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The role of the psychiatric social worker in psychiatric hospitals and clinics

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The role of the psychiatric social worker in psychiatric hospitals and clinics

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Content THE HOLE OF THE PSYCHIATRIC SOCIAL WORKER
IN PSYCHIATRIC HOSPITALS AND CLINICS
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
Robert Leroy Nease
June 1954
UMI Number; bHbbb22
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Oi&sffiftation R jbi ahrtg
UMI EP66522
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This thesis, w ritte n under the direction of the
candidate's F acu lty Com m ittee and approved
by a ll its members, has been presented to and
accepted by the F a cu lty of the School of Social
W o rk in p a rtia l fu lfilm e n t of the requirements
fo r the degree of
MASTER OF SOCIAL WORK
Thesis o f Robert Laray aNQAae
Faculty Committee
......
Chairman
& L a
Dean
TABLE OF CONTENTS
CHAPTER Page
I. INTRODUCTION .................................. 1
,Purpose of Study
^Psychiatric Social Work
History of Psychiatric Social Work
Scope and Method of Study
II. ANALYSIS OF ANNOTATIONS ’ ............... 19
Total Aspect of Practice
Casework Service
Collaborative Work
Intake
Supervision and Consultation
Social Study
Supportive Therapy
Discharge Planning
Education of Community
Patient’s Family
Group Therapy
Controversy
Selected Aspects of Practice
Collaborative Work
Patient’s Family
Casework Service
Emotional Support
Environmental Manipulation
Relationship
Discharge Planning
Specific Diagnostic Groups
Consultant to Community
Social Study
Vocational Services
Intake
Interpretation
Confusion
The Social Worker in Psychotherapy
Public Health as a New Setting for Practice
Training Programs
III. CONCLUSIONS.......................................49
ANNOTATED BIBLIOGRAPHY .............................. 56
CHAPTER I
INTRODUCTION
Psychiatry as we know it today is relatively
young, and psychiatric social work is even younger.
Evidence of immaturity on the part of both is
seen in the lack of optimum understanding and
teamwork, which should come with time and growth
in wisdom. This lack is due to the fact that
areas of responsibilities are yet not clearly
defined.^
Joseph Sutton is referring here to an unresolved
conflict in the "areas of responsibilities" of the psy-
j chiatric social worker. There is sufficient conflict
Ion this score to warrant further clarification here.
The conflict grows out of a confusion, in part semantic,
(as to the precise meaning of "psychiatric" when used
)with "social worker." This confusion, or lack of clar-
Iity, is not so much an overlapping of responsibility
I as a difference of methodology in the practical enact-
/ ment of social casework as seen in different settings.
Because of the work that remains to be done in defining
areas of responsibility in psychiatric settings, in the
Elizabeth Beck, "Psychiatric Social Work Possi
bilities in a Mental Hospital"; cited in Joseph Sutton,
"Discussion," Journal of Psychiatric Social Work,
(Spring, 1949), 182.
2
interest of better practice of psychiatric social work,
enlarged understanding with other professional groups,
and more effective teamwork within common settings,
^ this study is undertaken. This study, which is based on
articles published in professional journals in the fields
of psychiatric social work and psychiatry, is an effort
to clarify and combine the thinking of authors concerning
the areas -of responsibility of the psychiatric social
worker.
One of the differentiating factors of psychiatric f
social work is the fact that casework service must be
coordinated with the contributions of the other members
of the clinical team in which the psychiatrist has the
ultimate responsibility for leadership. "Casework in
the psychiatric setting carries specific emphases that
derive from this collaborative effort."^
Psychiatric social work is the youngest speciali
zation in the field of social casework and has had a
particularly divergent and uneven development compared
with the development of casework in other settings.
During the past twenty-five years the literature of
psychiatric social work has been characterized by a
1
Ruth Knee, "Psychiatric Social Work," Social
Work Year Book, ed. by Russell Kurtz (New York: American
Association of Social Work, 1954), 38?.
3
recurrent concern with definitions of function. Volume
twenty 1950 of the Journal of Psychiatric Social Work
contains twenty-eight articles. Of this total, seven
articles, or one-fourth, were devoted to some kind of
analysis of the function of the psychiatric social
worker.
One aspect of this concern with defining function
is the effort to assess the role of the psychiatric
] ;
social worker in psychotherapy. That there is still con- /
cern is evidenced by this statement in a current issue
of a professional Journal:
Tb has often been said that casework is the
poor man’s psychoanalysis. This is more truth
than Jest. The broad therapeutic goal is to
help man achieve the real quality of being human--
the ability to come closer to his fellow man,
to be part of a social process. This is also
the larger goal of casework. By no standard can
casework not be called psychotherapy.1
Dr. Nathan Ackerman, in a symposium on the train
ing of caseworkers in psychotherapy in the January 1949
issue of the American Journal of Orthopsychotherapy, said, :
"I believe that the difference between psychotherapy by |
a social worker and by a psychiatrist can be only a ;
1
Clara Rabinowitz, The Caseworker and the
Private Practitioner of Psychotherapy," The Jewish Social
Service Quarterly (December, 1953), 166.
difference in degree."^
From September of 1940, the year the National Se
lective Service Act was passed, up until, the end of World
War II in August 1945, the role of.the psychiatric social
worker in the adult mental hygiene clinic had undergone
many changes. This change was the subject of a thesis
2
by Stanley Finley in 1952, which is further evidence
of interest in the changing role of the psychiatric
social worker.
That there is lack of agreement as to what con
stitutes psychiatric social work was stated clearly by
Leon Lucas in his presidential address before the American
Association of Psychiatric Social Worker in May 1951,
when he said:
Some say that what our members do defines
what psychiatric s.ocial work is; others say
that our professional association defines as
psychiatric social work what is the only cri
terion for the definition of practice. Thus
it might be said that if a number of members
practice psychotherapy or lay analysis that
fact should set the limits of our professional
competence. Others would limit such practice
Nathan Ackerman, "Symposium on Training of
Caseworkers in Psychotherapy," American Journal of
Orthopsychiatry (January, 1949), 27.
2
Stanley Finley, "The Role of the Psychiatric
Social Worker During World War II in the Adult Mental
Hygiene Clinic" (Unpublished Master's thesis. University
of Southern California School of Social Work, 1952), 1.'
to social work in the psychiatric services of
clinics and hospitals. Is this a semantic prob
lem, or is it more basically a problem concerned
with the professional area of competence and the
socially and legally accepted role of our field?
The issue has been bandied about with little re
sult and should be carefully studied by our as- ^
sociation in view of its long term implications.
The American Association of Psychiatric Social
Workers, Inc., made this a topic of research and in
1953 Tessie D. Berkman published Practice of Social
Workers in Psychiatric Hospitals and Clinics. It repre
sents a "pioneer effort" in the analysis of the psychi
atric worker's Job in psychiatric settings. Although
the data for the study were collected during one period
of time--the spring of 1950--the study Is more than a
description of practice In a certain year. It is a
"backdrop" which brings future developments into clearer
focus. Miss Berkman defined a psychiatric social worker
as any person designated as carrying social work respon
sibility In a psychiatric hospital or clinic that satis
fied specified criteria. She found nearly 2000 persons
to be employed as psychiatric social workers on the
staffs of 223 hospitals and 290 clinics which comprised
the data for her study. She mailed schedules to each
Leon Lucas, "issues Pacing the American Associa
tion of Psychiatric Social Workers on Its 25th Anniver
sary," Journal of Psychiatric Social Work (June, I95I),
133. “
6
social worker, of which 1,793, or 90 per cent, returned
schedules that were used. Of these, 974 were from
1
hospitals and 819 from clinics.
Purpose of Study
Many articles have appeared in professional
Journals on the different aspects of psychiatric social
work practice. In these publications some difference
in psychiatric social work activity in the various agency
settings Is apparent. It also appears that the field of
psychiatric social work and the field of psychiatry have
had a tendency toward fusion in settings where the two
professions have worked together to help people In
trouble, partially as a natural result of a common pur
pose which emerges from a common psychological base.
This fusion may be a result of the performance of like
functions by psychiatric social workers and psychiatrists,*
and this may In turn be attributed to two factors: (1)
the common goal of both professions, that of helping
people, and (2) educational similarities of both pro
fessions, with course content in dynamics of development
and psychological disorders.
Tessie D. Berkman, Practice of Social Workers
in Psychiatric Hospitals and Clinics %New York: American
Association of Psychiatric Social Workers, Inc., 1953),
19.
Thus in an ever-changing field, such as psychi
atric social work, it is important to stop and clarify
objectively the psychiatric social worker’s status.
Unless psychiatric social workers know what their roles
are, and can define them, there will continue to be a
lack of clarity. Another circumstance which may con
tribute to confused objectives and methods between
psychiatric social workers and psychiatrists is in the
settings in which social workers practice. Psychiatric
social work is not the host profession and consequently
the social worker’s role has been dictated by others.
If the practice of a social worker is a profession with
a separate function, this function will be understood
only as practitioners themselves are clear in their pur
pose, and spell it out for all to see.
The road to greater understanding and clarity
lies in the re-identlficatlon of the original psychiatric
social worker goals toward which, with enhanced knowledge,
they can move with assurance and dignity, and with pride
in the unique contribution that psychiatric social work
can make toward the relief of human ills. If our goals
are clear,, confusion may be avoided in our methods.
The purpose of this study, then, is to clarify and
analyze the role of the psychiatric social worker as
seen in articles written by psychiatric social workers
8
and published in professional journals. It will be con-
I ;
cerned with psychiatric social work in psychiatric hos
pitals and clinics.
Psychiatric Social Work
A study of the role of the psychiatric social
worker in psychiatric hospitals and clinics Immediately
brings up the question, "What is psychiatric social
work?" But definitions often have little meaning until
one has some comprehension of the larger area within
which a part is to be described. A definition of psychi
atric social work is not easily grasped until one has
a picture of social work as a whole.
In organizing itself to play a professional role
in forwarding the objectives of a health-and-decency
standard of living and of satisfying human relationships,
social work has come to Identify four main methods of
approach. There are mass needs and mass solutions,
community needs and community solutions, group needs and
group solutions, individual needs and individual solu
tions, The first way of meeting needs might be called
social reform or social action. The other three methods^
are termed, respectively, (1) social welfare planning.
1
Gordon Hamilton, Theory and Practice of Social
Casework (New York; Columbia University Press, 1940), 7*
9
or community organization, (2) social group work, and
(3) social casework.
Social action rests mainly on the techniques of
public education and propaganda, social legislation and
cooperative and collective enterprises. When the social
worker turns to the forces of the community or government
action to achieve his objectives rather than relying on
individual initiative or voluntary group processes, we
think of this as social action.
Social welfare planning is concerned with organiz
ing social agencies and activities. Today community or
ganization is as much concerned with public as with
private organizations. It must study the whole -field of
expanding human needs, and must forecast as well as
interpret trends.
Because social welfare planning rests quite as
much on the intelligent functioning of groups as of
individuals, and because group experience is a way of
meeting needs and developing healthy interests and the
contributions of individuals, social group work has come
to have an increasingly well-defined place as a basic
method in social work. Most group work has developed
in what are commonly thought of as leisure time activi
ties, such as have been undertaken by settlements,
churches, scouts, and youth organizations. Group
10
experience can develop capacities for participation,
for acceptance of others, for leadership and for person
ality development. Recently group workers have also
begun to practice in non-traditional settings such as
hospitals, child guidance centers and children's insti
tutions .
It now becomes possible to arrive at a definition
of social casework and psychiatric social work, without
confusing them with the total profession of social work.
In 1922, Mary E. Richmond arrived at her definition of
casework. She identified casework as ". . . the develop
ment of personality through the conscious and comprehen-
1
sive adjustment of social relationships."
Since then more has been learned about inner
conflicts and personality problems. Psychological pro
cesses and techniques have been identified which have
added to our casework skills.
In 1929 two different definitions of psychiatric
social work were formulated. The first definition em
phasized the setting in which social casework was prac
ticed. It defined psychiatric social work as ". . .
social casework established within psychiatric agencies
^ Mary E. Richmond, What is Social Casework (New
York: Russell Sage Foundation, 1922), 98^ .
11
as a form of service essential to the medical program
of such agencies."^
The second definition emphasized the qualitative
nature of the practice regardless of setting. It defined
psychiatric social work as ". . . practice possessing
certain qualities deriving from knowledge of psychiatric
concepts and from the ability to adapt them to the social
„ 2
casework process.
-------Lois Meredith - Frenoh^—ifWPsychiatric Social Work,—
published in 1940, referred to the two different meanings
ascribed to psychiatric social work as contributing to
"growing confusion due to a dual basis for definition
3
of the field." Remnants of this confusion remain today.
History of Psychiatric Social Work
In the development of psychiatric social work it
is inevitable that emphasis should shift with social
changes, since social work is a service for people whose
• 1
R. Lee Porter and Marion Kenworthy, Mental
; Hygiene and Social Work (New York: The Commonwealth
, Fund, 1929T, T6Ï.
2
Tessie D. Berkman, Practice of Social Workers
: An Psychiatric Hospitals and Clinics %New York: The
American Association of Psychiatric Social Workers, Inc.,
1953), 1.
3
Lois Meredith French, Psychiatric Social Work
(New York: The Commonwealth Fund, 1940), 116.
12
lives are affected greatly by those changes. The aims
of psychiatric social work, as well as the form and
method of its services, are not fixed or final. There
fore, experimentation and analysis of practices in the
light of social developments are the obligations of
social workers in the professional field. It is rather
difficult to determine exactly when important changes
in the objectives and the techniques of psychiatric
social work took place since changes came about gradu-
ally and unevenly.
The year I905 marked the first time when psychi
