The art of child placement

THE ART OF CHILD PLACEMENT

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The Art of CHILD PLACEMENT by

JEAN CHARNLEY

UNIVERSITY OF MINNESOTA PRESS, Minneapolis

Copyright 1955 by the UNIVERSITY OF MINNESOTA All rights reserved. No part of this book may be reproduced in any form without the written permission of the publisher. Permission is hereby granted to reviewers to quote brief passages in a review to be printed in a magazine or newspaper.

Third Printing, 1966

Library of Congress Catalog Card Number: 55-7693

PUBLISHED IN GREAT BRITAIN, INDIA, AND PAKISTAN BY GEOFFREY CUMBERLEGE: OXFORD UNIVERSITY PRESS, LONDON, BOMBAY, AND KARACHI

To MARGARET LINEHAN WALLACE a teacher who opened doors for children. At thirteen, I sat in her classroom and thought, "Some day I shall dedicate a book to her." Twenty-five years later, here it is. I know Mrs. Wallace will approve its consecration to the belief that the confidence a generous adult offers a child is a gift beyond price.

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Introduction

THIS is a lively book on child placement. Between its covers are incorporated the rich experiences of the author. These are documented by the work and study of many social workers who, also, have dedicated themselves to this field of endeavor. The title of the book is significant. It suggests what is already well known, that child placement compounds scientific theory and its application to practice with an additional ingredient—an easy, creative, and imaginative use of the theory as this is expressed through the personality of the social worker. To have any real potency in the lives of people, the theories of child placement must be expressed through the disciplined emotions of those who practice. It is this creative use of theory which earns this book its title— "The Art of Child Placement." For the reader, Mrs. Charnley unlocks a vast storehouse of material. She covers all the facets of child placement and uncovers their complex network of psychologies. Brought to view through her animated pen is the actual and. fantasied meaning of separation to the child at his various stages of development. The placement worker's "forgotten man," the child's own parent, is born again and realistically pictured in his paradox of being at the same time a parent and a person. Foster parents are portrayed as real people, as parents to other people's children, and as the long strong arm of the agency's service. The price of foster parenthood without ownership of the child is depicted in all its shades vii

The Art of Child Placement of black and white. The role of the placement worker as she guides and steers the process itself is clearly seen. Like the hub of a wheel, she holds together the several radiating bars of placement. To the child, to his natural parent, to the foster parent, she lends her strength, her identifications, and her understanding so that the process can proceed with greater help to all. She makes use of a great fund of knowledge. To this knowledge she adds an individual and creative touch which springs from the wisdom of life experience. She is the true professional in that she blends an objective knowledge of placement with self-knowledge and puts both to use in this business of helping people through foster care. Throughout the chapters of the book controversial questions are dealt with and analyzed. For example, foster home care as over against institutional care; the child's own home as opposed to his care in a foster home; adoption as a goal, or long-time foster care. In addition, the author in light of her experience brings a fresh point of view to old prohibitions, such as placing the adolescent in a foster home or returning a child to his own parents before the community is ready. Such controversial subject matter is embellished with a wealth of case material and thus removed from its academic plane. The disputes of the field melt away before the testimony of the individual case. The reader finds the answers for himself and, as a result, feels nourished. In this book the author has stripped the actors of their social work categories. They are unencumbered and speak for themselves through her to the reader. The dynamics of placement are there to be recognized in their full meaning to the particular child and his parent. Their clinical significance is apparent, but naming the particular form of behavior is less necessary when it is demonstrated so aptly through the living record. This is achieved not only by "telling" case illustrations, but also by the author's informal homespun style which makes the subject matter take on a brisk and spirited quality. In her hands the orthodox and traditional principles of placement achieve a greater freedom in their application to children and adults alike. This is possible because over and beyond her professional knowledge and exVlll

Introduction perience she has a profound faith in the capacity of the child to grow if given needful things. She also has a conviction that both parents and foster parents can collaborate with her as allies for the child. Certain truths are brought out clearly, a few of which are the following: only a positive transference unlocks a child or an adult to our help; there are very few really rejecting mothers, most of them are ambivalent; a child's feeling for his own "neglecting" parent may be very different from what we think it should be; the worker always stands for reality to the child, to the parent, and to the foster parent, and supports them warmly in this reality. Here is a book which makes a case for foster care. More and more, over the past few years, this form of child care has been questioned, especially in the big cities. One hears that foster care is a "dead end" for the child, that he should either be placed for adoption or helped in his own home. One hears that foster care is no solution in itself and should be used only on a temporary basis. Mrs. Charnley's experience disputes this growing trend. Foster care, enriched with casework, stands out not only as "fitting and proper" for selected children and their parents, but in these instances as the only possible and profitable way of helping them. Contrary to what has been said, this trend does not spring primarily from the paucity of good foster homes, nor from the difficulties with natural parents who may destroy these homes, but more from a laissez-faire attitude which denies both our casework opportunities and responsibilities. The case "loafs along" without benefit of diagnosis and planning, and the worker with it. "The Art of Child Placement" comes to grips with knotty case situations. These are studied and thought through. Appropriate goals are set and steps taken to bring these about. Mrs. Charnley has produced a much needed document for the field and one which will be helpful for social workers in all types of agencies and in particular for those working in foster home programs. She has achieved what is hard, if not impossible, for many professional workers, namely, a writing style which makes ix

