togetlfer and Ted made the plan with his parents to come to California. Then Ted did not go ahead with this. Father adds, you know how I came to California for him. Father tells about his personal disappointments in working here, of his recent injury and set back. Father mentions that parents are selling their home and plan to move out of the city. Ted will stay in the city and go to junior college. Father concludes by saying that " i t ’s hard not to relate at all to Ted.” He does say though that Ted has been at home more lately. In leaving, father indicates that in some way he and mother feel they have not failed Ted. Yet they know Ted has ruled the roost and they have let him. They are puzzled as to why this happened. Father wonders about talking to doctor before leaving; an appointment is arranged. Father does not keep appointment with doctor. VI.

Analysis of Interrelationships in the Ending Process: 1.

Which Parent Introduced Wish for Ending:

It is

the child in this case that talks of the wish to end.

Both

parents go along with his wish, signifying perhaps their growing awareness of his making his own decisions.

Ending is

95 discussed only briefly with mother;

it is discussed more

fully with father in the last interview*

Father seems willing

to accept s o n ’s decision about ending, although he shows some hesitation about it in his still wanting an appointment wibh the doctor*

His not keeping it may show his readiness to end

without it. 2.

Confidence in G-oing on Own Without Clinicr

Father

talks of both parents having come to some acceptance of the s o n’s present adjustment and of allowing him to make plans for his future on his own.

Father tells in the last interview

of having confidence that the family did provide a good home and of confidence that son will always be welcome there. 3.

Differences from Beginning in Expressions About

Parent Holes?

The changes in parents’ feelings, as reported

by father, are in the area of their being able to express their real disappointment in their son not being quite what they had expected in him.

They no longer have a need to talk

as much about what a fine boy he is, and begin to think of the progress of their other children.

In this expression of

fa ther’s disappointment, he is able to say that he has accepted his son and that there is an open door for him at home.

Father

is able to plan with his son about allowing him to leave the home and work out his own adjustment. the son to work out his own adjustment.

Such plans might allow

96 VII.

Interrelated Processes of Parents as Seen in the Movement from Interview to Interview. Initiating process begins with father coming to Clinic

but finding it difficult to discuss his s o n ’s problem.

In

the next interview, both parents come to the Clinic and indi­ cate they would like to see the worker.

It is as though

with their coming together they help one another to share the problem with an outside person and agency.

At the end of

this interview father is able to tell of parents * feelings that they may have been wrong somewhere.

In the third inter­

view, mother discusses more specifically the family relation­ ships.

F a t h e r ’s having talked of both parents being "wrong

somewhere," leads mother to think of father’s part in the problem.

By the end of her interview, mother can consider

her own relationship with her son.

Father proceeds in the

next interview to talk of the m o t h e r ’s share in the b o y ’s growing up.

He can then speak of his own lack of closeness

to his son and he tells of his efforts to change this. In the continuing process, both parents come to the Clinic one time.

They are no longer projecting the problem

on one another and talk of the changes they are making in their ways of being with their son.

Father, partly because

of his illness, is spending more time with his son; mother talks of not waiting the whole household on s o n ’s mood.

97 In the ending process, father accepts the s o n ’s wish to end with the Clinic,

Although father expresses his deep

disappointment that the son has not lived up to his expectations, and perhaps has not made a further use of the Clinic, he nevertheless has been helped to accept his s o n ’s behavior in terms of his present age and adjustment*

Father is able

to accept that the son is not going to work on his problem at the present time.

He does see that Ted is making constructive

plans for his future in terms of schooling.

Father is able

to say also that he will always welcome his son at home.

CHAPTER III SUMMARY AND CONCLUSIONS A study of the findings in the six cases here pre­ sented has pointed up some of the factors involved in the interrelated processes of mother and father in their joint use of the casework service in a child guidance clinic.

Due

to the small number of cases studied it should be made clear that the findings represent only indications of factors that occurred in these particular situations.

To conform with the

arrangement of the case material in Chapter II, the summari­ zation of the findings has been divided into three sections. Factors of interrelationships in the initiating process s

The value of both parents having a part in the

initiating process, as has been suggested in the literature about child guidance clinics, was born out in this study. In all six of these cases where both parents made good and full use of service, it was found that some participation occurred in the initiating process.

In four of the cases,

the interest of both parents in using service was seen by the time of the initial interview.

In the other two, the wish of

both to participate in the Clinic program followed later, but still within the period that might be considered the initiating phase of the process.