atric social work was employed in neurological clinics,
and in that year it was so used both in Boston, Massa
chusetts, and in New York City. It was at the Boston
Psychopathic Hospital in 1913 that psychiatric social
work was given a distinct name to designate a special
function. It was also at this time that facilities for
1
professional training were provided.
The year 1917 is important in psychiatric social
work history for the publication of Social Diagnosis, by
Mary E. Richmond, and also for the emergence of evidence
of the influence of psychology and psychiatry on the
1 !
Ruth Knee, "Psychiatric Social Work," Social Work;
Year Book, ed. by Russell Kurtz (New York: American Asso- |
elation of Social Work, 1954), 389.
13
practice of the psychiatric social worker. Methods
evolved for securing information and weighing evidence,
and certain techniques employed in interpretation and
diagnosis are stressed in Miss Richmond’s book. Treat
ment, in the author's experience, was always in terms of
concrete material service, such as monetary aid, moving
a client to better living quarters, or providing him
with medical care; the important thing was to discover
or diagnose the client's need and then endeavor to supply
1
it.
The World War of 19l4-l8 had far-reaching effects
on the practice of the psychiatric social worker.' The
war stimulated the organization of training for the
field and widened the opportunities for psychiatric
social work practice. It changed its philosophy and
method toward the care of children and widows of war
victims, the rehabilitation of returned soldiers, and
the service to the unemployed following the collapse of
war industries. These and other social problems of the
war years called for an understanding of the importance
of attitudes and behavior in the social adjustment of
individuals.
1
Josephine Strode, Introduction to Social Case
work (New York: Harper and Brothers, 1948)1 40.
14
In the period from 1919 to 1930, psychiatric
social workers were interested in the application of
psychological principles to problems of individual adjust
ment. They were concerned with the hidden mechanisms of
attitude and motivation and less interested in environ
mental situations. Psychiatric social workers believed
that the client should be helped to a place where he
could solve his own problems.
_______In keeping with this trend of psychological em- _
phasis in social work, schools of social work became in- I
creasingly concerned with the personal development of
their students, particularly as to their attitudes toward
themselves and toward clients.
Again, in the years from 1930 to 1940, social
changes took place. The economic debacle of 1929 direct
ed attention to the insecure foundation of our postwar
prosperity. Millions lost their savings and had to depend ;
upon public relief of some sort. Responsibility for a
large share of the administration of this public relief
was entrusted to psychiatric social workers. The major
ity of psychiatric social workers had had their field j
placements and work experience in private agencies. The
number of trained workers was limited. Even before this I
period, the demand for trained social caseworkers had i
always exceeded the supply. And so in this emergency i
15
many, psychiatric social workers moved out of psychiatric
agencies and assisted in the administration of mass re
lief programs.
During the second world war, psychiatric social
workers on the home front carried on their responsibil
ities in hospitals and clinics, plus service in induc
tion centers; they participated in community planning
for neuropsychiatrie rejectees and for returning veter-
ans, with rehabilitation services for war and civilian
casualties. It was during the second world war that
under the auspices of the War Service Office psychiatric
social work was accepted as a military specialty. Then
in September of 1945, for those specialists who could
meet professional requirements, officer status was
1
approved.
In the postwar period, interest has been in pro
viding adequate care and treatment and rehabilitation
services for psychiatric patients. The passage of the
Mental Health Act in 1946 provided for expansion of
facilities, training opportunities, and community effort
directed toward the prevention of mental illness.
Clinics on the state, local, and federal levels have
1
Ruth Knee, "Psychiatric Social Work," Social
Work Year Book, ed. by Russell Kurtz (New York: American
Association of Social Work, 1954), 340.
16 ;
expanded, placing increased demands on psychiatric social
work personnel.
Today social workers are thinking that psychiatric
social work must Toe redefined in terms of the present
social situation and human needs. It must be redefined
not only from the standpoint of method, but also in
broad terms of philosophy, objectives and function.
Scope and Method of Study
This study has been developed through an analysis
of articles that pertain to the subject. The articles
which have been used have appeared in publications of
professional associations in the fields of social work
and psychiatry. These periodicals are: Journal of Psy
chiatric Social Work, Social Casework, American Journal
of Orthopsychiatry, American Journal of Psychiatry,
Mental Hygiene, Social Service Review, Social Work.
Journal, and The Social Welfare Forum. Only articles
written by psychiatric social workers in psychiatric
hospitals and clinics are used. Articles are chosen
which have to do with psychiatric social work practice
and function within specified agency settings.
The period covered in this study is from January
1, 1952, to December 31, 1953* This span of time was
chosen to make it possible to direct the focus toward
17
determining the present-day thinking of psychiatric
social workers as to their role and function in psychi
atric social work settings.
This study is based on twenty-six articles written
by psychiatric social workers concerning their role in
, psychiatric hospitals and clinics. This is a small seg
ment when compared with Miss Berkman's study of about
2,000 psychiatric social workers in relation to the
entire scope of the practice of psychiatric social work;
however, it is also recognized that in preparing an
article for publication an author has more motivation
for developing his thinking and more opportunity for full
expression than in answering a questionnaire.
Questions to be answered are these: Is there lack
of agreement among psychiatric social wprkers today as to
whether they are doing casework or psychotherapy? Are
the authors clear in defining their function? In what
way does casework vary from one agency to another? Is
there comparability of practice in like agencies? What j
difference in practice is there between public and i
private agencies? Is there a difference in practice i
j
among agencies on the federal, state and local levels? i
Are psychiatric social workers particularly well quali-
. fied to help patients in certain diagnostic groups? 1
/ An annotation was prepared on each article selected I
18 :
for inclusion in the bibliography. Each annotation had
a threefold purpose: (1) to identify the author, (2) to
summarize the material related to the role of the psychi- i
atric social worker, and (3) to give the role of the
psychiatric social worker as seen by the author. I
The articles have been classified under four
general headings. Group one includes articles concerned
with the general aspects of the role of the psychiatric ;
social worker. Group two includes articles concerned ‘
with specific services of the psychiatric social worker
or part of the service dealing with specific groups of
patients. Group three includes articles written concern
ing the emergence of public health as a setting for
psychiatric social, workers. Group four includes articles |
on the training of student social workers, technicians
in the armed services, and state-wide conferences.
The second chapter contains the analysis of the
articles. Chapter three contains the conclusions and
recommendations. The annotations comprise the appendix.
CHAPTER II
ANALYSIS OF ANNOTATIONS
Numerous articles dealing with the role of the
psychiatric social worker in hospitals and clinics ap
peared in the literature of the profession during the
years 1952 and 1953- There were twenty-six articles pub
lished in the eight periodicals included in this study.
These fell into four natural divisions. The first six
dealt with general aspects of the function of the psychi
atric social worker. Second, there were thirteen arti
cles concerned with specific services of the psychiatric
social worker or part of the service dealing with a
specific diagnostic group. Third, there were three ar
ticles relating to public health agencies as a setting
for psychiatric social work. There were, fourth, four
articles concerned with the training of the student
social worker in field placements in psychiatric agencies,
the untrained social worker in the armed service, and the
use of psychiatric social workers as consultants. In an
effort to evaluate adequately the published contributions
concerning the role of the psychiatric social worker in
20
psychiatrie hospitals and clinics, the annotations pre
pared from the bibliographical entries were reviewed
with special reference to the individual interests and
agency experience of the authors.
The annotations were analyzed from the stand
point of three factors: (1) the amount of agreement
among the authors regarding the function of the psychi
atric social worker, (2) the amount of disagreement re
garding the function of the psychiatric social worker,
and (3) the authors' differences of opinion as they
contrasted one agency with another.
Total Aspect of Practice
There were six articles which dealt with the
total responsibility of the psychiatric social worker
in hospitals and clinics. Three of the authors were
affiliated with psychiatric hospitals, two were with
state hospitals, and the third with an Army hospital.
The other three authors were affiliated with psychiatric
clinics ; two of these were mental hygiene clinics serv
ing general population groups, and the third was an
Army out-patient clinic.
21
Casework Service
"Casework service" was described as the psychiat
ric social worker's function in all six articles chosen.
However, only one of the six authors was explicit in de
fining the meaning of casework service. This was Velma
Mood who was specific in her presentation of the function
of the psychiatric social worker. She stated that the
psychiatric social worker uses his knowledge in under
standing an individual in order to help him first to
define the problems (in particular, those of an inter
personal nature) concerned with his present living situa
tion; and then to help the patient "come to grips" with
reality situations. "The accepting, non-judgmental
attitude of the caseworker makes this possible between
caseworker and client as a medium or tool through which
the process of help is carried out."
The other five authors who mentioned casework
service as the function of the psychiatric social worker
discussed concepts without further elaboration, or de
scribed their agency program, giving content of casework
service. There seemed to be different emphases between
authors from hospital and clinic settings, related
largely to their specific responsibilities in the care
of patients.■
22
Pauline Peters, in an article on "Current Prac
tice in a State Hospital^-" describes casework service
as "formulating history material at the time of intake,
which is given to a doctor who makes recommendations for
commitment or discharge." Although she listed areas of
responsibility such as intake, discharge planning and
family care planning for the patient, she did not pre
sent or discuss the casework process and role in formu
lating these plans. She reported that twenty per cent
of the psychiatric social worker's time is taken up
with service to voluntary patients, while over forty per
cent of his time is devoted to the "intramural" services
which include work with the newly committed, as well as
with the "not-new" committed group.
Captain Ryan, writing of the psychiatric social
worker in a neuropsychiatrie outpatient clinic of a
general hospital, stated that the military psychiatric
social worker is concerned with preserving the fighting
strength of the unit (the clinic also has as its function
the training of psychiatric social workers). Therefore,
the social workers satisfy themselves with attaining the
point in treatment in which the patient begins to func
tion effectively as a soldier. "Because of this there is
no routine exploration of some of the more basic psycho
logical conflicts which are largely unconscious."
23
Ryan stressed another point of emphasis in
casework process. He stated that if casework can be ef
fectively practiced within the military framework, two - - ,
fundamental propositions must pertain: (1) "Psychiatric
. social work can be practiced effectively in a setting
where the primary focus is on the welfare of the group",*
and (2) "psychiatric social work can be practiced ef
fectively in an authoritative setting."
Eleanor Basserman described casework service as
aiding the patient in the acceptance of hospitalization,
and with his concern about what is happening at home.
In a selected group of cases, the social worker was
called upon to work with patients who were not able to
respond to a therapeutic relationship with the doctor
and whose reality problems were of primary concern.
This she categorized as direct service to the patients.
Margaret L. Newcomb and co-authors Gay, Young,
Stewart, Smith and Weinberger described the casework
' help as treatment to meet the needs of the patient which
concerned the patient and his adaptation to his environ-
. ment. These authors stated that the foundation of
treatment by the social worker was the casework relation
ship. A relationship was established in which a large
measure of emotional independence was encouraged in the
patient, and current reality was the major focus of
24
attention. The caseworker deals with derivatives from
the patient's past which were manifest in the present
reality. They further stated that casework techniques
include emotional support, environmental help, abreac-
tion and clarification which, although not elaborated
upon, suggested some exploration of the unconscious.
A patient might also have been assigned to a caseworker ^
I
when he was not yet ready for intensive psychotherapy, |
but could be prepared by a reassuring relationship with '
the caseworker. The social worker was used as the
"first step" in therapy.
Collaborative Work
Another aspect of the psychiatric social worker's
function mentioned in all six articles was the collabora- !
tion with other team members. Treatment of the patients
involved the skills of the psychiatrist, psychiatric
social worker, psychologist, and in some cases it in
cluded nurses and attendants, pooled to offer a program
I
of mental hygiene. Fergus Monahan, describing supportive ;
casework in,an Army hospital setting, stated that because ^
of the collaboration among team members, patients might
receive any one of the following types of treatment:
"psychotherapy, casework, including supportive treat
ment, and group therapy." Some group therapy and
25
supportive casework therapy was also offered in the
field.
Intake
Five of the six articles discussed intake as a
function of the psychiatric social worker. Of the five
authors describing intake, three were affiliated with
psychiatric hospitals and two with psychiatric clinics.
There was some difference of opinion as to what the
intake interview should include.
Newcomb and co-authors described intake in a
psychiatric clinic as "a team function in which the
social workers and the psychiatrist interview the pa
tient." Monahan, describing intake in a psychiatric
hospital, concurred with Newcomb in this respect. The
psychiatric social worker had the first clinical contact
with the patient in the intake process. He summarized
the salient factors in the patient's history and con
cluded with a social-diagnostic evaluation and recom
mendation for treatment. If eligible for treatment in
the clinic, the patient was next seen by the intake
psychiatrist for further diagnostic purposes.
In discussing intake in a psychiatric hospital,
Basserman described this aspect as "using the psychiatric
social worker in pre-admission planning." The psychiatric
J
26
social worker discussed the patient's feelings about
coming into a hospital, being behind locked doors, and
living with ill patients. An interpretation is also