The Art of Child Placement the book a living event. She has been able to combine accurate theory and method with a universal and human "moving picture" of children, foster parents, and natural parents—thus the technical comes to life for the reader, whoever he may be. DOROTHY HUTCHINSON The New York School of Social Work Columbia University January 195;

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Preface

IN THE coming years, thousands of children will be removed from their own homes and placed in foster homes and institutions. This book is written for all of those who will have a part in helping children to take the terrifying step from the familiar into the unknown. Child welfare workers are practically without exception a group deeply convinced of the importance of doing their job well. They know that children who face separation are suffering children. As the adults who stand nearby, they want to be able to offer as much help as is humanly possible to ease the pain, the bitterness, the aloneness, that children inevitably feel. Many factors enter into the degree of excellence with which child welfare workers do their jobs. An understanding heart, an ability to empathize and communicate with children, a knowledge of the method and philosophies of child placement, are important elements in helping social workers aid children facing placement. A child welfare worker comes equipped with some of these traits, such as the understanding heart. But hearts, like brains, can be educated to greater sensitivity. The knowledge of what happens to the feelings of children in placement has a way of spilling over from the brain into the heart. But mostly, the understanding heart is part of the original equipment of every child welfare worker. It is a part of the force that led her to a school of social work, to a county welfare board to "fill out an application." xi

The Art of Child Placement The ability to empathize with children is partly talent, but it is also a skill that can be acquired and one that becomes more sure with practice and training. In the early history of social work, "the ladies of the parish" who reached out to plan Christmas baskets for poor children in orphanages acted largely out of a sense of sympathy. If they had been equipped with empathy— that fine term of the social worker that means "to feel into"— they would have been quicker to see that growing up in a rigid, overcrowded orphanage was almost as painful and damaging as any hunger or squalor from which a child had been rescued. Communication with children—deep communication that goes beyond the ability to get them to express their superficial feelings or to giggle when their newly skinned knees are still smarting— is perhaps the highest of all skills. Once in a popular magazine for women, I read an article whose purpose was to tell adults how to talk to their friends' children. The article was published, I am sure, because many adults find this a hard assignment. It was richer in don'ts than dos. I wasn't certain that those who read it would come away better able to talk with children. But I had no feeling that I could have written the article better. Learning to communicate with children is much too complicated for a simple how-to-do-it article. It comes from thoughtful practice and improves slowly through the years. It is the flowering of a whole philosophy of life about children and the things, good and bad, that happen to them. I don't think that any article or book can teach just how it should be done. A book can offer enrichment of understanding that may speed the process. Mostly, however, the adult who is able really to communicate with children is one who couples a sound background of knowledge with a sensitive ear. The good child welfare worker learns a great deal about communication with children by being a good listener. How does the social worker or the student begin to be a good listener? Is there no short cut? Must she practice on her first children?

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Preface There are, I believe, different ways of listening. This book is written by a listener. For ten years I have listened to the voices of troubled children—both those who spoke out in sharp, clear, angry tones and those so little or so frightened that their words were barely audible. I have written down many things about how children feel when they face separation. But generalizations come alive only when they are related to freckle-faced Johnny who steals, four-year-old Mary who one day stopped talking. But Johnny can teach something that will help later in understanding Teddy and Jerry and Jack. And four-year-old Mary can show, through her eloquent silence, how Bob and Dorothy feel too. As a listener, I have tried to put down what my foster children have taught me. I have listened to other educating voices as well —those of teachers and other social workers. Their words are here to be used and thought about. This book is based primarily on lessons taught by children placed in foster homes and institutions in Minnesota. My guess is that what they have said is very close to what frightened children have tried to tell adults everywhere, always. But one more prerequisite remains after a worker has begun to have the three important personal traits—the understanding heart, the ability to "feel into" children's secret thoughts, and the power to communicate. That is a sure, unfaltering belief in the philosophy and the techniques supporting child placement. If a social worker thinks of child placement as mere environmental manipulation, or as a resource to be used only when all else has failed, it will be reflected in her work, and parents and children will have subtle confirmation of their this-is-the-end-ofmy-world feeling. Foster placement is something much more positive than this. It should be used as a tool in treatment—a tool whose use is arrived at diagnostically and whose handling involves the utmost thought and care. In the field of social work with children, one of the first truths that a caseworker learns is that there is normally no full satisfaction to a child comparable to a place in his own home with his xiii

