Imágenes de páginas

er for sympathy and help in problems that have been too much for him. Unless she interests him in recognizing the sources of his difficulty and thinking out with her ways and means for gradual solution, she may unconsciously be encouraging his dependence on her and allowing him to rely on her sympathy to back him up whenever an issue arises. When the worker is unable to give him the sympathy he wants, he will be resentful because he thinks she has lost interest, and it becomes clear that he has been reacting all along to her instead of to the situations confronting him. Take the sixteen-year-old boy with whom the worker has been on the best of terms and whom she has helped through various minor emergencies. Suddenly he rebels against his stepfather's oppressive authority by refusing to work. He is resentful of the pressure brought to bear by his older brother, and turns a deaf ear to his mother's entreaties. With considerable difficulty the worker secures the sort of opening he has professed to want. He turns the job down. If, as his family has done in the past, she shows irritation and falls back on the conventional arguments used by them, he will see her as still another parent and will unconsciously find satisfaction in her pique. If she sympathizes with him she will encourage his subjective reaction to his problem and intensify his difficulty. By showing no reaction to the situation and remaining neutral in her sympathy she will be best able to show him how the subjective attitudes resulting from his conflict with the parental situation are blinding him to the reality issue, which is his own necessity for having a job if he is to live an independent and satisfying life. Such a stand on the worker's part is likely to prevent his reacting to her as part of the old struggle against authority, and instead may help him gain insight from the crisis that will further his development.

/Because her rôle as case worker is so likely to place her in a position of parent to her client the worker must be aware of the need to make the relationship as far as possible that of one adult to another, so that perhaps for the first time the client begins to acquire insight into his own needs, to make adjustments, not because others force them upon him, but because he sees them as essential to his own welfare.) If, unconsciously, the worker enjoys the parent rôle, she will take over the whole situation and run it, instead of putting it up to her client and helping him to work it out or to carry it as much as possible. He may cooperate, but not actually participate. The worker may not demand gratitude from him, and yet continue to expect it in the more subtle form of submission to her influence. She establishes her contacts on a personal rather than professional level, and comes to look upon the contact as an end in itself instead of merely a means to an end. If her contacts are good she may actually obtain concessions from both parties to a situation, concessions that they make, however, to her, and not to each other, and which therefore will not last. She may be unaware of this desire of a client to please her and inadvertently allow him to play up to her; this blinds them both to the real issues and makes an actual change of position unlikely, for a shift that comes in an effort to please the worker

rather than for the satisfaction it gives the client himself is unlikely to be permanent.

If the worker assumes the authoritative rôle she will be inclined to make decisions for her client and jump to conclusions about what should be done before she has investigated the emotional issues that must be taken into account. She will want to control the situation and will be impatient with external obstacles that block her plans, such as an inadequate agency budget, the requirements of the school law, the policies of the public schools or other agencies. She will be impatient of the client's limitations which she failed to recognize at the outset because of her eagerness for complete success, and, not realizing that her mistake was in expecting the impossible of him, will condemn him for not living up to her ideal of him. However shrewd the case worker is, she will frequently discover this discrepancy between her first judgment of the client and his actual capacities, and will have to admit the fault as hers if she is to capitalize the experience and plan on a realistic basis for further treatment of his problem.

Since at every turn in the progress of the case the worker's personality is involved, her first responsibility is to study her own reactions and maintain a detachment that will keep her emotionally free. Not to do so is essentially irresponsible, for it means ignoring the very nature of her rôle. The objectivity the worker ought to maintain toward her cases is not a fixed state of mind, but is a point of view that is maintained only by conscious effort. If the worker is willing to include herself as well as her clients as objects of her case work, her increasing self-control will be apparent, not only in case work results, but in the greater satisfaction she finds in meeting the problems of her job.