given of the part the psychiatric social worker will
have in helping both relatives and patient. Basserman's
discussion of intake was somewhat like Ryan's discussion,
in that he described the psychiatric social worker's ef
forts to help the patient to accept the referral and the
choice of treatment at the time of intake.
,Peters described a plan in which the patient
was seen in a diagnostic center before admission to the
hospital. This served as the intake interview, at
which time the psychiatric social worker interviewed each
patient and available family members to formulate history
material. This material was then given to a commission
of two doctors who made recommendations for commitment
or discharge. If commitment was recommended and agreed
upon by the family, a social worker sat beside the judge
in a closed hearing to interpret the history and the
social situation.
Supervision and Consultation
Six authors discussed supervision. Two of them,
both affiliated with psychiatric clinics, stated that
psychiatric social workers supervised all casework.
27 :
Another author, from a psychiatric hospital, reported
that the psychiatric social workers were "supervised"
by psychiatrists. In the other three articles, the
relationship with psychiatrists, other than the collabora
tive aspect, was on a referral basis. Velma Wood, writing
from a mental hygiene clinic, stated that having a psy
chiatrist within the agency framework entitled the
social worker to the use of the title "psychiatric social
worker." She continued by saying, "We are indebted to
the psychiatrist with whom we work for help in understand
ing the dynamics of our client’s behavior, but we should
not expect--nor is a psychiatrist equipped to give--help
in the application of skills and techniques in casework."
In contrast to this opinion, Basserman stated, "Guidance
and supervision may be given to the worker by the psy
chiatrist in charge of the case."
Social Study
In four articles, three written concerning the
function of psychiatric social work in psychiatric hos
pitals, and one written concerning the function in a
mental hygiene clinic, the formulation of a psychiatric
social study was discussed as part of the worker’s func
tion. There seemed to be a unanimity of opinion that
the social study was secured for the purpose of helping
28
the entire team formulate diagnosis and treatment plans.
Supportive Therapy
Supportive therapy was described as part of the
social worker's function in four of the six articles.
Two of the four were not explicit in their meaning. The
other two authors did not agree. Monahan discussed this
aspect of work in a military hospital, stating that sup
portive casework was directed toward improving the pa
tient 's effectiveness as a soldier, and it was also di
rected to those patients for whom separation from the
Army had been recommended. Supportive therapy in this
instance was aimed at offering the soldier a chance to
verbalize his feelings, attitudes,, and thoughts. Then,
when the patient's discharge had been approved, he was
encouraged to think of future civilian plans.
Newcomb approached the supportive therapy function
from a slightly different aspect. She believed that pa
tients ' life-long standing emotional difficulties, with
poor prognosis for psychotherapy, may be referred to the
social worker for long-time supportive relationship and
' evaluation of environmental stresses. Supportive therapy
in such cases was for the purpose of helping the patient
to make a more adequate adjustment to some small part
of his present environment.
29
Discharge Planning
Discharge planning as a function of the psychiat
ric social worker was discussed in three of the six arti
cles. All three authors were affiliated with psychiatric
hospitals. These plans were concerned with helping the
patient in his feelings and attitudes about leaving the
hospital, and also with exploring vocational counseling
and Job opportunities with the help of specialized
agencies. In two of the three articles, foster home
placement was discussed as service for patients who
either have no home or have been rejected by their family.
Only two of the six articles described offering casework
help to the patient’s relatives at the time of the pa
tient’s discharge.
Education of Community
Part of the social worker’s function was described
in three of the six articles as the enlightenment of or ^
i
interpretation to the community of the mental hygiene
factors which may help* members of the community in under
standing the patients in treatment. Two of these authors |
were affiliated with psychiatric hospitals. |
Patient’s Family
Three of the six articles described treatment of
30
the patient's relatives or family as an aspect of the
psychiatric social worker's function. The social worker
concentrated on the relatives' problems as they affected
I
or will affect the patient in planning for his discharge.
Of the authors who agreed on this aspect of the psychiatric
social worker's function, two were affiliated with psy
chiatric hospitals.
Group Therapy
Two authors discussed the work of the psychiatric
social worker with the psychiatrist in group therapy ses
sions. Here the worker dealt mainly with the problems
of interpersonal relationships with social or environ
mental difficulties and current reality problems.
Controversy
In endeavoring to answer the question as to
whether the social,workers did or did not do psychotherapy
and what the difference was between psychotherapy and
casework, two of the articles discussed the controversy
from opposite viewpoints. Wood believed that there was
. no longer any doubt as to whether the work done by the
; psychiatric social worker was different from that done by
the psychotherapist. She stated, "the psychiatrist, or
the psychotherapist, focuses his attention upon the in
stinctive drives of his patients." To work with
31 ;
unconscious material, she continued, "... involves
experience and skill in that area as well as the self
discipline which comes out of one's own instinctual
drives. Skill in one area does not imply skill in the
other." However, she goes on to say, this is not to
imply that a caseworker cannot work in the area of un
conscious material, but that training and experience in ,
psychiatric social work is not in itself sufficient to j
I
equip a caseworker to work with the transference phe- |
nomenon and unconscious material. The author did not
elaborate the meaning of the transference phenomenon.
She concluded, "Casework has-professional status and
can have more if we as practitioners state clearly first
to ourselves and then to others, what we do, why we do
it, and how we do it."
In a contrasting viewpoint, Newcomb described
intensive casework as dealing with the patient at the
level of his understanding and avoiding the bringing out
or discussing of unconscious phenomena such as dream
content. The function.of the psychiatric social worker
is to provide help through clarification which she de
fined as helping patients who are emotionally disturbed
in t^heir own understanding of their environment, to dis
entangle some of these emotions so that they can per- j ,
ceive the reality possibilities and mobilize their inner ;
Î
^ j
32
resources.
Selected Aspects of Practice
There were thirteen articles that were concerned
with one or more specific aspects of the social worker's
role but not, as in the preceding group, encompassing the
entire function. Each author described the treatment
given in his agency as it applied to particular aspects
of the psychiatric social worker's function, or the
treatment of certain diagnostic groups.
These thirteen authors were affiliated with three
different classifications of agencies. There were seven
hospital affiliations, four of which were Veterans Ad
ministration neuropsychiatrie hospitals or facilities,
two were state hospitals, and one was a city hospital.
There were five authors affiliated with psychiatric
facilities for children, three of which were child guid
ance clinics, one a child development center, and the
other a child guidance home. There was also an article
concerning the treatment of one specific diagnostic group,
written by a staff member of a public health service.
Collaborative Work
The outstanding emphasis of the thirteen articles
was the "technique" of collaboration, teamwork, or inte-
33
gration with other professions in the agency setting.
Ten of the authors discussed this aspect of the psychi
atric social worker's function. Seven of the ten authors
were affiliated with hospitals and three with clinics.
Three of the ten articles merely stated that there was
collaboration among team members, without elaboration,
but the other seven were in general agreement and spelled
out the importance of this aspect of the function of the
psychiatric social worker. Dorothy Robinson devoted her
entire article to the topic, "Some Aspects of the Inte
grative Process in a Psychiatric Setting," which illus
trated well the other eight authors' discussions. She
stated,
To work effectively with other disciplines
the social worker needs to know not only his
own role and function and where it fits into
the particular setting, but also the social worker
must regard other professional groups with respect
for their background, training, and comparable
contributions.
She concluded her article by discussing the necessity of
the lines of communication between professions remaining
open. It was in this way, she believed, that psychiatric
social workers share their experience and thinking and
focus their contributions in reaching a common goal--that
of helping the patient to get well. Ruth Latimer dis
cussed the team work between Alcoholics Anonymous and
social work in a state hospital, showing how these
34
principles were utilized in the casework process.
Patient's Family
Seven of the thirteen articles discussed some as
pect of the psychiatric social worker with the patient's
family, involving relatives in treatment for themselves,
even though, initially, the problem is seen as the pa
tient and his illness. There was some disagreement,
however, as to the form that this aspect of function
of the psychiatric social worker takes. The two articles
by Siporin and Latimer discussed the involvement of the
patient's wife in treatment because of marital problems.
Mr. Siporin stated.
There is increasing evidence of a new em
phasis in practice in a psychiatric hospital
setting. This new practice is the psychiatric
social worker's treatment of individuals with
marital problems.
He describes it as "one of the methods of treatment in
the mental hospital." Latimer described the psychiatric
social worker as invariably treating the marriage rela
tionship. She stated that "... the role of the marital
partner should not be underestimated." McGriff and
Robinson stated that "... there may be times when work
with a member of the family becomes of importance," but
gave no further clarification. There were also three
authors affiliated with child guidance settings who
35 ;
described the involvement of the patient’s family in
treatment. Bamford, Krug and Garrett described the
psychiatric social worker's relationship with the child's :
mother, as the child is in therapy with a psychiatrist.
The goal of treatment with the mother was to help her
. . . through the behavior disorder, and to help
her gain enough insight into her conflicting
feelings to give her child freedom in his future
development and, at the same time, find more
satisfaction in their relationship.
Casework Service
There were seven articles out of the total of
thirteen that described casework service as the function j
of the psychiatric social worker. In all seven there
was very little elaboration as to the meaning of casework |
service. Casework service in these articles seemed to
vary according to the limits of the setting and the
author's opinion. As presented in these articles, case
work service may be described as follows:
1. Helping a foster mother gain some understand
ing of her giving to her foster child on the
basis of feelings of guilt.
2. Having a special role with psychotic patients |
j
in view of the unusual demands on patience i
and flexibility. ^
I
3. Having an awareness of the patients' person-
36 ^
allties, their reactions to authority, and
their acting-out on the basis of previous
experiences.
4. Recognizing the sincerity of the patient's
desires, but helping him to accept the reality,
' of his need for continued hospitalization.
5. Helping a mother to recognize and accept the
feelings of her son.
Emotional Support
Emotional support as a concept of casework treat
ment was mentioned in seven of the thirteen articles.
There was no elaboration as to definition of the concept
other than listing "emotional support" as part of the
function of psychiatric social work, and using synonyms
like "encouragement" and "maternal attitude." Schmidt
stated, '^In supportive treatment we use a re-repression
technique," which was described as discouraging a patient
when he begins to flood the interviews with products of
his imagination.
Environmental Manipulation
Another concept of casework treatment mentioned
is environmental manipulation. Siporin described en
vironmental manipulation as an emphasis on the patient's
J
37 :
cultural and social situation, a recognition of the need
in treatment of the patient to modify his environment.
This aspect of the function of psychiatric social work
was described by authors affiliated with psychiatric
hospitals only. ■
Relationship
The use of relationship as a casework treatment
concept was discussed by five authors ; three of the
authors were affiliated with psychiatric hospitals, while
the other two were affiliated with psychiatric clinics.
Platt discussed this concept of relationship as
. . . the medium of treatment. . . . It is con
trolled by the worker as a representative of a
clinic and in terms of time, place, and the
kind of help offered. In this relationship the
child or parent works through ambivalent feel
ings toward himself and others. He struggles
against change and yet toward finding a new use
of himself in his efforts to solve his problems.
This was the only article in which relationship was
elaborated upon. The other authors merely listed it.
Discharge Planning
Discharge planning as part of the psychiatric
social worker’s function was described in four of the
thirteen articles. Again, the authors did not define
the term. Platt’s article on "Termination Planning in
a Child Guidance Clinic" described termination planning
38
as a part of the total treatment process. The author
formulated both general and specific statements as to
when termination was indicated.
The ending should be part of the beginning.
Realistic goals in treatment may be initially
and tentatively established and a time set for
re-evaluation in terms of progress or preparation
for closure.
Co-authors McGriff and Rackow stated that as the patient
improves and becomes more articulate, the relationship
with the worker can be strengthened to help him enter
actively into discharge planning and the patient’s re
actions to returning home may be evaluated and discussed.
If his plans are not realistic, an effort is made to
help him outline other possible objectives.
Specific Diagnostic Groups
In six of the thirteen articles, the authors
described the contribution of the psychiatric social
worker to treatment of specific diagnostic groups. Co
authors McGriff and Rackow were concerned with re
orienting the patient following lobotomy in a Veteran's
) Administration Hospital in relation to his attitudes
toward himself, his family and others. According to the
^ authors, "There is an increasing need for the service of
the psychiatric social worker to work with patients who
, do not respond to other forms of treatment." Two of the
39 !
six articles, those by Brill and Schmidt, described the
growing feeling that the caseworker has a special role
to play in treatment of psychotics. Social work skills,
according to both writers, can be of even more value to |
psychotic patients than was realized in practice here
tofore. Brill believed that the "therapist’s" own atti
tude constituted a primary factor in treatment; in view
of the special ampathetic qualities of psychotic patients,'
they are quick to pick up any feelings of disrespect, i
anxiety, and pessimism which may reinforce their own
anxieties. Latimer also discussed the patient as being
treated by the psychiatric social worker, but in coopera- |
tion with the Alcoholics Anonymous program. The article ;
described the Alcoholics Anonymous philosophy, coordinated!