The Art of Child Placement own parents. Social workers, profiting by past mistakes, have come to realize that some pretty serious imperfections in a home may not be reason enough for removal. It is not difficult for a social worker to break a family up. Putting it back in working order is a much higher art. But the knowledge of all the pain and inadequacies that may be part of foster placement should not operate in her thinking in such a way as to make placement when it is indicated a negative rather than a positive kind of treatment. Child welfare workers who have had major experiences in agencies where placement is consciously used as a tool in treatment are sometimes accused of being "too quick to place." Actually, it seems that the more thoroughly a worker knows children, the more cautiously she approaches the decision that placement is the best solution. The social worker who has ridden in her car beside a hundred frightened children who are leaving their pasts behind and moving into a threatening new world does not need to have it explained to her that this is terrifying to a small client. And the social worker who has listened to a hundred crying, angry adolescents who are still trying to recapture a place in their own homes that they lost years ago will know that the decision to place a child without a clear and reasonable expectation of how it will all end is a grave one. Most children in placement are there because of major dislocations in family life in which there has been no alternative. But effective placement does not wait this long—it does not wait until the situation has so thoroughly blown up that there is no home left. In many cases organized society, represented by the police or Juvenile Court, has found that children are seriously neglected or abused. Here the social worker begins the placement job robbed of one of the most helpful tools in placement. The rights of parents and child for self-determination are gone. The parents are accepting placement only because a force bigger than their own wills has imposed it upon them. The child too has been robbed. He is going into placement not as a result of a series of

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Preface emotional dislocations that have transpired between him and his parents but because some outside force (perhaps he names it "the dirty cops") is pushing a "cruel" plan on him and his parents. Signs of family breakdown have often been apparent long before the culminating events that lead to court orders. In many instances social workers have had opportunity—but failed—to use placement as a tool in treatment before the crises occurred. If a social worker has failed to use placement in time, it is because she has learned too well not to break up families, and has learned too poorly that child placement can be a tool used to prevent total destruction of what is healthy and sound in a shaky family situation. How does the social worker decide when it is time to break up a family group? Sometimes, if she is fortunate, she will have access to psychiatric consultation for help in evaluating the degree of disturbance in her principal clients. But more often she must go it alone. The answer should not lie in the exact kind or degree of neglect or rejection but rather in the future chances of parents and child to succeed in living together. When she can predict quite clearly that a harmful situation will continue, or almost certainly reach that slightly worse point at which the parents "break," abandon, or are brought to court for their failures, she can be fairly sure that she is .facing a placement situation. When she finds herself working with a child in a home in which it becomes clear that the "dice are loaded" against him, she may confidently decide that placement is the answer. Once a social worker's diagnosis has led her to the belief that placement is indicated, she should use it with conviction. Her plan should envision it as an opportunity for parents and child to come to an understanding of themselves and one another that will make it possible for them to come back together and again to function as a family. The child who faces placement because his parents have requested it as a help toward better understanding is not nearly so damaged as if this were a plan imposed on him and his parents by an outside force. The parent, however disturbed, who has enough mental health and vigor to go to a XV

The Art of Child Placement children's agency and ask for help, has by that very act demonstrated that chances of family rehabilitation exist. At the point at which a parent asks for placement, he has taken a monumental step, as any experienced worker knows. The request for placement is fraught with pain to the self-assurance, the conscience, and the pride of the average parent. One of the skills of the caseworker is the perception to see quickly whether placement is the appropriate answer to the problem. Perhaps there is a simpler, easier, safer solution—homemaker services, parent-child boarding home, or parent-child counseling in the home. When these and all other possibilities offer inadequate help, the caseworker moves carefully and painstakingly toward a soundly conceived placement. The social worker uses her skills in bringing the child and parents to working together with her in the plan for placement. The child needs to feel that the plan arises from his parents, not from his worker. As the worker begins her relationship with the child, she must get across to him what she represents as she stands in the middle of the three forces in his life—the foster parents, his own parents, and his strange new world. She offers him her hand and says, "I'll be right here to help and understand all along the way." The child in placement is in a unique and trying experience that threatens him in ways that are probably deeper than those that threatened his security in his own home. He needs the help of an expert to guide and comfort him in his exile. His foster parents too are experiencing a strange, unnatural kind of experience in which they must adjust to emotional disciplines that life has not often called on them to make. They too need the warm support and help of the expert. And the expert in the center of the circle made up of strangely interrelated humans is the social worker. She holds in her hand a secret without which she could not function. It is a deep belief in the ability of people—adults and children—to change. She has dared to help them to this peculiar mode of living because of this belief. It is this belief and her ability to communicate it to all of them that is the chief source of her power to help. xvi