Eleanor Clifton, Resident Psychologist, Berkshire
Industrial Farm, Canaan, New York

Two years ago the Berkshire Industrial Farm at Canaan, New York, with the cooperation of the Commonwealth Fund, established a psychiatric research department. It was felt by the board of managers and the officials of the Commonwealth Fund that the Farm, with its adequate physical equipment and wellplanned educational program, would constitute an excellent research laboratory for the study of conduct disorders in children. Eleven hundred acres of field, woodland, and lake shore, organized athletics, modern cottages, trade training, academic school, and a well-stocked library are only a few of the many facilities for working with the laboratory material-about 125 adolescent problem boys. These boys are committed by juvenile courts or deeded by parents under the

technical charge of delinquency, including truancy, stealing, running away, persistent lying, temper fits, and general incorrigibility. They range in mental ability from the borderline to the very superior, the median being within the low average group. Their material home environments vary from dependency to wealth, with relatively few families known to social agencies. Less than a fourth come from the so-called "normal" family groups with mother and father living together. In all the remainder there are various disrupting factors; deserting parents, separated parents, step-parents, widowed parents, and so forth.

The first step in our work as a psychiatric research department was naturally a getting-acquainted process. This, so far as the boys were concerned, was easy. With an engaging responsiveness, reflecting the institution's spirit of freedom, they welcomed us into their midst without reservation. Our official title was mastered with some difficulty, but our good intentions were generously taken for granted. The clinic offices, far from being limited to formal conferences in time of trouble or in the name of research, have from the start been places where a fellow may have a friendly chat, display a letter from home, exhibit a new suit, and park anything from a box of home-made fudge to a trade school diploma.

For two years we have observed, studied, and lived with them. We have seen them, not only as end products of past difficulties, but also in the act of struggling with present difficulties. A few, to be sure, cast off their problems with miraculous dispatch, once removed from an acutely irritating home or school environment, but in most the old mechanisms disappear only with time and re-education.

We have been onlookers and, at times, participants in an old drama, that of adolescence, a struggle of youth to find a place of his own in the world of reality, now spurred on by his growing need of love and life, now routed by the terrifying aspect of new responsibilities and relationships. To most of our boys the drama hitherto has been more or less a tragedy. In their effort to satisfy fundamental urges they have been thwarted by circumstances of environment and personality and, having failed to adjust to their own little world of home, school, and neighborhood, have been labeled delinquent and passed on for specialized training. Fortunately the Berkshire Farm has lived down the word "reform."

The psychiatric research department, in its participation in the institution program, has found that physical equipment, educational and recreational facilities, and even responsive, cooperative boys do not tell the whole story. There is always that incalculable and immeasurably important element, the institution staff. In every phase of the department's work-the preliminary investigation, the diagnosis, and the treatment processes-we have to understand and reckon with the attitudes of the adults with whom the boys come into daily contact. The problems involved in this interplay of adolescent and adult personalities are far too many and too complex to be presented adequately in a paper of this length. However, there are certain high lights which will serve at least to

indicate the degree to which the staff member affects psychiatric treatment of the boy.

The initial investigation begins at the time the boy is referred to the clinic for study. The worker in referring the boy often gives unconsciously a clue to his own attitudes: "I wish you would take John for study. I'm afraid he's hopeless, though. Do you know what he did yesterday? He left the cottage during work time without permission and was actually impudent when I took him to task about it." Or, "Will you please talk to William and find out whether he had anything to do with stealing tools from the shop. He'll probably lie to you about it, so don't let him put it over on you."

In seeking information we often find it difficult to get a satisfactory description of a child's behavior. The overworked housemother, untrained in scientific observation, completely overlooks many points and colors others with her own prejudices. As the teacher is all too likely to place a premium on unimaginative docility and discount disturbing curiosity and ingenuity, just so the weary matron has a way of describing her boys in terms of muddiness of shoes or ability to polish floors well. It is easy to obtain categorical descriptions of the boys as "dishonest," "disagreeable," "good," or "bad," but it is only after much time and effort that we obtain an objective detailed account of the child's behavior.