with the casework process, as helpful to patients who
have been alcoholics.
Consultant to Community
An emerging aspect of the function of the psychi
atric social worker was his utilization as consultant to
community groups and to parent study groups. Three of
the thirteen articles described this aspect as including j
the education and guidance in mental health of preschool '
I
children of the community and their parents. In Barnes' |
article this aspect of the psychiatric social worker's |
40
function was to work with parent groups on an educational
level, often to give specific advice. The parent study
groups have two special values:
They enable parents to grow in understanding
and awareness of the importance of psychological
development during the early period of childhood
and, through educational enlightenment, to handle
their children more effectively; and many parents
who gain a new understanding through the group
process may have children who have developed
emotional difficulties.
In one article the psychiatric social worker's function
is described as a consultant during the therapy of the
patient. Co-authors Dewald and Harle illustrated the
use of a single consultative interview with another pro
fessional person during the course of brief psychotherapy.
Social Study
An aspect of the psychiatric social worker's
role which was mentioned in two articles was that of
securing a psychiatric social study of the patient. The
two authors, McGriff and Bamford, were of one accord that
the social study is needed to throw light on the illness
itself and on the attitudes of the patient's family.
The family’s capacity to carry the responsibility for
the patient's support and guidance must also be determined
before treatment plans can be made or discharge plans
formulated.
41
Vocational Services
Referral services to help the patient with em
ployment was mentioned in only one of the thirteen
articles. This was discussed with respect to referral
from a psychiatrist to a psychiatric social worker for
help with the problem of employment at time of dis
charge.
Intake
Intake was also mentioned by only one author.
Bamford’s article on "Selecting Patients at a Preschool
Treatment Center" described a treatment center which
selected patients who presented behavior difficulties
and offered guidance and treatment to them and their
parents as a preventative measure against more serious
difficulties which might occur. The author, however,
did not elaborate on the intake process.
Interpretation
Interpretation as a part of the casework service
by social workers was mentioned only once. This was in
Siporin's discussion of casework treatment of individuals
with marital problems. The article stated.
42
Depending upon diagnostic evaluation and
treatment goals, the caseworker’s activities
with the wife may involve interpretation and
assistance in understanding the patient, his
behavior, his illness, and hospital treatment,
and the resultant changes.
Confusion
Articles by Morris and McGriff brought out the
profession of psychiatric social work as operating in
organizational settings dictated by another profession--
psychiatry. This is because the final diagnostic treat
ment decisions rest not with the social worker but with
the psychiatrist.
One of the hypotheses of this thesis is the con
fusion which seems apparent concerning the role of the
psychiatric social worker in that the areas of responsi
bility were as yet not clearly defined by the workers
themselves. It is hard to come to any definite deduc
tions concerning the results because of the small number
of elaborations of the social worker’s function in such
areas as emotional support, environmental manipulation,
and relationship. However, when functions of the social
worker were defined, varied opinions appeared on such
aspects as casework service and collaboration with team
members.
43 ;
The Social Worker in Psychotherapy
The controversy over the role of the psychiatric
l i
social worker in psychotherapy, as described by Appelbaum |
was not introduced in any of the thirteen articles under
study. There were a few authors, however, who implied
that the social worker deals with unconscious material.
Schmidt stated that in supportive treatment the psychi- i
atric social worker uses a "re-repression technique." |
I
There were two other articles describing the caseworker
as actively handling the client’s guilt, and beginning
the process of softening the client’s rigid super-ego.
However, there was general agreement that psychiatric
social workers do not handle unconscious material and
there was a definite demarcation between the role of the
psychiatric social worker and the psychiatrist.
Public Health as a New Setting for Practice
In three of the twenty-six articles annotated,
a public health function of the psychiatric social
worker was presented. Two of the three articles con
cerned the function of the social worker in public health J
1
Mildred Appelbaum, "The Controversy over the
Role of the Psychiatric Social.Worker in Psychotherapy"
(Unpublished graduate thesis. The University of Southern
California School of Social Work, 1949).
44
psychiatrie clinics ; the other described the function
in the public health department.
All three articles dealt with mental hygiene
as an essential part of the public health program.
Co-authors Gundry, Hunter and Itykow discussed the func
tion of the public health department in bringing to the
general public knowledge of mental hygiene.
The type of teaching in which public-health
departments have had most experience and success
depends on giving information and help to indi
vidual patients and parents about their own
problems.
The public health nurse was the member of the staff who
had most to do with this case-by-case teaching. The
authors posed the question, "If a nurse is to do this
job, how can we give her help?" They discussed the
answer which they had found:
Attempts have been made to do this in our
organization by adding a social worker to the
ether resources which, for twelve years, had
been available for the training of the nurse
in mental health practices.
: The articles attempt to show how the social worker has
helped the nurse The main task was to provide specific
> guidance to each nurse in her function as detector of
emotional ills and dispenser of mental hygiene. Along
with this, an interpretation of casework was made to the
nurses.
The articles by Maril and Kleinschmidt showed how
45 }
mental hygiene clinics for emotional disturbed persons
were organized under public health auspices.
The emphasis is on making the mental hygiene
clinic one of the many health department services,
in an effort to break down the stigma that many
people may feel is attached to a psychiatric out- ‘
patient clinic. I
Maril's article described the psychiatrically trained
staff which consists of a full-time psychiatric social
worker, two psychiatrists and one psychologist who give i
service only oh the "clinic day." Since the social
worker was the only full-time member of the staff, he
assumed administrative responsibility for the clinic
program. This involved arranging the clinic schedule,
taking care of correspondence and reports, and following i
through on recommendations, in addition to being the social
work member of the clinic team. The author did not
specify what the social worker did as a member of the
team. The psychiatric social worker also served as con
sultant on mental health problems to the public health
nurses. Nurses were utilized as a part of the intake
service of a psychiatric clinic, which marked a departure
from the orthodox procedure in which intake was handled
by the psychiatric social worker.
Kleinschmidt, in an article on "Psychiatric
Social Work Practice in an All-Purpose Community Clinic,"
tells the thinking and efforts behind the planning under
46
public health auspices of six clinics which would em
phasize preventive care. A division of mental hygiene
was established, staffed by a psychiatrist with special
skills in child psychiatry as its director; a psycholo
gist; and a psychiatric social worker. In the beginning
the social worker joined the staff to become responsible
for running the clinic with other team members, and for
working with the community. The clinics had' two primary
functions: "(1) to provide psychotherapy for emotionally
disturbed children, parents and other adults; (2) to
provide a token service in diagnostic and consultation
work." The social worker in these clinics "treated"
emotionally disturbed children, parents, or single
adults, frequently in cooperation with another member
of the team. A definition of treatment was not given.
The psychiatric social workers of supervising status did
the intake interviews almost exclusively. During intake
there was an attempt made to clarify the likelihood of
the person moving into or away from therapy.
Training Programs
A group of four articles concerned the training
program for social work students, the training of tech
nicians in the Army, and the training aspect of state
wide mental hygiene conferences for clinic teams.
47
Two of the authors were on the staff of psy
chiatric clinics in rural and urban areas and were con
cerned with the training of the social work student in
his field work placement. These articles discussed
casework training as dealing with both intellectual and
emotional processes. Feldman contended that supervision
as a method of training aimed to help the worker develop
his creative abilities by increasing his intuitive under
standing of human behavior. In doing so it was brought
into harmony with a scientific discipline so that the
ability to understand and help others became an integral
part of the person's total personality.
The social work student with the help of
his supervisor must develop an ego tolerance
that will permit him to remain objective even
in a highly emotionally stimulating situation.
Rooney described the social work technician in
the Army as the person who augments the professionally
trained social worker and who works under his direct
supervision. He presented the training schedule offered
to qualified enlisted personnel in a medical field ser
vice school in conjunction with other military medical
establishments throughout the United States. Graduates
of this course have been working with neurotic patients
in hospitals, disciplinary barracks, and in mental
hygiene consultations services throughout the United
States, Europe, and the Far East.
48
The social work technician was responsible for
gathering social history Information, corroborative data
for military records, and preparing the social history.
In this capacity the technician performed the function
of patient orientation. He also discussed the patient's
needs with the patient's unit commander and interpreted
to the officer the manner in which the mental hygiene
consultation service could best serve his personnel.
Crutcher discussed the training aspects of con
ferences sponsored.by the State Department of Mental
Hygiene for clinic teams throughout the state of New
York. The author has drawn material from the proceedings
of these conferences of clinic workers which included
not only the papers given but discussion of both pro
gram and techniques of treatment. The author brings
out the importance of the social worker having the abil
ity to identify positively with the community.
He must be aware of its strengths and po
tentialities, its ability to unite in spite of
rivalries, and be able to share its satisfaction
in each progressive step taken.
The following chapter will attempt to answer the
questions proposed in the introductory chapter. It will
give the significant concluding facts of this study.
CHAPTER III
CONCLUSIONS
The purpose of this study was to identify and
clarify the psychiatric social worker's area of respon
sibility in psychiatric hospitals and clinics as set I
forth by psychiatric social workers in articles published ■
in professional journals in 1952 and 1953.
This concluding chapter will attempt to answer
these questions: Is there a lack of agreement among
psychiatric social workers today as to whether they are
doing casework or psychotherapy? Are the authors clear
in defining their function? In what way does casework
vary from one agency to another? Is there comparability
of practice-in like agencies? What difference in prac
tice is there between public and private agencies? Is '
!
there a difference in practice among agencies on the
federal, state and local levels? Are psychiatric social
workers particularly well qualified to help patients in
certain diagnostic groups? j
Only two authors expressed an opinion as to the
question of whether the social worker did psychotherapy,
and as to what the difference was between psychotherapy
50 !
and casework. These two authors took opposite views.
Wood believed that there was a distinct difference be
tween the work of the psychiatric social worker and the
work of the psychotherapist. However, she left her state
ment open as to finality of conclusion by saying that she ‘
did not mean to imply that a caseworker can not work in
the area of unconscious material. She led to further
confusion by saying that bhe training and experience
in psychiatric social work is not in itself sufficient
to equip a. caseworker to work with the transference phe
nomenon and unconscious material.
Almost the opposite viewpoint was expressed by ;
Newcomb who believed that the psychiatric social worker's i
role was to provide help to the patient by clarification. ;
She defined this concept of clarification as helping
patients who are emotionally disturbed to understand
their own environment and to disentangle some of their
emotions so that they can perceive the reality possi
bilities and mobilize their inner resources.
There were other authors who implied that the \
\ ;
social worker deals with unconscious material. Schmidt \ i
{ ^
stated that in supportive treatment the psychiatric j j
: i
social worker used a "re-repression technique." Two
I
other authors described the caseworker as actively ■
> I
handling the client's guilt and beginning the process
51
of softening the client's rigid super-ego. There was
agreement, however, that there is a line of demarcation
between the role of the psychiatric social worker and the/
psychiatrist, but none of them spelled out a clear de
lineation of the responsibilities of each.
Ryan raised a question with his description of
the psychiatric social worker's role in a military out
patient clinic. He presented the social worker's func
tion as the preservation of the fighting strength of
the military unit. The social workers satisfied them
selves when the patient attained the point of functioning
effectively as a soldier. He then stated that because
of this goal there is no routine exploration of some of
the more basic psychological conflicts which are largely
unconscious. This seems to imply that there would be
routine exploration of unconscious material by social
workers in other agency settings.
The concluding fact of this study is that the
authors studied were not clear in their definitions of
psychiatric social work function. For instance, in one h
grouping five out of six authors described "casework
service" as the area of responsibility of the psychiatric ^
social worker, but did not define their meaning of this '
basic concept. The articles listed functions such as I
intake, discharge planning, environmental manipulation.
52
supportive therapy, and family care planning, but did \\
not spell out their content. Therefore, conclusive
answers to the questions basic to this study (as stated
at the beginning of this chapter) have not been found in
the material examined.
Because the authors were not explicit in stating ;
!
the function of the psychiatric social worker, it is
difficult to draw a line of demarcation of casework from j
one agency to another. In one area it was apparent,
however, that social workers in psychiatric hospitals,
as compared with psychiatric social workers in psychiatric
clinics, considered the formulation of social studies and
helping the.patient plan his discharge as among the re
sponsibilities of the psychiatric social worker. Of the
seven authors who mentioned these aspects, only two
were affiliated with psychiatric clinics. Where there '
was definition given, it was interesting to note that,
although the agency structure and goal of treatment
varied from setting to setting, such as a child guidance
clinic or an army outpatient clinic, the,junderstanding of
t ^
casework process was the same. \