Preface Child welfare workers find themselves doing placement in many different kinds of settings—protection agencies, large and small public agencies, private agencies. In some, the clients come with court orders; in some, troubled people find their way to agencies to ask for help. In some agencies a worker carries a large and varied caseload so that child placement represents a small segment of her work. In others, she works with the luxury of a small caseload, expert supervision, and easy access to good psychiatric consultation. Whatever the setting, whatever the circumstances of her job, she still needs and must have and use the skills and understanding basic to good child placement. For example, what of the social worker in an agency that assigns large and undifferentiated caseloads? Suppose that among her cases are four or five children in placement. Does she need to develop all these skills? Does she have the time or energy to apply them? The answer is even more ardently affirmative. Because a worker is busy, is she to excuse herself for speaking reproachfully or in an authoritarian fashion to failing parents? May she, because of her heavy caseload, take the short cut of suggesting that naughty children on her caseload be spanked? Can she turn away from foster parents who ask for help? She cannot because of the very fact that she is so busy. Such short cuts are short cuts only to failure, only to more and more work for her. The principles of good child placement are predicated on truth born of experience and study. They are as true for the social worker with the very large caseload as for the one in a small private agency whose load is planned to give her plenty of time for intensive treatment. She faces the knotty problem of selecting what is most urgent, which client needs her most. The kind of help she gives and the philosophy back of the work should be the same wherever children need placement. The impulse to write a book is a strange one. As an author finds himself midway in the project, facing colossal questions of what to put in, what to leave out, whether he has written anyxvii

The Art of Child Placement thing dimly resembling what he actually means, he wonders about his own sanity in undertaking the task. For a social worker to undertake such a task is even stranger. Social workers are essentially doers who find it hard enough to get their dictation done, to say nothing of doing writing that their jobs don't require. (Ask any teacher of social work who tries to get university students to leave their field placements to write their theses!) Nevertheless, social workers may sympathize with the two impulses that have been at the base of the development of this book: the puzzling fact that beginners in the field must go to twenty, or forty or a hundred, sources in libraries to find information merely to begin to get the feeling of this many-faceted work; and the continuing hope of being of help to children's social workers and—more importantly—to the children who need their help. This book grows from a desire to share some of the knowledge foster parents, children, and supervisors have taught me. I must admit that writing such a book has been an excellent experience in humility. Concluding it, I am deeply aware of the many things the book does not say. For example, it skirts completely the current question of the Functional and Diagnostic schools of thought —deliberately, because it is more concerned with ideas which are genuinely useful and less concerned with identifications and differing orientations. My own training and philosophy are Diagnostic, but I have not hesitated at times to learn from Functional thinkers when their contributions seemed helpful. I am aware that this is not a "scholarly" treatise. For this I offer as my explanation the fact that I am a practicing caseworker in the field of child welfare. A scholar in the field would have done quite a different book—but I believe that such a practical one as I have tried to make this may prove equally useful. JEAN CHARNLEY Minneapolis January 1955 xviii

Acknowledgments

I MUST extend thanks and appreciation to three careful and generous critics: Mr. Richard Guilford, professor in the School of Social Work, University of Minnesota; Mrs. Mary Jo Grathwol, supervisor at Children's Service, Inc., St. Paul, Minnesota; and Mrs. Lorena Coates, supervisor at Family and Child Service, Austin, Texas. I must also thank the agencies in St. Paul and Minneapolis which not only opened records to me but also helped in the search for illustrative case history material. And my deep gratitude goes to the executives and board of Children's Service, Inc., St. Paul. Had they not made it possible for me to take time from agency tasks to work on this book, it might never have been written.

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Contents

INTRODUCTION by Dorothy Hutchinson

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PLACEMENT OF THE VERY YOUNG CHILD

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ESTABLISHING A RELATIONSHIP WITH THE GRADESTER

31

FOSTER HOMES AND INSTITUTIONS

69

CASEWORK WITH "OWN" PARENTS

106

CASEWORK WITH FOSTER FAMILIES

144

CASEWORK WITH ADOLESCENTS

205

ADDITIONAL READING

255

INDEX

262

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THE ART OF CHILD PLACEMENT

Timmy, a four-year-old foster child just placed on a farm, stood with me watching Bess, a fine white collie, nurse her pups. When Timmy referred to Bess as "he," I wondered why. "Dogs are he," he said, "and cats are she. Of course, they aren't, not really—but it's easier that way" In the use of the personal pronoun in this book, social workers are she, and children are he. Parents too are mostly he. Of course, they aren't, not really. But it's easier that way.