After the preliminary investigation we are faced with the problem of interpreting our tentative diagnostic findings to teachers, housemothers, and other staff members who are to assist in treatment of the boy. Occasionally it is the problem of science struggling with the mind closed by ignorance or instinctive prejudices. "I don't need the psychiatric research department to tell me about my boys," said one good woman, with a complacent smile, "I know them all, perfectly." Another expressed much concern over the psychiatrist's permitting a boy with minor epilepsy to be retained in the Farm infirmary pending his discharge. "The doctor can say what he pleases, but I know some things that he doesn't. Now that boy has fits, and, if there should be a draught from a window or a fireplace between him and you, you'd get them!" Even the efficient and well-trained teacher often finds it hard to accept the fact that Billy cannot learn any more in academic school and that his restlessness is his protest at being expected to do the impossible. She is sure he could work out percentage problems if he tried, because he is clever enough at stealing from the kitchen. Those who have been engaged in psychological work know all too well the difficulties of interpreting the borderline child with a glib tongue and a deceptively alert smile.

In planning treatment, more than at any other stage of the game, we have to reckon constantly with the personal equation. We must expect to find in the housemother and teacher many of the same mechanisms that we find in the problem boy. However much we long to concentrate upon the child's problems, we shall find them so closely interwoven with those of the adult that we cannot detach them if we would.

One of the most important tasks in our treatment of the boy consists in aiding him to adjust to authority as a part of the world of reality. Most of our boys come to us much in need of this type of therapy. In some cases they have become overt rebels against the autocracy embodied in an overexacting mother, a harsh father, or a teacher famed for her discipline. One boy may react as a chronic runaway, setting forth with a fine disregard of hardships and dangers in his determination of escape. Another shows his rebellion by disobedient acts and a persistent negativism. Then there is always the hardy spirit spoken of by his peers with bated breath-the boy who blacked a teacher's eye! When these children enter the institution they do not, of course, leave behind them their reactions to authority. The most sincere resolutions "to be good and mind" weaken when the shop teacher "hollers like Dad," or the matron reminds a fellow of mother when she keeps on nagging and nagging about that corner that wasn't dusted. The setting is new, but the old reaction flares up under the old stimulus.

Our boys learn rather quickly to accept reasonable routine and impersonal group discipline. It is when they come into conflict with the individual that the adjustment is difficult. Stephen, a bright, mature fifteen-year-old, confesses in a discouraged manner to the psychologist that he is having trouble with his teacher. "He makes me sick!" the boy bursts out, "There was mud on the floor and he told me to clean it up. I said it wasn't from my shoes and he made me do it anyway." "Why, Stephen," the psychologist says in surprise, "it isn't like you to be so disobliging. You could hardly expect a busy teacher to hold court to decide just who is responsible, could you?" "No," the boy answers, “but he ordered me to do it. It wasn't cleaning the floor I minded, but he's so arrogant." Stephen cannot be told what is apparent to us, that the "arrogance" of which he complains represents an attempt on that teacher's part to compensate for physical inadequacy. He can be shown, however, that the game of rebellion in so trivial a matter is hardly worth the candle.

One of our greatest problems is to interpret to the boy the worker's personality without undermining discipline thereby. After all, the boy must many times make the adjustment where the worker cannot or will not, and we do not consider this always an undesirable state of affairs. Our adolescent must, in a very few years, make his adjustment to all manner of personalities in the community, and we would not, if we could, provide an ideal environment for him in the institution. We cannot deceive him or defend the staff member in a situation obviously unfair to the child, but we can put before him the worker's problems without belittling the worker, and thus lead him to an attitude of cooperation. When a boy comes in and bursts into angry tears at an undeserved punishment by his housemother we may assure him of our confidence in him, but we do not express pity for him or indignation toward the housemother. Instead, we try to show him the inevitability of an occasional misjudgment by a busy person and point out to him her positive fine qualities and good faith. Sometimes we'

« AnteriorContinuar »