This statement also holds true of the casework
process in both public and private agencies. Many times j
i
the patient needs to be helped to take help or use j
53
treatment whether in an authoritative setting, as de
scribed by Ryan, or in a state hospital, as described
by BasGerman. The outstanding aspect of the psychiatric
social work that differed between private and public
agencies was in the military setting, where the social
worker satisfied himself when the patient attained the
point in treatment where he functioned effectively as
a soldier.
The previous statement would hold true when
describing the difference in practice among agencies on
the federal, state and local levels. Where defined, the
casework process was fundamentally the same, except for
the military setting where it was limited and of a more
authoritative nature.
The authors were clear, however, when the social
worker was described as making a unique contribution to
patients in certain diagnostic groups or certain problem
situations. These patients were divided into seven
specific groups. The authors were almost unanimous in
their description of psychiatric social workers working
with the patients’ relatives while the patients were in
therapy with the doctor. The patient's wife was singled
out in two articles as a special group to be treated by
the social worker. Alcoholics in a state hospital were
also described as needing and being able to use the
54
psychiatrie social worker's help. There were four
\ articles that described the social worker's function
I as working with patients unable to accept hospitalization.
/The fourth group was composed of those patients who were
unable to respond to a therapeutic relationship with the
doctor, and whose reality problems were of primary con-
'cern. Two articles described the psychiatric social
/worker as treating chronic patients, or those patients
jwith long-time emotional problems, with poor prognosis
for psychotherapy. The re-orienting of the lobotomized
patient following lobotomy was also described by one
author as the social worker's special function. Authors
Brill and Schmidt discussed the "growing feeling" that
A the caseworker has a special role to play in treatment
of psychotics. The skill of the social worker is, in
his view, of even more value to psychotic patients than
has been realized heretofore in practice.
Two authors described the use of it own members
as psychiatric casework supervisors. It was noted that ;
the process of supervision has been well formulated and *
now social workers are being used as consultants to people
in other professions. •
Public health is emerging as a new setting for j
psychiatric social work. New developments such as this j
indicate the changing and broadening aspects of psychiatric
55
social work. Because psychiatric social work was not in
the public health picture a few years ago, it would seem
safe to conclude, therefore, that what is described as
the area of responsibility at any one time does not hold
in another period of time. Rather than a static condi
tion within the profession, there seems to be continual
expansion of health services where the need for psychi
atric social work is recognized.
A N N O T A T E D
B I B L I O G R A P H Y
57
ANNOTATED BIBLIOGRAPHY
Bamford, Cora and Heinstein, Martin. "Selecting Patients
at a Preschool Treatment Center,".Journal of Psychi-
, at>ic Social Work (June, 1953)^ I89. Child Develop-
ment Center, Children's Hospital, Oakland, California
is given as the reference.
In August 1944, the Child Development Center, a de
partment of the East Bay in Oakland, California, was
established to extend hospital services, including
education and guidance in mental health, to preschool
children of the community and their parents as an
essential part of the practice of pediatrics. One
part of the program was the Well-Child Conference,
which emphasized the total growth and development of
the child with opportunities for adequate anticipa
tory guidance for the parents from both pediatrician
and the public health nurse. The other part of the
program offered study and treatment of children
presenting behavior difficulties and guidance and
treatment for their parents. Although the total
family constellation was evaluated and utilized in
treatment, an effort was made to select cases in
which the mother's anxiety was sufficiently focused
on the child's difficulties to make guidance mean
ingful. The goal of treatment, which was highly
individualized, was to help both child and mother
through the behavior disorder and to help the mother
to gain enough insight into her conflicting feelings
to give her child freedom in his future development
and, at the same time, find more satisfaction in
their relationship. Therapeutic services were lim
ited to the mother and child who were sufficiently
healthy to accept growth and change. If the intra
psychic difficulties of the mother are so great
that anxiety was not primarily focused on the child's
behavior, the mother was referred elsewhere for help.
In attempting to determine which mothers could make
use of corhparatively short-term therapy (average
length of thirty-four weeks) as well as the kind
and degree of disturbance manifesting itself in the
child, the intake process allowed for the diagnostic
evaluation of both mother and child. In summary,
the author described the intake process designed
to obtain a diagnostic picture of the child, to
58
evaluate the mother-child relationship, to evaluate
these in relation to treatment that was available
at the Center, and to be therapeutic for the parent
in the process of helping her to clarify where and
how she can use help.
Barnes, Marion J. "The Educational and Therapeutic
Implications in Working with Parent Study Groups
Around the Problems of the Normal Pre-school Child,”
American Journal of Orthopsychiatry (April, 1952),
26b. At the time the article was written the
author was Psychiatric Casework Consultant, Univer
sity Hospitals, Cleveland, Ohio.
The author analyzed the method of presentation,
content of the course, and the effectiveness of
a study group in meeting the needs of parents by
helping them to understand both the theory of
childhood development and the practical implica
tions. Throughout this series, the discussion
method was used rather than the lecture method.
The author discussed the importance in working
with parents of creating, as early as possible,
enough freedom in the group so that members will
discuss specifically their own children and the
areas in which the children were having difficul
ties. When the social worker departed from the
clinical settings to work with parent groups on
an educational level, she was often reluctant to
give specific advice. In a study group it was
necessary for the leader to share more fully and
in detail her viewpoints on any number of phases
of childhood.
Basserman, Eleanor. "Trends in Casework Treatment in
In-Patient Service in Hospital Setting," Journal
of Psychiatric Social Work (January, 1953), 6l.
The author !s position was not given, although the
University of Pittsburgh, Western Psychiatric In
stitute and Clinics was given as the author’s af
filiation.
In this article the author discussed trends in
casework treatment confined to two types of hos
pital settings; (1) the state hospital, and (2)
59
the smaller psychiatric hospital concentrating on
study, research, training, and intensive treatment
of a small group of patients. The author also
pointed out that certain functions of the psychi
atric social worker were similar in both settings.
"Psychiatric social workers are used most frequently
in pre-admission and postdischarge planning." Where
the patient was voluntary and not acutely ill, he
was encouraged to participate as much as possible
in planning for hospitalization. Prior to admis
sion, he should see the psychiatric social worker
to discuss his feelings about coming into a hos
pital, being behind locked doors, and living with
ill patients. In the pre-admission interview, an
interpretation should be given of the part the
social worker will have in helping both relatives
and patient, and in some Instances the social
worker will carry the case to completion.
In postdischarge planning, the psychiatrist referred
the patient back to social service, usually with a
specific recommendation, or requested the social
worker to explore vocational counseling and Job
opportunities with the help of specialized agen
cies. Poster home placement may be entailed,
either through a community agency or through the
psychiatric social worker. In any event, the
worker was constantly giving support, reassurance,
and help with the reality problems involved in
transfer from the sheltered hospital existence to
the complications of community living and might
continue to give follow-up service for many months
beyond that.
At times, casework help was requested for the pa
tient relative to continued acceptance of hospital
ization or concern over what was happening at home.
In a selected group of cases, the psychiatric
social worker was called upon to work with a pa
tient who might not be able to respond to a thera
peutic relationship with the doctor. This was
done, for example, when a patient's reality prob
lems were his primary concern and precluded his
participation in any other way. Guidance and super
vision were given to the worker by the psychiatrist
in charge of the case, and he would again take over
when the patient felt capable of discussing the
deeper areas of his problem. In some hospital
60
settings, the psychiatric social worker worked
with the psychiatrist in group therapy sessions.
Here the worker dealt mainly with problems of inter
personal relationships, with social or environmental
difficulties, and current reality problems. In some
settings, the psychiatric social worker devoted
his time almost exclusively to treatment of the
relative, keeping pace with the psychiatrist in
what was happening to the patient, concentrating on
the relative’s problems as they had affected and
would continue to affect the patient, or planning
for the patient’s discharge. In diagnosing the
planning casework treatment for the disturbed
relative, the psychiatric social worker demonstrated
his ability and his use of casework skills and did
not rely to any great extent on leadership or
direction from other professional persons.
One of the most pertinent casework services in any
psychiatric setting was the obtaining of social in
formation. Participation of the psychiatric social
worker in the various staff conferences was an im
portant part of the social as well as the medical
treatment plan. "Trends in casework treatment in
a psychiatric setting indicate that the psychiatric
social worker is devoting a major part of his time
to service to relatives and hopefully aiding them
to become more helpful, sustaining individuals in
relation to the patient."
Brill, Leon. "Changing Viewpoints in the Casework Treat
ment of Psychotic Patients," Journal of Psychiatric
Social Work (June, 1952), 197. When this article
was written, Mr. Brill was Psychiatric Social Worker
with the Public Health Service.
Mr. Brill discussed some recent progress in success
fully treating psychotic persons which have been a
departure from some social work assumptions, and
undertook a re-examination of these traditional
concepts. The author explained that nothing in his
discussion was meant to imply that psychiatrist and
social worker would be doing predominantly the same
things in treatment, and stated that what social
workers do was determined by such factors as agency
setting and function, the degree of training and
61 '
"comfortableness" of workers inthe goals they set
for themselves, the existence of research programs,
and other factors. "It may well be that they will
continue to work with.numerous, perhaps the majority,
of their patients on a supporting level."
Mr. Brill's article was divided into four parts:
(1) describing the contributions of leading prac
titioners such as Pedern, Sullivan, Fromm, Rerch-
mann, Rosen, and Sechehaye; (2) examining some
variatiors in casework thinking; (3) summarizing
several cases from the writer's practice to point
up (4) the diversity of approaches required.
Psychiatry and social work, operating in different
ways, have shown that psychotic patients have a
tolerance for frustration, reality testing, and
denial, and were capable of insight, growth, and
cure. There was a "growing awareness" that the
therapist's own attitude constituted a primary
factor in treatment; in view of*the special empa-
thetic qualities of psychotic patients, they were
quick to sense any feelings of disrespect, anxiety,
or pessimism which might reinforce their own an
xieties. There was a need for greater flexibility
in moving out towards patients and helping them to
accept treatment. "Goals for psychotic individuals
cannot be drawn in traditional terras or in terms
of our own needs. True individualization requires
a fuller understanding of their needs and strivings
which may not correspond to conventional ones."
The author concluded by saying that in view of the
special need for an adequate social adjustment on
the part of psychotic persons and the unusual de
mands on patience and flexibility, there was a
"growing feeling" that caseworkers have a special
role to play in treatment.
Crutcher, Hester B. "Training of the Psychiatric Social
Workers," American Journal of Orthopsychiatry (July,
1953)J 556. The State Department of Mental Hygiene,
Albany, New York, was given as the affiliation of
the author. * *
For the last three years the New York State Depart
ment of Mental Hygiene through the Mental Health
Commission has arranged a conference for clinic teams
throughout the state. The clinics represented varied
62
in size of staff from those whose only full-time
member was the social worker to those with several
full-time members of each discipline. The one thing
in common was that all of the clinics represented
were set up for the treatment of emotionally upset
patients. It was obvious that the clinic program
had to be conditioned by community demands for a
wide variety of services, and it was the training
of the social worker to meet these varieties of
service with which this paper was concerned. The
community wanted a staff of experts to treat the
children whose behavior had been either baffling
or troublesome. The next thing the community
wanted was to have the clinic accept all referrals
and begin treatment promptly. In most of the clin
ics serving rural areas it devolved upon the social
worker to accept or reject the case.
When the child or parent was under treatment the
delicate job of keeping interested agencies in a
helpful role was a major responsibility of the
social worker. This may be thought of as a broad
adaptation of casework skills, but learning to make
such an adaptation was often difficult and it was
not usually given a prominent part in the curriculum
of the graduate schools of social work. The social
worker must have the ability to identify positively
with the community; he must be aware of its strengths
and potentialities, its ability to unite in spite
of rivalries, and he must be able to share its
satisfaction in each progressive step taken. The
major demands on the clinic by the community were,
then, prompt and fairly extensive treatment of
patients, varying degrees of cooperative service,
intensive and extensive educational work, and com
munity planning. In all these activities the social
worker assumed much responsibility.
Dewald, Paul A. and Harle, Marjorie. "Utilization of the
Psychiatric Caseworker as Consultant during the
Psychoanalytically Oriented Therapy of a Patient,"
American Journal of Orthopsychiatry (October, 1953)j
785. The authors were affiliated with the Depart
ment of Psychiatry of the University of Rochester
School of Medicine and Dentistry, and Strong
Memorial Rochester Municipal Hospital, Rochester,
New York.
63
This article illustrated the successful use of
a single consultative interview with another pro
fessional person during the course of brief psycho
therapy of a neurotic woman. In the three inter
views with the therapist before the consulting
interview with the caseworker, the patient focused
on her relations with her older son. Since from
her description the child was seriously disturbed,
the possibility of his being in therapy was brought
up, and she was referred to the social worker to
discuss this. The caseworker in the interview
with the patient helped her to see the importance
of recognizing and accepting feelings of her son