CHAPTER I

Placement of the Very Young Child

SINS AGAINST THE LITTLEST CLIENTS

THE keynote of success in all child placement is careful preparation. Preparation is aimed at helping the client know, understand, and accept what is happening to him. The social worker recognizes that the need to be separated from one's own family, to be taken to a new family, is a painful reality. She has learned that pain of this kind is more bearable if it conies "in little pieces." The skilled worker comes to sense the tempo at which her child can move from the old to the new and develops ways of helping him to meet this painful change. The placement of a child should have as little of the "being-done-to" flavor as possible. Whatever parts of the process the child can do for himself as a dramatization of his acceptance of what is happening to him will be important in the ultimate success of the plan. A social worker who has children of all ages on her caseload would not think of running out one afternoon to pick up an adolescent whom she had never met, to move him to a home he knew nothing about. And yet, many an agency that is extremely thoughtful in assigning the case of an "acting-out" adolescent will entrust a baby to any worker who has a free hour or two to make a placement. Such casual assignment can lead to care of babies by workers who have thought little about them and whose very physical handling denies any belief that these are the most delicate and sensitive of humans.

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The Art of Child Placement Sometimes it seems as though the littlest of our clients get the least from us. This is in spite of the fact that we completely accept their dependence and are perfectly sure that above all we want to help and protect them. One student social worker asked a puzzled public health nurse, "Show me a couple of good ways to pick up a baby." She was a warm, thoughtful girl who had observed the care and skill with which an experienced mother handles her babies. She wanted a short cut to such skill. Her question was naive; her attention to an important detail was exactly right. This attitude was consistent in all aspects of her work with babies—that is, that this is an important job that can never be done carefully or well enough. She will not belong to the group of social workers who unknowingly sin against babies. Other sins against babies are many. Most seem to arise from thoughtlessness. Social workers do not know enough about babies and therefore cause them unnecessary pain. All workers recognize that babies are miserable when safety pins stick them or when they're cold or hungry, but many a worker does not always feel with the babies the terror of a move into the unfamiliar. Before trying to understand a baby's ability to experience change, it would be well to consider the influences that add up to security for babies. GOOD MENTAL HYGIENE FOR BABIES

Dr. C. Anderson Aldrich has written a clear description of the rights of infants: Every baby, from the moment he comes into the world, is influenced by certain basic needs or drives which are easily recognized by anyone who observes young infants over a long period of time. The most evident are perhaps (i) the need for physical safety, which includes protection from hunger, cold, wetness, and other dangers that threaten the life of a young baby; (2) the deep need for warm affection, which broadens out later into the desire to be an approved member of his own particular family group ... the 'belongingness' spoken of by Lawrence Frank; and (3) the need to grow and develop according to his own habit patterns and rhythms. This last is the device that safeguards individuality, 4

Placement of the Very Young Child produces artist, mechanic, or statesman, and makes each baby different from every other baby.... These needs, so important to a baby, persist under the surface of a child's personality and influence his conduct and happiness from the cradle to the grave. Their great importance to us lies in knowing that when they are unduly thwarted, psychological difficulties, which we call behavior problems, occur. When they are fulfilled, stable personalities are fostered.1 These are not new ideas to caseworkers, and in their way they try to see that the rights of the infants in their care are protected. Perhaps child placement workers have not recognized that when they move babies abruptly to new surroundings, they have, as Dr. Aldrich puts it, "unduly thwarted" them. Many social workers know that change is painful to babies, but as placement workers they know, too, that change is a necessary reality for them. It is not easy to inflict pain on these small, dependent humans. Social workers mistakenly try to do it speedily and get it over, having a memory that the sharp speed of a surgeon's knife is the easier way to have done with an unavoidable pain. They need instead, to understand more of what change means to babies and how best to help them meet it. What in change disturbs babies? Dr. Margaret Ribble has written about some of the details in the changed environment to which they respond: "When a baby is placed in a room where sudden loud noises occur, such as from a streetcar passing at certain intervals, a doorbell ringing, or a sudden clatter of dishes, he reacts sharply to sudden stimulation. On the other hand our study showed that when infants were taken from a hospital nursery where there had been more or less bustle of human sounds and where lights went on and off, they gave an equally strong reaction to the stillness of an entirely quiet room ... the stimulation given to a small baby has to be as carefully regulated as his food intake if the child is to be nervously stable."2 Among the thoughtful experts who have concerned themselves

1 C. Anderson Aldrich, "High Lights on the Psychology of Infancy," Mental Hygiene, 30:590 (October 1946). 2 Margaret A. Ribble, The Rights of Infants (New York: Columbia University Press, 1943), p. 64.