99 Prom analysis of these cases it would seem that there could be considerations for agency policy*

On the assumption

that the participation of both parents would be of value for the most effective treatment potential of a clinic, the point at which the parents ’ participation could be encouraged would be in the initiating process*

The initial interview

might be considered as the best time to explore the wish of both parents to participate in the use of the casework service* The fact that in these cases there were apparently different reasons for the parentfs wanting the participation of the other parent did not seem to counteract .this conclusion, although it gave indications for an understanding of the parents 1 interest in working on the problem*

A policy for

the inclusion of both parents in the initial interview might avoid some of the difficulties in casework arising from one parent having feelings about having asked that the other be included in the service*

In the two cases where the second

parent’s coming depended on the first p a r e n t ’s wish that he (as both were fathers) be helped with his relationship to the child, there was some evidence of resistance to beginning on the part of the second parent*

In these particu­

lar cases this added resistance was overcome and both parents continued to use the service*

However, it is logical that in

many cases the resistance might not be easily handled and the values from both p arents’ use of service would be lost.

100 The factor of the p a r e n t fs feelings about the other being interviewed by the same caseworker showed another aspect of the interrelationships in the initiating processes. In all six of the cases there was noted to be some degree of change in the activity of the first parent after the interview of the second. to be quiet.

The general tone in such interviews was noted If the worker did not bring up the matter of

the interview with the second parent, the first did not usually refer to it.

If the matter was brought up, there were

recorded only cursory responses, generally to the effect as in the Baker ease* ”1 guess he agrees with you.11

The feelings

of the parents apparently revolved around their concern about the wo r k e r ’s opinion of themselves or of the other parent. The conclusion that might be drawn from this, is that when both parents are interviewed by the same worker, assistance to each parent in expressing the feeling about the otherfs interview would facilitate a sustaining of the case. In the process of acceptance of clinic service, the parents expressed the usual ambivalences about taking help. Sometimes one parent, sometimes the other emphasized one aspect of feeling to the exclusion of the other.

In all

instances the participation of the second parent stimulated much progress toward the emotional acceptance of the Clinic service by both parents.

In both parents* use of service,

therefore, there was no indication for essential changes in

101 casework understanding and method about the handling of an acceptance of agency service.

There was indication that the

application of these aspects of casework would be to both parents as a family unit rather than as individuals. Factors found in the parents* feelings *about the child*s problem gave clues about the areas of work which came during the continuing processes.

In view of the fact

that the focus of the interviews was largely on the parentchild relationships (as will be discussed later) the problems that might exist between the parents were seldom discussed directly, even though they might contribute to the child’s difficulties.

These findings gave the impression that clues

about the nature of the parents* conflicts with one another could be seen in their differences of feelings about the ch ild ’s problem and in their statements of closeness to or separateness from the child.

In every case studied there was

some correlation between the parents’ expressions of differ­ ences in feeling about the child, and in their later indica­ tions of difficulties with one another.

From this material

it was seen that while still focusing on the parent-child relationship, the caseworker could have found clues in the expressions about the child for areas in which she could later help the parents in understanding their own parts in the problem.

102 Factors in the interrelationships in the continuing proce ss:

Noticeable in the findings in this phase of the

process was the fact that the focus of the interviews remained largely on the parent-child relationship.

In one case, the

Dodd case, there was some discussion of the marital relation­ ship, although the father later expressed some guilt about discussing it.

In the other five cases where successful use

of service was made by both parents, the focus was entirely on the parent-child relationship.

This would suggest the

hypothesis that such a focus lends itself to both parents making good and continuous use of service. During this period in the process there was a connec­ tion between the parents f expressions of ambivalences about the child and reports of Improvements In the chi ldfs problem and In the parent-child relationships.

It occurred to some

extent in all the cases that after the parents had expressed both their positive and negative feelings for the child, that they began to talk of Improvements.

This was noticed most

strikingly in the Dodd case, when after the parents had acted out their negative feelings to place their child,

they were

then able to begin thinking of plans for him to stay at home. They soon reported that things were better and worker was asked, !,why is this way working?”

This factor, however, of

helping around the expressions of ambivalences was similar to that In casework generally, and showed no particular differences

103 when it occurred in the two-parent situation. The interaction between the two parents in their use of the Clinic was seen only in the movement'from interview to interview.

It was obvious that the movement of one parent

stimulated that of the other.

There was also evidence that

the coming of the second parent helped the first to end his or her projections about the problem.

A possible inquiry for

another study would be to learn if discussions about the interaction would facilitate movement in the case.

There was

the possibility that parents might have made fuller use of service if they had been helped to talk of this interaction as it related to changes in the parent-child relationships. Factors in the interrelationships in the ending process:

In the ending process as in the beginning process,

the findings showed both parents involved in a joint way in giving up clinic help*

Again it was seen that one or both

parents expressed positive and negative feelings about ending.