so that he could share his feelings with her. Sup
port was given on what a difficult thing this was
to do. The patient was then able to work through
her feelings and to gain insight with the therapist.
In the interview with the caseworker the focus was
on the behavior of the child, for whom the patient
was requesting treatment. The main thing accomplished
was a clarification of the nature of the problem,
namely, its direct connection with the patient's Î
conflict in regard to her mother which was the
problem on which the patient was engaged in her |
therapy.
Feldman, Yonata, Spotnitz, Hyman and Nagelberg, Leo,
"One Aspect of Casework Training through Supervi
sion," Social Casework (April, 1953) 150. At the
time the article was written Mrs. Feldman was
Supervisor in Charge, Bronx Office, Child Guidance
Institute, Jewish Board of Guardian, New York City.
Dr. Spotnitz was Consultant Psychiatrist and Dr.
Nagelberg was Clinical Psychologist in the same
institution.
The article discussed the process of supervision as
consisting of both teaching and learning and how,
in practice, these two processes go hand in hand.
It dealt with training for casework, and stressed
the point that intellectual understanding of a
concept does not mean that the worker is emotion
ally able to apply it. Casework training through
supervision deals with both intellectual and emo
tional processes. Supervision as a method of
training was aimed at helping the worker develop
his creative abilities by increasing his intuitive
64
understanding of human behavior and by bringing it
into harmony with a scientific discipline so that
the ability to understand and help others becomes
an integral part of the worker’s total personality.
"The very nature of casework requires that the
client be able increasingly to reveal his feelings;
worker ân# client must be able to understand the
sources from which the present difficulty stems in
order to restore a balance. The worker, face to
face with the client in the interview, is exposed
continually to an onslaught of unrepressed primi
tive feelings which cannot help but call forth in
him echoes of old forgotten emotional states in
his own life which aroused anxiety. The onslaught
of these emotions may cause a general emotional
upset in the beginning worker."
In scrutinizing a beginning worker's total per
formance, a supervisor should become aware of the
working specific pattern of mistaken and certain
emotional state that he tends to avoid. The super
visor should help the worker to develop an ego
tolerance that will permit him to remain objective
even in a highly emotionally stimulating situation.
The authors concluded the article with four points
relating to an evaluation of personal, capacity es
sential for casework performance. "First, how
receptive is the worker to new constellations in
clients' emotional expression? Second, how in
sulated is the worker against impulsive reaction
to emotions of others? Third, how much capacity
has the worker to understand the meaning of emo
tional expression in its symbolic form? And fourth,
what mental, emotional and verbal equipment does
the worker possess with which to provide the cor
rective emotional experience needed by clients ?"
Gundry, C. H., Hunter, Trenna and Itykow, H. "An In-
Service Training Project in Mental Hygiene," Mental
Hygiene (January, 1953), 47* At the time of writing
the article Dr. Gundry was Director, Mental Hygiene
Division, Metropolitan Health Committee, Vancouver,
B.C., Trenna Hunter was. Director of Public Health
Nursing, Metropolitan Health Committee, and H.
Itykow was Social Worker, Metropolitan Health Com
mittee .
65
This article attempted to show how the social worker
has helped the nurse in a public health program.
It outlined some of the difficulties anticipated
and encountered, and the steps taken to meet them.
While working in the schools and child health
centers, the nurse located cases and referred them
to the mental hygiene clinic. Contact in the first
instance was with the teacher and the mother who
asked for advice and help/ In addition to inter
preting this to the community the nurse made the
social investigation and explained the meaning of
the clinic and-how it could be of assistance. The
social worker’s main task was to provide specific
guidance to each nurse in her function as detector
of emotional ills and dispenser of mental hygiene.
In assessing the social worker's part and how much
was accomplished, one must know the proportion of
time spent with the nurses. Because of other de
mands, he visited each unit on an average of two
days per month. The remaining days were employed
in keeping records, visiting agencies, giving staff
talks, attending meetings, and doing casework with
a selected number of children and adults.
Garrett, Annette. "Discussion--'Artie': A Victim of an
Inconsistent Parental Relationship," American Journal
of Orthopsychiatry (January, 1952),.33* At the
time the article was written, Annette Garrett was
Associate Director, Smith College School for Social
Work, Northampton, Massachusetts.
The case of "Artie" was a classical example of a
large group of child guidance clinic cases. It
illustrated the interdependence of parallel treat
ment with parent and child; it revealed typical
dynamics ; and it portrayed universal casework tech
niques. The worker actively handled the mother’s
guilt about the hostility shown toward her child.
One specific treatment procedure was the worker’s
conscious avoidance of becoming identified with
the maternal grandmother. She did not merely avoid
becoming identified with the mother’s mother but
consciously developed a permissive, positive rela
tionship. The worker constantly kept the mother
and her worries as the focus of the worker’s at
tention and interest.
66 I
Kleinschmidt, Sara. "Psychiatric Social Work Practice
in an All-Purpose Community Clinic," Journal of
Psychiatric Social Work (March, 1952), 120. At the
time the article was written Sara Kleinschmidt was
Supervisor of Case Work, Division of Mental Hygiene,
Westchester County Department of Health, White
Plains, New York.
The article described how a psychiatric social
worker who became chief social worker was hired to
do administrative and community work and to organize
a clinic. The worker gained his orientation in
agencies functioning in social, medical, and group
work areas, and by visiting with their personnel
to discuss functions and to arrive at a method of
working together. As psychiatric social workers
joined the staff each one went through a period of
orientation. In starting a clinic, a psychiatric
social worker joined the staff to become respon
sible for running the clinic with other team mem
bers and in working with the community. Simul
taneously, a second psychiatric social worker and
a psychologist were added to the staff, and the
three disciplines began functioning as a team.
The clinics defined by the social workers had two
primary functions: "(1) to provide psychotherapy
for emotionally disturbed children, parents and
other adults; (2) to provide a token service in
diagnostic and consultation work." A secondary
function was to provide educational and research
services through interpreting mental health material
which passed through the clinic and was pertinent
to the needs of the community.
Policies and procedures to carry out the functions
were defined principally by social work supervisors
with other disciplines participating. The social
worker, of supervisory status, did the intake inter
views almost exclusively. During Intake there was
an attempt made to clarify the likelihood of the
person moving into or away from therapy. The final
decision on the person's acceptability for treatment
was made by the psychiatrist. All social workers
treated emotionally disturbed children, parents
or single adults, frequently in cooperation with
another member of the team. The director spent
many hours each week conferring with the social
worker on dynamics of behavior and in defining
goals of treatment.
67
Krug, Othilda, Hayward, Helen and Crumpacker, Bernice.
"Intensive Residential Treatment of a Nine-year-old
Girl with an Aggressive Behavior Disorder, Petit
Mai Epilepsy and Enuresis," American Journal of
Orthopsychiatry (April, 195271 405. .The authors
are staff members of the Central Mental Hygiene
Clinic, Department of Psychiatry, University of
Cincinnati, and of the Child Guidance Home, Cin
cinnati, Ohio.
This article was an attempt to show the integration
of individual psychotherapy, corrective residential
experience, and casework with the foster mother of
a disturbed five-year-old child. Betty was treated
by a psychiatrist three times weekly. She rapidly
developed a close relationship with two women
residential workers to whom she turned for "mother
ing" and reassurance, especially at night when she
was,fearful that she or the adults would be killed.
In psychiatric casework, the worker helped the
foster mother to gain some understanding of her con
stant giving to Betty on the basis of feelings of
guilt over her aggravation about Betty’s lack of
response.
Latimer, Ruth. "The Social Worker and the Alcoholics
Anonymous Program in a State Hospital," Journal of
Psychiatric Social Work (June, 1953)^ 17^ The
author is on the staff of Longview State Hospital,
Cincinnati, Ohio.
The article was concerned first with a description
of some of the principles of the "AA" philosophy
as they affected the patients under study. A second
purpose was to show how these principles were uti
lized in the casework process. The social worker
interested in the social implications of changes
effected could help the patient to enlarge his con
cept of "unmanageability" in terms of family,
children, job, and inadequate general social adjust
ment. To help the patient to recognize this reality
and to have him see himself in relation to actuality
as well as to operate within these limitations was
a part of the worker's goal. The caseworker's role
had to do with recognizing the sincerity of the
patient's desires, by helping him to accept the
reality of his need for continued hospitalization.
68
The social worker was often confronted with the
marriage relationship problem. The securing and
handling of a job was often a major event in the life
of the alcoholic. "To the state hospital social
worker overwhelmed by the number of patients and
the lack of professional staff, the AA offers a
powerful resource. They can carry a large share
of responsibility for the alcoholic patients if
their activity is properly correlated with other
plans being formulated with the patient, and if
the social workers and AA representatives work
closely together."
Maril, Esta C. "The Mental-Hygiene Clinic in an Or
ganized Health Department," Mental Hygiene (October,
1952), 560. At the time the article was written the
author was Mental Hygienist, Baltimore County Health
Department, Towson, Maryland.
For a year and a half, the Baltimore County Mental
Health Clinic has been operating a one-day-a-week
all-purpose clinic. Since the social worker was
the only full-time member of the staff, he assumed
administrative responsibility for the clinic pro
gram. This involved arranging the clinic schedule,
taking care of correspondence and reports, and
following through on recommendations, in addition
to being the social work member of the clinic team.
He also served as consultant on mental health
problems to the public health nurses. He was given
the title of "mental hygienist" and was administra
tively responsible to one of the assistant health
officers who headed the program medically and who
was responsible to the health officer. Emphasis
was placed on making this one of the many health
department services in an effort to break down the
stigma that many people might have felt was attached
to a psychiatric outpatient clinic. In this program
the public health nurse was fully utilized as a part
of the service. In referring cases, she was in
corporated as a member of the clinic team. This
utilization of nurses as a part of the intake ser
vice of a psychiatric clinic marked"the main de
parture from the orthodox procedure in which intake
is handled by the psychiatric social worker. Regu
lar monthly regional mental health conferences were
held by the social worker with small groups of
69
nurses and their supervisors to discuss potential
cases and select those most able to utilize the
clinic service.
McGriff, Dorothy and Rackow, Leon. "Psychiatric Case
work, and Its Relationship to Pre-front'al Lobotomy,"
Journal of Psychiatric Social Work (March, 1952),
136• At the time the article waswritten, the
Veterans Administration Hospital, Roanoke, Virginia,
was the affiliation for author Dorothy McGriff, and
the Veterans Administration Hospital, Montrose,
New York, that for Dr. Rackow.
"with the increasing use of prefrontal lobotomy
in the treatment of certain mentally ill patients
who do not respond to other forms of treatment,
there is increasing need for the services of psy
chiatric social workers to work with these patients
and their families." In the first instance, a
social history was needed to throw light on the
illness itself and on the attitudes of the patient’s
family. The family's capacity to carry the respon
sibility for his support and guidance was determined
before decision could be wisely made. Following the
lobotomy, the psychiatric social worker re-oriented
the patient in relation to his attitudes toward
himself and his family and others. As the patient
improved and became more articulate, the tenuous
relationship with the worker was strengthened so
that he was able to enter actively into discharge
planning, and the patient's reactions to returning
home were evaluated and discussed. His responsi
bility for his own adjustment was introduced when
he showed readiness for such discussion. If his
own plans were not realistic, effort was made to
help him outline other possible objectives.
Throughout hospitalization, the social worker and
the ward physician conferred frequently so that
both were aware of the changes in the clinical pic
ture and both had current information concerning
the patient's home situation and social adjustment.
When the doctor felt that clinically the patient
was ready for home visit, such recommendation was
made to the social worker. Actual planning for
home visit was primarily the responsibility of the
social worker but was discussed with the ward
physician who made the final decision. The services
70
described, with a few minor exceptions, are those
employed in actual practice for patients in general,
whether lobotomized or not.
Monahan, Fergus T. "Supportive Casework in an Army
Setting," Social Casework (November, 1952), 388.
At the time this article was written, the author was
Chief, Psychiatric Social Work Section, Mental
Hygiene Consultations Service, U.S. Army Hospital,
Port Ord, California.
The article was concerned chiefly with the experi
ence of the psychiatric social work officer and
social work technician in the treatment program of
supportive casework in the training situation, or
"field follow-up." "Diagnostic evaluation does not
alleviate a patient's disturbance." Therefore, a
program of supportive casework in the field was
initiated for those patients who needed some help
in meeting the demands of basic training. This
program was carried out by the Social Work Section.
The commanding officer, platoon sergeant, field
first sergeant, and other members of the staff
were interviewed in order to obtain their impres
sions of the patient and his performance, and also
to discuss the patient and his illness. The bulk
of the case load was composed of the patients who
were recommended for continued duty but who were
in need of some support in coping with the problem
of adjustment to military life. It was the social
worker's aim to strengthen the patient's positive
desires and help him to use his own strength.
Supportive casework was directed toward improving
the patient's effectiveness as a soldier. Another
part of the case load consisted of patients for
whom separation from the Array had been recommended.
Supportive casework was aimed at offering them
some chance to verbalize their feelings, attitudes,
and thoughts. Until final action was taken, the
patient was helped to realize that he was still
in the Army and that he must meet the day-to-day
demands made upon him. When a patient's discharge
had been approved, he was encouraged to think of
future civilian plans.
71
Morris, Thais and Stevenson, Ian. "Psychiatry and Social
Work in the Vocational Rehabilitation of Psychiatric