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The Art of Child Placement with the study of infants and their response to emotional trauma is Rene Spitz, whose excellent movie, Grief, graphically depicts the shocking physiological and affectual changes in a group of infants following separation from their mothers and placement in a nursery setting. In the July 1950 issue of the American Journal of Orthopsychiatry, Dr. Spitz wrote an article entitled "Psychiatric Therapy in Infancy." At the conclusion of his article, which describes various psychic disturbances in infancy, Dr. Spitz suggests "preventive psychiatry" for babies. He says that separation from the mother person, such as occurs when a baby is hospitalized, is harmful. If separation must occur because the mother is ill or dead, he recommends that a "substitute mother" should be found. Dr. Spitz feels that the giving of "age-adequate stimuli" (toys) is very important, as is the freedom of a baby to move about in space when he is ready for locomotion. "BRIEF" HOSPITALIZATION OF BABIES The "mother substitute" that Dr. Spitz refers to will not be found in a hospital working an eight-hour shift. Real mother substitutes take the hard, twenty-four-hour shift, a fact that spells security to babies. Social workers seem to forget this easily because the convenience of the ever-ready hospital is tempting. Often while an unmarried mother tries to decide whether to let her baby be adopted, it seems "least complicated" to leave the baby in a hospital. Weeks sometimes become traumatic months, while social workers go about mistakenly serene in the idea that the baby is getting "the best of care."3 It is not uncommon for small children to be hospitalized, for example for a preplacement physical, and left in the pediatric ward for several days "until the clinical findings come up from the lab." Perhaps a court hearing is pending and it saves effort not to move the children to a foster home until afterward. 3 Herman Vollmer, in "Psychosomatic Significance of Body Orifices," American Journal of Orthopsychiatry, 18:345 (April 1948), describes the confusion of the abruptly hospitalized child as follows: "Children admitted

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Placement o] the Very Young Child What does such a baby think and feel? Gone is whatever was familiar and warm and sure in his past. That woman who always met his needs in her own way is gone, that woman whom he would soon have called "Mama." Instead, there is much light, a tighter, firmer bed, and a procession of fast-moving men and women, all starched and white, who sometimes come with needles. There are voices of many children crying. There is a confusion of motion to and fro. Gone is the warm, soft, giving breast. Here are the taut sheets, the bottle with the nipple. The phrase "A hospital is no place for a well baby" has become almost a cliche. Once in the home of a psychiatrist whose fourmonth-old baby was severely ill, I heard the doctor discussing with his wife the advantages of caring for the baby at home because of the importance of the maternal relationship to an infant who is trying to get well. He grinned and said, "A hospital is no place for a sick baby." I wish that social workers would think more of the meaning behind this wry joke and be less fearful to leave sick babies in foster homes. Social workers are as a group too quick to hospitalize for diagnosis, for observation, even for habit training. They trust foster mothers to watch babies through stair climbing and on busy streets, but not as often through high temperatures and diphtheria. Perhaps it is because caseworkers feel so deeply challenged by the helplessness of these littlest clients that they are not able to trust them in illness away from the experts. Inadvertently, they are hard on babies because they do not understand them. It is not difficult to look at the twitching, "near-tears" expression of a four-year-old and know that it is hard for him to leave his mother and go into the unknown. The social worker feels with to a hospital ward without proper preparation frequently show during die first days a well-known pattern of behavior. They cry, refuse to talk, turn their eyes away from every approaching person, or hide their faces in the bedcovers. They have anorexia, refuse to eat, or if they eat they vomit. They are constipated. . . . Sudden separation from home and mother and the fear that this separation might be permanent is obviously the causative psychic trauma. The child reacts with a general negativistic attitude toward the world with which he severs all relations." 7

The Art of Child Placement him; and feeling with him, she instinctively does what she can to ease his pain. Children old enough to tell how they feel are spared many of the errors that child-placement workers make with babies. Food, clothing, and shelter have become an oversimplification of the needs of babies. A proper stress of the needs of babies might well place mothering and a consistent environment ahead of these necessities. The older child, when set down in an unacceptable environment like a hospital, when moved about "like so much luggage," can let fly with a torrent of angry words pungent with hostility; or he can become delinquent, or neurotic. Other children, not blessed with the happy release of angry words, act out their feelings in gestures hard to misunderstand. Babies act out, too. But they are little and new at the business of educating social workers, so that it requires a more delicate eye and ear to understand what they are saying. The greatest mistake in social work with infants is crediting them with too little feeling. EFFECTS OF INSTITUTIONAL CARE

For many different reasons, for many years children who became suddenly dependent on the community were taken to nurseries, hospitals, or orphanages. In some communities this is still a common solution. It is growing more uncommon to leave them in institutional care for protracted periods. In looking back on the reasons for the move away from institutional care one can learn a great deal about babies. Babies have much to tell about themselves and about other babies if one listens with what Theodore Reik has referred to as "the third ear." Denied the power of speech, they act out a mighty drama with the whole of their tiny selves. They stare into space. They do not eat. Their digestive systems are upset. And if we still cannot understand, they die to show us. The idea of foster homes for babies emerged at the turn of the century. America was then devoted to the sterilized, antiseptic, routinized school of infant care. The idea of germs haunted the conscientious mother and the conscientious nurse. It also stultified and stiffened them. The fact that a goodly number of babies sur8