Both expressed confidences and doubts about going on

on their own without the Clinic.

The parents* activity in

ending was carried out as a family unit. Factors studied in the ending process showed that the activity of the parents in their participation around ending had a correlation with changes in their parent roles.

The

ending activities further, when compared with those of the beginning, showed an interesting connection to the movement

J

/

104 that had taken place in the case* Specifically,

in the Andrews case, mother was most

active in beginning with the Agency.

The problem was later

seen to evolve around the m o t h e r fs closeness to and the father's separateness from the child.

After moving through

the ease it was the father who initiated ending.

The changes

reported in the parent-child relationship were in the area of father taking a more active role in the family's life and of mother accepting this amount of change. In the Baker case, it was mother who was active in beginning with the Agency.

The problem centered on the

mother's extreme identification with the child and father's concern about the mother rather than about the child. again, it was father who initiated ending.

Here

The change in

the relationships that had been reported was that of father's now being more active in the family and mother being less concerned about the problem. In the Conner case, it was the father who was active in starting the contact with the Agency, even though it was mother who first came to the Agency.

This correlated some­

what with the problem in the family situation in which the mother was trying to assume a mother role she did not want. During the case mother tried other ways of adjusting her role as mother and father supported her in this. who supported the ending with the Agency.

It was father

105 In the Dodd case, mother was most active in beginning with the Agency.

The problem later developed to be around

the m o t h e r ’s intense closeness to her children, and the father’s jealousy of this.

As a readjustment in the fam i l y ’s

relationships was worked out, the mother faced some of her lack of interest in being mother.

Father showed greater

acceptance of his own dependence on his wife and was able to face his own lack of closeness to his boy.

The ending was

initiated in this case by the mother, signaling the keeping of her

active role but being more comfortable about it. In the

Eldridge case, beginning was initiated by

but both parents came for the first interview.

father,

The problem

developed to be that of the p arents’ closeness to their only child and their difficulty in giving him up.

As the case

proceeded, parents became more comfortable about the amount of freedom and discipline they should give their son.

It was

the child who initiated the ending, signaling in this case hisgreater freedom in In the

making his own decisions.

Ferguson case, both parents were active in

starting with the Agency.

The problem concerned their diffi­

culty in allowing their son to grow away from them and in their involved interpersonal relationships.

In this case,

also, it was the child who asked for the ending.

This showed

a relationship to his having taken greater responsibility for himself.

The parents’ acceptance of his ending

106 with the Agency showed their greater acceptance of his work­ ing out his problem in his own way. The conclusion drawn from this more detailed account of the findings would be that the parent who took initiative in beginning with the Agency presented a clue to the problem in the relationship, w.i-th-the child.,.

The degree of partici­

pation during the case movement indicated which parent was the most active in working on the changes in his role in the family.

Further, it appeared that the person in the family

who initiated ending gave an indication of the changed roles of the parents or child within the family.

j^

In all of these

findings too there was frequent substantiation of the fact that the participation of the whole family unit was helpful in sustaining the contacts with the Clinic, particularly at times when participation was difficult for one or another member of the family. From these conclusions it would appear that a policy for the inclusion of both parents should not be a rigid one, but rather one of. allowing the parents to take some initiative at the point at which they begin or end with the Agency; Agency policy expressing the importance of participation by both. These findings did show that a study of the inter­ relationships involved when both parents use casework services, can be made.

They showed that such a study can lead to

107 considerations for casework and for agency policy.

They

pointed also to areas for further study and experimentation, in this field.

Particularly interesting among such areas

for study would be inquiries to determine the values of a two-parent~pa-rticipation as compared with one-parent partici­ pation.

A suggested subject for such an inquiry would be a

comparison of the time span and number of interviews involved for the successful completion of each type of case.

Another

suggestion would be that of an evaluation of cases in a clinic where policy did express the importance of the par­ ticipation of both parents.

It would be interesting further

to inquire into the affects of fee charging on the use of service by one or both parents.

These subjects would be of

importance and could reveal further ways of extending help to those persons most influential in the child's life.

BIBLIOGRAPHY

109 SELECTED BIBLIOGRAPHY A.

BOOKS

Allen, Frederick H. > Psychotherapy With Children* New York: W. W. Horton and Company, Inc*, 1942* 506 pp. Aptekar, Herbert H., Basic Concepts In Social Case W or k. Chapel Hill: University of North Carolina Press, 1941. 201 pp. French, Lois Meredith, Psychiatric Social Work. The Commonwealth Fund, 1940. 344 pp.