Patients," The Social Welfare Forum, Official Pro
ceedings of the National Conference of Social Work,
Vol. 80 (1953)J 148. The article was based on a
study of twenty-five patients of the Louisiana
State University Psychiatric Service at Charity
Hospital, New Orleans, Louisiana.
The authors, a social worker and a psychiatrist,
undertook a direct approach in the vocational re
habilitation of a group of chronically unemployed
psychiatric patients instead of attempting further
psychotherapy along traditional lines. After several
interviews in which the topic of employment was dis
cussed, the psychiatrist suggested to the patients
a referral to the social worker for help with the
problem of employment. The social worker almost
immediately took up the-problem of job placement as
the natural purpose of his discussions with the
patients. This combination of'authoritative firm
ness and economic pressure from one therapist
(the psychiatrist), and a supportive, maternal
attitude on the part of the other therapist (the
social worker) LBually resulted in the patients'
making serious efforts to find employment. The
types of casework therapy utilized by the social
worker were two: (l) relationship therapy and (2)
environmental therapy. Insight therapy as prac
ticed by caseworkers was deliberately not used.
Exploratory techniques and interpretation were em
ployed sparingly and then only in relation to the
specific problem of unemployment. The continuing
support and encouragement, together with the steady
focus on practical obstacles to employment, were
considered by the therapists to have been of greater
important than working through the psychodynamic
aspects of the problems presented.
Newcomb, Margaret S., Gay, Eleanor, and Levin, Barry L.
"a Training Program for Social Work Students in a
Psychiatric Clinic," Social Casework (May, 1953) j ,
204. The authors of this article were affiliated
with the Mental Hygiene Clinic of Veterans Admin
istration, Boston, Massachusetts--Mrs. Newcomb as
Assistant Chief Social Worker, and Miss Gay and
Mr. Levin as Case Supervisors.
72
This article described the training program for
social work students at the Boston Veterans Adminis
tration Mental Hygiene Clinic. The purpose of the
social service department of the Clinic determined
the content and operation of the training program.
The main function of the department was to give
maximum casework help to patients. The authors
gave as the principle educational purpose of the
field work training (l) to enable the students to
gain specific knowledge of casework with patients
and of aspects of administration^ research and
community organization; (2) to assist the students
in their integration of theorefical knowledge and
casework principles; and (3) to help them develop
a professional use of themselves in their relation
ships with people. The supervisor was the key
person in the training of the student. "The supervis
ory process has long been considered the most impor
tant teaching method used in field work training in
social work." The supervisory process emphasized
the conscious use of the dynamics of the student-
supervisor relationship to teach casework. The
development of the role of the psychiatrist as a
consultant to the social worker in this clinic
occurred as the natural result of the medical
responsibility of the psychiatrist. Caseworkers
assumed major treatment responsibility in the
cases assigned them. The authors also discussed
the part of the training program in which the as
sistant chief social worker served as discussion
leader, and the roles of the research consultant
and the intake supervisor, as well as the part
they played in reaching the clinic's goal--to give
maximum casework help to patients.
Newcomb, Margaret L., Gay, Eleanor, Young, Ruth L.,
Smith, Stewart R. and Weinberger, Jerome. "The
Function of the Psychiatric Social Worker in a
Mental-Hygiene Clinic," Mental Hygiene (April,-
1952), 131. The Mental Hygiene Clinic, Veterans
Administration, Boston, Massachusetts, was the
affiliation of the authors.
The article attempted to describe the function of
the social worker in the Boston Veterans Administra
tion Mental Hygiene Clinic. This function was based
on a philosophy which maintained that social case-
73
work principles can be integrated into the direct
treatment program of a psychiatric center. The
casework practice in this clinic encouraged case
workers to deal directly in a treatment relation
ship with a broad group of patients. The philosophy ■
consisted of several principles that were Integrated
as part of the setting: (l) The psychoanalytical
orientation of the entire clinic was focused on an
understanding of the individual patient; (2) the
aim of treatment was to meet the needs of the pa
tient, and thus treatment was concerned both with
the patient and with his adaptation to his environ
ment; (3) the presence of a sufficient number of
casework supervisors and psychiatric consultants i
provided the help the caseworker needed in carrying
on Individual treatment. !
The social service department was part of the total
clinic functioning, and was responsible to the chief I
psychiatrist. The activities of the social service
department were divided for purposes of discussion
into intake, casework treatment, casework supervi- i
Sion, and psychiatric consultation. The intake inter
view probably required the greatest interviewing (
skill in casework and was characterized by a great
variety of problems calling for promptness in making I
formulations and reaching appropriate decisions.
This social-diagnostic evaluation was generally made i
without background information. Intake was a team
function in which the social worker and the psychi
atrist interviewed the patient. The social worker
had the first clinical contact with the patient,
summarized the salient factors in the patient’s
history, and concluded with a social-diagnostic
evaluation and recommendation for treatment. If
eligible for treatment in the clinic, the patient
was next seen by the intake psychiatrist; if con
sidered ineligible, the patient was referred to
other community resources. The major purpose of
the intake interview was to determine motivation
which was of importance in assessing the patient’s
treatment potential. The intake worker also learned
about the patient’s real life situation. The func
tion of the clinic was explained by the social
worker so that the patient might be able to accept
treatment. The social worker gathered sufficient
information to aid in determining the patient’s
74
social-psychiatrie diagnosis and his treatability
in the clinic.
After the Intake process, the psychiatrist assessed
the patient’s treatment potential and made appro
priate disposition for treatment. The patient was
then referred (l) to a psychiatrist for psychotherapy,'
(2) to a social worker for social casework therapy, 1
or (3) to a psychologist for group therapy in con- !
Junction with treatment either with a psychiatrist
or social worker. Patients with long-standing
emotional difficulties with poor prognosis for
dynamic psychotherapy were referred to the social j
worker for a long-time supportive relationship and |
alleviation of environmental stresses. In cases
of older patients with more rigid character struc
tures, more limited goals were set; such a goal
might be in helping the patient to make a more ade
quate adjustment to some small part of his present
environment. The degree of the patient’s emotional
investment in the situational maladjustment was
determined before a decision was made as to which
discipline he should be assigned to for treatment.
The foundation of treatment by the social worker
was the casework relationship. The social worker
established a relationship in which a large measure
of emotional independence was encouraged in the
patient and current reality was the major focus of
attention. The social worker dealt with the patient
at the level of his understanding and avoided
bringing out or discussing unconscious phenomena
such as dream content. In intensive casework the
worker dealt with the derivatives from the patient’s |
past that were manifest in the present reality. i
Casework techniques included emotional support,
suggestion, environmental help, abreation, and
clarification. The authors defined clarification
as the social worker's- task of helping the patients
who were emotionally distorting their own understand
ing of their environment to disentangle some of i
these emotions so that they could perceive reality I
possibilities and mobilize their inner resources.
Patients were assigned to casework for the following ,
reasons: (1) when the patient was not yet ready 1
for intensive psychotherapy but could be prepared |
for it through a reassuring relationship with the I
caseworker (the social worker acting as the "first
step" in therapy); (2) for a generally supportive
75
type of relationship, to help the patient maintain
his present level of adjustment; (3) to aid the
patient’s establishment of a positive relationship
by providing encouragement and dealing only with
conscious material with him; (4) for "collateral
treatment"--i.e., work with a relative or a marital
partner while the patient was being treated by
another person at the clinic ; or (5) for providing
help through clarification of the behavior pattern
by means of an intensive casework relationship
with the social worker. All cases assigned to
social workers were re-evaluated by the casework
supervisor and the psychiatric consultant to deter
mine the suitability of the patient for casework
treatment.
In this clinic casework supervision consisted of
education, evaluation of work done, responsibility
for professional development, and clinical manage
ment. The supervisor combined casework and teaching
skills and stimulated the workers to develop their
own abilities, to function professionally, and to
evaluate their own methods. The psychiatric con
sultant functioned by: (l) clarifying the central
problem and goal of treatment; (2) reviewing the
worker’s case load to insure suitability, and offer
ing medical-evaluation as an adjunct in treatment;
(3) recommending transfer of the patient when the
presenting problem was considered to be not within
the province of the worker; and (4) clarifying the
caseworker’s problems in treating the patient.
There was an expressed difference in the way psychi
atrists did psychotherapy and the way in which social
workers did casework therapy, based on differences
in philosophy, training, and skill. "Generally
speaking, the psychiatrist’s primary orientation
and interest are in the internal problems of the
client and the total functioning of his personality.
For the most part he deals with environmental re
flections secondarily. The social worker is aware .
of the dynamics of the total personality; he focuses
on these environmental maladjustments that are re
flections of the inner stresses of the patient as
they are translated into social reality."
76
Peters, Pauline R. "Current Practice in a State Hospital,"
Journal of Psychiatric Social Work (March, 1952), j
129» At the time the article was written. Miss
Peters was Chief Social Worker in the Chicago State
Hospital.
This article was concerned with the current respon
sibility of a social service department in a state
hospital. Briefly, the author defined the respon
sibility as. "being concerned with developing, ex
panding, and.completing work started by social
service in the county diagnostic center of a county
psychopathic hospital." Such an arrangement, the
author felt, complicated social service procedure j
in the state hospital but allowed, through its
inter-agency centering, a multiplicity of services :
which far outweighed the problem created. At the
diagnostic center each patient and available family
member were seen by a social worker and history
material was formulated for a commission of two
doctors who made recommendations for commitment or
discharge. A social worker sat beside the judge
in a closed hearing to interpret history and the
social situation.
The Social Service Department of the state hospital
consisted of the chief and five workers trained in
psychiatric social work. Out of 120 committed pa
tients sent to the hospital each month through the
diagnostic center, the social service department
was able to serve not quite half that number. Twen
ty per cent of the social workers’" time was taken
up with casework service to voluntary patients (at
least 20 new patients per month). The worker was
notified 24 hours after admission of a voluntary
patient from the diagnostic center and the patient
was visited on the ward. Except on direct request
of the doctor, no attempt was made to secure history
or contact relatives without the consent of the
patient. If patient’s consent was not granted, the
social worker continued to visit him on ward and
bring all the resources of the hospital to his
knowledge. Prom these daily visits a history was
formed, often after many weeks of work. Over 40 per
cent of the social workers’ time was devoted, to the
"intramural services" which included work with the
newly committed as well as with the "not-new" patient|
group. There was a high percentage of patients over
77
60 years of age who came to the hospital mainly
from their own homes where their families could
not or would not tolerate them longer. It has been
found that minimal social service care was indi
cated for the majority of these patients. Foster
home placement care required about 10 per cent of
social service staff time. When the decision was
made for foster home placement, the social worker
began to interpret the program to the patient and
to make plans with him. The patient was visited
regularly while on family care and seen frequently
by the psychiatrist in the outpatient’ clinic. Thirty
per cent of a social worker’s time was spent on.
discharge planning. A patient’s release might be
in one of three forms: (l) absolute discharge, to
himself; (2) conditional discharge, to a relative
or friend for a period of one year; or (3) foster
care. The patient with the absolute discharge,
unless he sought out social service was a closed
case to the social - service department. A patient
with a conditional discharge was prepared for his
move into the community through interviews with the
social worker. Help and interpretation at time of
discharge were given to relatives if need was seen.
All workers participated in all phases of the social
service program. Each admitted patient and each
intramural patient was assigned to one worker for
the entire handling of the case. All the work of
the social service department was arranged so that
the worker was able to focus on the patient at the
initial contact and from that time on, as well as
to enlarge that focus to include the family. Each
worker took his turn at the outpatient clinic for
intake experience. The social service department
found that workers in the outpatient clinic were
constantly reformulating their knowledge of the pa
tient in his social cultural setting. They were
able to work with the psychiatrist in a treatment
plan that was more specifically related to the pa
tient ’s illness than that which was afforded him
while hospitalized. "in this may be seen the trend
in which the social worker, as emissary and coun
selor, extends his service out from the institution
through the patients’ needs into the community."
78
Platt, Clarice. "Termination Planning in a Child
Guidance Clinic," Journal of Psychiatric Social
Work (March, 1953)^ 125. At the time the article
was written, the author was Chief Psychiatric
Social Worker, Kalamazoo Child Guidance Clinic,
Kalamazoo, Michigan.
The author formulated both general and specific
statements as to when termination was indicated.
"The ending should be part of the beginning.
Realistic goals in treatment may be initially and
tentatively established and a time set for re-
evaluation in terms of progress including further
treatment plans, or preparation for closure."
Collaboration of the clinic team was necessary,
the author stated, in establishing goals at points
of re-evaluation when possible, and generally in
termination planning. The author stated that the
so-called "goal-setting" should be realistic in
terms of the problem presented, the client’s
understanding and capacity, the function and ca
pacity of the clinic including worker skill and
time, community tolerance, and standards. Inter
views were time-limited in a definitive way that
is rare in total treatment planning. Aptekar’s
Basic Concepts in Social Case Work was quoted:
"Each interview in a total casework process repre