Placement of the Very Young Child vived this epoch and grew to be pleasant, outgoing people could be explained by the strength of the mothering instinct which caused many a woman, in spite of the rules, to be a natural mother —cuddling and rocking her baby, smiling when her crawler gave his puppy a slobbery kiss and got one back. But the people who dealt with children professionally and in large numbers followed the rules conscientiously. Often they put babies in lovely sunny orphanages with excellent physical standards. Most of the experts in the field of infantile development have looked back to these earlier unsuccessful days of congregate infant care in an effort to understand the meaning of mothering to infants. In the history of the now nearly extinct illness marasmus, they have found an important clue. Spock, Spitz, Ribble, and others have described the illness and its implications. Dr. Ribble writes: Not many years ago one of the most baffling problems of child health was a disease known as marasmus. The name comes from the Greek word which means "wasting away." Sometimes it is also called infantile atrophy or debility. It affects particularly children in the first year of life, and less than three decades ago was responsible for more than half the deaths in that age group. To combat this tragic evil a special study of infant care was undertaken by both medical and social agencies, and the most astonishing discovery was that babies in the best homes and hospitals, given the most careful physical attention, often drifted into this condition of slow dying, while infants in the poorest homes, with a good mother, often overcame poverty and unhygienic surroundings and became bouncing babies. It was found that the element lacking in the sterilized lives of the babies of the former class, and generously supplied to those that flourished in spite of hit or miss environmental conditions, was mother-love. In consequence of this new insight, science, without attempting to analyze the life-giving quality of mother-love, came to terms with sense. Hospital authorities began looking around for a "Pharaoh's daughter" to care for unloved children who fell into their hands. A new system of carefully selected foster mothers was developed, and whenever an infant had no suitable person to care for him, he was sent to a foster home rather than to an institution unless the illness was acute. Young infants are now 9

The Art of Child Placement kept in hospitals for as short a time as possible. As a result marasmus is becoming a rare disease.4 When child therapists look to the personalities of children who have experienced institutional life, they agree in their findings that lasting damage is apparent many years later in the personality development of these children. Anna Freud and Dorothy Burlingham made careful observations on small children given congregate care in a thoughtfully run institution during World War II near London. They write: Superficial observations of children of this kind [i.e., children reared in institutions] leaves a conflicting picture. They resemble, so far as outward appearances are concerned, children of middle class families; they are well developed physically, properly nourished, decently dressed, have acquired clean habits and decent table manners, and can adapt themselves to rules and regulations. So far as character development is concerned, they often prove— to everybody's despair and despite many efforts—not far above the standard of destitute or neglected children. This shows up especially after they have left the institutions.5 Dr. Ribble echoes this observation: Sincere and interested people ask: "Does it affect an infant to be placed temporarily in an institution?; is he disturbed by being 'tried out' in one foster home after another?; does it make a difference if several different people care for the baby?" The answer is that it usually makes the difference between a well-adjusted child with a sense of security and the child with behavior problems. . . . A more far-reaching result in children who have had many changes in father, mother, or in nurse or caretaker may be that their ability to form attachments is not possible until much later on. Their capacity to respond may be lessened. Often foster mothers or adoptive parents make the complaint that these children do not respond to love or to gifts or to other things that are done for them. This unresponsiveness is an extremely unfortunate thing and often makes the particularly sensitive child who needs a home incapable of accepting one. Depression and feeling of not being wanted is another response to such changes. Perhaps most serious of all is the child who becomes very auto-erotic in an exaggerated 4 5

Margaret A. Ribble, The Rights of Infants, p. 4. Anna Freud and Dorothy T. Burlingham, Infants without Families (New York: International University Press, 1944), p. 10. IO

