Psychiatric consultation in case work agencies.

Abstract

SYCHIATRISTS and social workers have long recognized that the key P problem in case work is the management of the worker-client relationship. The client may come with many problems of a personal, social, or financial nature; and while these can often be handled on a routine basis, attitudes of clients often complicate even the simplest routine, and behavior of clients turns out to be neurotically determined. That neurosis is extremely widespread appears to be one of the inescapable realities of our culture. There also seems to be little doubt that our social agencies help to carry a significant share of the neurotic burden of the economically less privileged segment of the population. I t is interesting, in this connection, that the schools of social work, in advance of our medical schools, have charted the realistic course of introducing a dynamically oriented psychiatry into their total curriculum, regardless of the special field for which the student is trained.I t has certainly been tempting to the psychiatrist, with experience as consultant to case work agencies, to look upon this aspect of his work as a genuine opportunity to extend to a larger field the techniques and insights derived from psychotherapy. And in fact there has accumulated a considerable body of literature which reflects the thoughtful interest of psychotherapists in discovering a formula that would make it possible to reduce dynamic techniques in therapy to the more circumscribed needs of the case worker. A number of formulas which have been recommended have either not survived the passage of time or have not won general acceptance. One might draw the conclusion that procedure in the worker-client relationship is not essentially different from that in the therapist-patient relationship, and that the one can no more be reduced to formula than the other.The worker can usually obtain direct training in psychotherapy only in those child guidance or mental hygiene clinics where he is given freedom to practice therapy and is afforded the adequate psychiatric supervision to make the practice an experience of professional growth. However, in the clinic team setting, the special contribution of the worker is the effectiveness with which he maintains the life-line between clinic and community, so that even in this most favorable atmosphere, the worker is still not able to devote to direct psychotherapy that intensive and exclusive preoccupation which is proper and necessary for its independent mastery. I am not saying that workers cannot, or should not, be trained to do independent therapy, but

Consultation in Public Health

“…Reassurance derived from consultation is gradually built up from components of the entire process. 4 5. Termination-The process may end with the consultee having arrived at decision for action and with the process having contained all of the above elements.…”

“…Direct examination of the problem by the consultant may in some instances be desirable. 4 In so far as consideration of courses of action is concerned, the perceptions, motivations, and needs of the consultee are most important, since the consultee has the responsibility for decision and action. Stokes17 has proposed that consultation should be tailor-made, individualized for the users.…”