sents in miniature the chief characteristics of
the whole process."
Relationship was the medium of treatment; this was
controlled by the worker as a representative of a
clinic and in terms of time, place, and the kind of
help offered. In this relationship the child or
parent works through ambivalent feelings toward
himself and others, struggles against change and
yet toward finding a new use of himself in his
efforts to solve his problems. As he feels success
in this new use of himself, he will need to try his
new-found capacity without the worker’s support.
In the termination of the relationship, it was their
mutual purpose to move toward freeing the client
from the relationship which had been so meaningful,
and toward a new beginning. For the worker, the
ending process required continued sensitivity to
the meaning of verbalization and behavior and the
purposive use of the material.
79
Robinson, Dorothy. "Some Aspects of the Integrative
Process in a Psychiatric Setting," Journal of Psy
chiatric Social Work (October, 195371 223• The
author was casework supervisor. Veterans Readjust
ment Center, University Hospital, Ann Arbor,
Michigan when the article was written.
The skill that is common to the medical and psy
chiatric social worker was called by the author the
technique of collaboration, teamwork, or integra
tion in a more controlled fixed setting. The
psychiatric social worker never works alone, but
always in a group. It is therefore basic to any
sound program for all to share the total case treat
ment with others on the team. There are times when
work with a member of the family becomes the
crucial aspect,* then it becomes the social worker’s
relationship and casework treatment which become of
the prime importance; but basically the social
worker needs to have awareness of his own person
ality, his reaction to authority, and his acting
out on the basis of previous experiences. The
author stated that of the members of the team the
social workers have probably most highly developed
the skill of supervision and that the other pro
fessions in the process of integration have come
to see its value.
Rooney, William. S. and Mason, Marshall A. "The Psychi
atric Social Work Technician," Journal of Psychiatric
Social Work (June, 1952), l8l. ' At the time the
article was written. Captain Rooney was Chief,
Psychiatric Social Work Section, Department of
Neuropsychiatry, Medical Field Service School, and
Captain Mason was Psychiatric Social Work Section,
Department of Neuropsychiatry, Medical Field Ser
vice School.
The purpose of the article was to present the train
ing offered to qualified enlisted personnel. Grad
uates of this course have been working with neuro
psychiatrie patients in hospitals, disciplinary
barracks, and mental hygiene consultation services
throughout the United States, Europe, and the Far
East. Enlisted personnel selected for this course
were trained in basic military subjects. In addi
tion to being high school graduates, of high average
80
intelligence, they must manifest characteristics
of emotional stability and sincere interest in
working with emotionally disturbed people. The
social work technician was usually responsible for
gathering social his'tory information, corroborative
data from military records, and preparing the social
' history. In this capacity, the technician was to
perform the function of patient orientation. This
activity, while it might approximate intake content,
differed considerably in depth and had as its pri
mary objective to make the patient comfortable in
strange hospital surroundings. The technician,
being aware of the immediate needs of the patient
through his interview, helped the patient to meet
these needs through the use of social work resources
in the military environment of the civilian commun
ity. He discussed the patient’s needs with the
patient’s unit commander and interpreted to the
officer the manner in which the mental hygiene
consultation service could best serve his personnel.
Non-commissioned officers of the patient’s unit
were to enter actively into the treatment plan and I
the social work technician, always under supervision
of the social work officer, helped in the orienta- !
tion of these "lay" persons. Being in an enlisted
status, the technician was able to discuss problems
of concern to non-commissioned officers which
otherwise they might be reluctant to discuss with
persons of higher rank. Also, the technician by
his frequent association with training personnel,
was particularly helpful in recognizing emotional
disturbances in their incipient stages and, by
utilization of his direct channel to the mental
hygiene consultation service, could play an im
portant role in the prevention of psychiatric
casualties. In disciplinary barracks, the social
work technicians worked with inmates, assisting
them with problems incident to their incarceration.
The technician collected data for presentation to
classification boards and in this capacity directly
contributed to board decisions regarding the in
mates ’ disposition. i
Ryan, Francis J. "Social Work in the Military Psychiatric I
Setting," Journal of Psychiatric Social Work (March, :
1952), l4l. At the time the article was written, i
Captain Ryan was Chief, Psychiatric Social Work i
81
Section, Neuropsychiatrie Service, Fitzsimmons
Army Hospital.
The specific environment of military social work
with which the author wrote was the neuropsychiatrie
outpatient clinic of a general military hospital.
In Fistzsimmons Array Hospital this clinic was an
integral part of the neuropsychiatrie service. The
staff of the clinic was made up of military person
nel who were graduate social workers ; a clinic
director who was a medical officer and senior
resident in psychiatry; other medical officers who
were residents in psychiatry; and a social worker
supervisor who was responsible for professional
supervision of all social work officers assigned
to the clinic. Military psychiatric social work
is defined in the Army manual as "a professional
service practiced in direct and responsible working
relationship with military psychiatry, designed to
assist military personnel as individuals to achieve
within their particular capacities and desires a
more efficient military service." This objective
was reached by (l) effecting through social case
work skills more awareness on the part of the in
dividual patient of the part he can take in adapt
ing his desires and capacities to his military
environment, and (2) effecting through mental
hygiene activities a deeper appreciation on the
part of military personnel of the wide range of
individual, personal, and social needs and desires.
The author believed that if casework is to be
practiced effectively within the military frame
work, two fundamental propositions must be true:
(l) psychiatric case work can be practiced effec
tively in a setting where the primary focus is on
the welfare of the group ; and (2) psychiatric case
work can be practiced effectively in an authorita
tive setting. Regarding the first proposition, the
author felt that such an approach to treatment in
no way contradicts the basic concern for the indi
vidual and his needs. Since military psychiatric
work was concerned with preserving the fighting
strength of the unit, social workers satisfied
themselves with attaining the point in treatment
at which the patient began to function effectively
as a soldier. This meant that there was no routine
exploration of some of the more basic psychological
conflict which was largely unconscious and which.
82
if explored, might require an extremely long period
of treatment. If patients can change attitudes
toward existing.situations with a resulting improve
ment in functioning, this was a goal the author
felt as acceptable for military service work.
The author discussed the second proposition empha
sizing that in the authoritative setting where
patients were frequently referred against their
wills for psychiatric evaluation and possible treat
ment, the role of the worker at intake became one
of helping the patient to accept the referral. The
choice of treatment at the clinic was to be a free
one on the part of the patient. In summary, the
author felt that psychiatric social work will play
a major role in preserving the mental health of our '
future armies. Social work has been integrated -
into the military psychiatric program to the point
where psychiatrists are working wherever possible
with social workers and psychologists as members
of a professional team.
Schmidt, Fritz. "The Psychotic Patient Adjustment to
the Community," Journal of Psychiatric Social Work
(April, 1953),.158' The Veterans Administration,
Regional Office, Seattle, Washington, was given as
the author's affiliation.
The author proposed two main questions: (l) "What
are the optimal conditions under which the psychotic
patient outside of an institution is able to form a
meaningful and positive relationship to a group
within the community?" (2) "What professional
assistance can be given in order to help the psy
chotic patient develop and sustain such a relation
ship?"
Twenty-five patients who (l)’had a clear-cut case
of schizophrenia and (2) had been hospitalized
within the last ten years, were studied in the
clinic's active treatment case load. Reviewing
the methods used by workers to help these patients,
the author arrived at the "formulation of a few
devices": (1) Frequently.the patient surpasses
the worker by his ability, to do things which are
not expected of him. In dealing with the psychotic
patient there was danger that we may feel that
83
"this patient is too sick to do this or that."
(2) One of the most important skills in supportive
treatment was to stand by, to be extremely patient,
to encourage the patient when warranted, and to
‘ show a great deal of appreciation whenever the pa
tient has something to offer. (3) In supportive
treatment the author discussed the use of a "re-
repression technique." The patient was discouraged
when he started flooding,the interviews with prod
ucts of his imagination, because he may become
more seriously sick as soon as he removes himself
too far from reality. The therapist was flexible
and able to find the principle for his discussion
in the individual situation rather than in general.
(4) Contact between casework and groupwork agen
cies was essential whenever both agencies dealt
with some of the'seriously sick veterans. (5) In
all three examples the worker spent some time in
interpreting and re-interpreting the patient rela
tionship to the groups he joined.
Siporin, Max. "Casework Treatment of Individuals with
Mental Problems," Journal of Psychiatric Social
Work (October, 1952), 201. The author wrote the
article from experience in psychiatric service of
a Veterans Administration Hospital.
The article described the social worker's generally
accepted function as working with families and in
volving relatives in treatment for himself, even
though initially the problem was seen as the patient
and his illness. The treatment activity with the
wife was assumed by the case worker, while the
psychiatrist worked with the patient. Depending
on diagnostic evaluation and treatment goals, the
caseworkers' activities with marital partners in
volved interpretation and assistance in understand
ing of the patient, his behavior, his illness and
hospital treatment, and the resultant changes. It
involved direct and referral services, environmental
manipulation, emotional support, and intensive
casework treatment in helping the wife to face,
understand, and change her own attitudes, needs,
motivations, and behavior as related to the patient
and herself. Staff members working in psychiatric
hospitals - can learn much from the extensive experi
ences of the family social agencies. By using.
84
interpreting, and making this genuine casework
knowledge and skill available to other disciplines
the author portrayed the psychiatric social worker
as contributing a fundamental service in the treat
ment of mental illness.
Wood, Velma. "Casework Practice in Mental Hygiene
Clinics,".Journal of Psychiatric Social Work
(January, 195364. The Guidance Center of
Houston, Texas, was given as the author's agency
affiliation.
The author began her article by stating that the
difficulty in the psychiatric social work field,
as in all other fields of social work, was our
inability to describe practice without resorting
to vague, theories, generalities, and long technical
words. She felt that in every group of practi
tioners there was considerable variation in phi
losophy, methodology, and procedure, as well as in
focus of work. Yet, there must be some common
ground that will lend itself to fruitful discussion
if we can avoid words that set up language barriers.
The presence of a psychiatrist within the agency
framework, the author stated, gives social workers
the use of the title "psychiatric,social worker."
Since there were structural and procedural differ
ences in mental health clinics affecting the use
to which a psychiatric social worker puts his
skills, it was difficult to propose for discussion
a common base in these areas. There was one point,
however, which the author stressed : no matter in
what structure a caseworker functions, as long as
he is working with individuals who need casework
skills and techniques, he is responsible for the
skills and techniques he applies. Social workers
are indebted to the psychiatrists with whom they
work for help in understanding the dynamics of
their clients' behavior, but social workers should
not expect help from the psychiatrist in thé appli
cation of skills and techniques in casework. In
order to be effective members, of the psychiatrist-
psychiatric social worker team, social workers
need to shoulder responsibility for what they do,
to feel a respect for the casework profession
itself, to recognize their present limitations, and
to accord the same respect and understanding to
85
Other team members.
"There seems to be general agreement that the psy
chiatrie caseworker uses her knowledge and under
standing of an individual to help him first to
define his problems in terms of his present living
situation, stressing particularly those problems
of an Interpersonal nature, and then tries to help
him come to grips with his reality situation. The
accepting, nonjudgmental attitude of the caseworker
makes this relationship possible between caseworker
and client, as a medium or tool through which the
process of help is carried out."
The successful psychiatrist or psychotherapist,
focuses attention of the patient’s instinctual
drives. In psychotherapy the patient is helped
to relive early childhood experiences which were
factors in the creation of his basic conflicts.
jTherefore, according to the author, there is no
longer any doubt that what psychiatric social
workers do and what psychotherapists do are
^different. Skill in one area does not imply skill
in the other. To work with unconscious material
involves experience and skill in that area, as
well as the self-discipline coming from an under
standing of one’s own instinctual drives. The
author did not mean to imply that a caseworker
cannot work in the area of unconscious material
but did state that training and experience in psy
chiatric social work were not in themselves suffi
cient to equip caseworkers to work with the trans
ference phenomenon and unconscious material. The
author concluded that casework has professional
status and can have more if practitioners state
clearly, first to themselves and then to others,
what they do, why they do it, and how they do it.

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Asset Metadata

Creator Nease, Robert Leroy (author)

Core Title The role of the psychiatric social worker in psychiatric hospitals and clinics

School School of Social Work

Degree Master of Social Work

Degree Program Social Work

Degree Conferral Date 1954-06

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag health and environmental sciences,OAI-PMH Harvest,social sciences

Format application/pdf (imt)

Language English

Contributor Digitized by ProQuest (provenance)

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c39-214576

Unique identifier UC11316431

Identifier EP66522.pdf (filename),usctheses-c39-214576 (legacy record id)

Legacy Identifier EP66522.pdf

Dmrecord 214576

Document Type Thesis

Format application/pdf (imt)

Rights Nease, Robert Leroy

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the au...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus, Los Angeles, California 90089, USA