New York:

Hamilton, Gordon, Theory and Practice of Social Case W o r k . New York: Columbia University Press, 1940. 371 pp. _______ , Psychotherapy in Child Guidance. New York: Columbia University Press, 1947. 340 pp. Witmer, Helen Leland, Psychiatric Interviews With Children. New York: W. W. Norton and Company, Inc., 1946. 306 pp. _______ , Social Work. 1942. 539 pp. B.

New York: Farrar and Rinehart,

Inc.,

PERIODICAL ARTICLES

Dawley, Almena, "Interrelated Movement of Parent and Child in Therapy With Children," American Journal of Ortho­ psychiatry, 9:748-54, October, 1939. _______ , "A Child'fs New Organization of Self in a Brief Treatment Situation," Social Casework, 18:268-72, December, 1939. Dawley, Almena, and Frederick H. Allen, "Social Aspects of Personality in Child Guidance Practice," The American Journal of Psychiatry, 106:462-67, December, 1949. Green, Rose, "Treatment of Parent-Child Relationships," American Journal of Orthopsychiatry, 28:442-46, July, 1948.

110 Greenfield, Beatrice, "Counseling in Parent-Child Relationship Problems,” Jewish Social Service Quarterly, 14:225-35, December, 1947. Hofstein, Saul, "Interrelated Processes in Parent-Child Counseling," Jewish Social Service Quarterly, 26:286-92, December, 1949# • Lowrey, Lawson G., "Trends in Therapy," American Journal of Orthopsychiatry, 9:669-706, October, 1939. Mead, Margaret, "What is Happening to the American Family?" Social Casework, 28:523-330, November, 1947. Sytz, Florence, "The Development of Method in Social Casework," Social Casework, 29:83-88, March, 1948. C.

PUBLICATIONS OF LEARNED ORGANIZATIONS

Abstracts from Smith College Studies in Social Work, Elizabeth WaltonJ "Fathers as Clients of a Child Guidance Clinic," February, 1940. Abstracts from Smith College Studies in Social Work , Mary E. Richards, "When to Include the Father in Child Guidance," February, 1949. D.

UNPUBLISHED MATERIAL

Minutes of the Social Workers Meeting, American Association of Psychiatric Clinics for Children, submitted by the Secretary, Mary F. Carswell, April 3, 1949. Annual Report of the Long Beach Mental Hygiene Clinic, submitted by the Director, Dr. John Russell, for the years of 1947, 1948, and 1949#

APPEHDIX

112 SCHEDULE Analysis of Interrelationships in the Initiating Process 1.

2.

3*

4.

5.

Evidences of Joint Decision to Use Servicer a.

First Contact: Made by: Mention of the other parent in regard to coming Mention of the other parent in regard to child

b.

Initial Interview: Who had: Mention of wish of other parent to participate at Clinic Mention of others 1 relationship to child

Participation in Application Process: a.

Did occur for both: How: When:

b.

When occur in first parent's process:

c.

What seemed purpose for second coming in:

Acceptance of Clinic Service: a.

Was ambivalence shown about decision to use service: How shown: Shown by each:

b.

When did acceptance seem fairly certain: Part of each parent in:

c.

Did accept for parents as well as child:

d.

Planning for participation in following interviews:

Feelings About Problem: a.

Similarities:

b.

Differences:

e.

Changes in definition of problem as goes through this phase:

Evidences of Closeness or Separateness from Child: a* b*

Mother Father

113 SCHEDULE Analysis of Interrelationships in the Continuing Process: 1.

Focus of Interviews fur Each Parent: a.

Main focus:

Mother

Father: b.

Other problems Introduced:

Mother:

Father: 2.

Feelings About Self as Parent:

Mother:

Father: 3.

Feelings About Other Parent as Parent:

Mother:

Father: 4.

Evidences of Interaction Between Parents Around Clinic Problem:

5.

Reaction of First Parent After Interview of Second: a.

6.

Did talk about:

Evidence of Working on the Parent-Child Relationship as Expressed In Ambivalence About the Child: Mother: Father: a.

7.

Changes from beginning:

Reports of Changes in Parent-Child Relationship and Problem:

114 SCHEDULE Analysis of Interrelationships in the Ending Process: 1.

Which Parent Introduced Wish for Ending: a*

Part of Each Parent in Ending:

b.

Feelings About Ending With Clinic:

Mother:

Father: 2.

Confidence in Going on Own:

Mother:

Father: a. 3.

Hesitations about:

Parents' Feelings at This Time About Their Holes as Parents: a*

Differences:

b.

Similarities:

4ft