Placement of the Very Young Child way and turns to his own body for the satisfactions he should get from the outside. This leads to the problem of masturbation, prolonged thumb-sucking, and many other so-called "habits" of early infancy.6 Dr. Kibble and others see a great deal in common between the often replaced child and the institutional child. In fact, they frequently write of them in an almost interchangeable fashion. This is because these two kinds of children have experiences which, psychically speaking, are similar. It is the fact that the institutionalized baby is cared for by three or more sets of nurses working short shifts—instead of by one person, a mother person, doing the total job—that makes him confused and unable to relate. With the frequently replaced infant there is a similar experience, though the time element varies. No one really knows what time means to an infant. One can be pretty sure, though, that it is not a clear-cut concept to him. It is possible that in an eight-hour shift with a nurse, a baby may experience a "little lifetime." It may not feel very different to him from a six-day placement with a foster mother. Most thoughtful child placement workers find frequent replacements the bitter medicine of their jobs because they recognize that replacements are damaging. Often they will decide that it is better to leave a baby in a hospital for a month or more than to submit him to a temporary placement or two before permanent plans can be worked through. It is their feeling that in this decision they are choosing for the baby the lesser of two evils. Anna Freud and Dorothy Burlingham have given an answer to this dilemma: "When choosing between the two evils of broken and interrupted attachments and an existence of emotional barrenness, the latter is the more harmful solution because it offers less prospect for normal character development."7 That is to say, placement subject to the many uncertainties that lead to replacements is no panacea. A caseworker knows as well as the man who fits a child with an artificial limb that this new leg will not be as 6 Margaret A. Kibble, "Infant Care and Emotional Growth," Bulletin, Child Welfare League of America, 23:1, 3, (October 1044). 7 Anna Freud and Dorothy T. Burlingham, op. cit., p. 63.

II

The Art of Child Placement good as the one he lost. But the caseworker also knows that this is the best substitute she has to offer. She approaches her job with the deep conviction that she is offering him an imperfect but very useful substitute. She has a belief that this is a job requiring high skill, one than can be done badly or well. It is up to her to make it as workable and helpful a remedy as she can. SEPARATION AND PAIN

Once having recognized the fact that separation and pain are intertwined, child placement workers need to sort out their feelings about pain. Since social workers are to live intimately with separating experiences, they can be overwhelmed by them unless they understand them. It is necessary to focus on the ability of all—children and adults alike—to take in pain, to give it recognition and a part in their lives, to grow from it, to go on with it. To protect any child from all pain, physical and emotional, would be a highly questionable way in which to build a sound adult. Beginning with the moment of birth, life is a series of separation experiences, and in each of these there is pain. Once, a vacation companion, at the end of a pleasant two weeks, said to me, "Parting is the price of meeting." We meet, we relate, we separate; we meet, we relate, we separate. Such is the pattern of life until we do not meet again, and this is death. And if we still breathe and meet but do not relate, this, too, is a kind of death. Change and separation are parts of the lives of all babies, but in the lives of the babies on the caseload of a placement worker they are dramatized, sharpened and stark. Change needs to be eased and maneuvered by a gentle expert so that it becomes something that the small clients and she can tolerate. It needs, above all, to be prepared for. One means by which social workers find an understanding of the experiences of their clients is through empathy. Let me tell you how I "feel with" my baby clients in the attempt to know a little of what they are feeling. I am again a little child in my parents' home. I push my memory back as far as it will go. I remember my home through broken 12

Placement of the Very Young Child imagery. An ornate glass lamp with a heavy beaded fringe is the first symbol of my early memory of home. Others begin to crowd in. I try to feel separation again as I felt it then. My mother is going downtown to shop. A gray-haired woman with a mending basket sits on our davenport. She is going to "watch after me." I see my mother in her downtown clothes and my anxiety mounts. When she puts on a fancy hat with feathers on it, I begin to cry. She says to the gray-haired one, "I'll just hurry along. When I'm out of sight, she'll be all right." The door closes and I run to the big window to watch her disappear down the street. There is a fuzzy memory of little streams of water—was it raining or were those my tears? I knew loneliness. And I can remember the pain of separation mixed with rejection in a brief little snatch. "Jean, you ate the frosting off the cake that I wanted to look nice for dinner tonight. Now you may go to your room and stay there." This was more difficult because my own badness was a part of it. But part of me knew that we would make up and that she would still love me. That night I would go to sleep in my own bed and my own mother would tuck me in. And on those days that she went shopping, my grief was tempered by an indefinable knowledge that she would return. But if she had not come home that night? If I could never again sleep in my own bed? If I had become a foster child? Then I would want it to have been this way: I would have wanted a social worker who came to help, a social worker like many I have since come to know. She would have said, whether I were old enough to know the words or not, "This is a really hard thing happening to you, Jean. But I am going to help you find a way to bear it. You may cry if you like, and I will hold you on my lap or let you cry alone if you prefer. I will tell you about how we are going to find a new Mama. It may help if you take your own teddy bear with you to the new Mama." I would know and she would know that the new Mama would not be the same. Nothing is just the same. But there would be parts of the new that would have comforting elements of the old in it, «3

The Art of Child Placement My social worker would have remembered that babies do not like to have things done to them against their wills. When their arms are held down, their faces become red and they cry. (Sometimes, of course, it is really necessary, as when the doctor comes with the offending needle.) So she would have held my hand very gently and said, "Atta girl!" and encouraged me to make whatever part of this change I could for myself. To me and to some other social workers it is easier to understand these things in terms of ourselves. Had a sharp separation happened to me, I know how I hope it would have come. In any separation there is a wound. But it can be treated in such a way that it will leave only a little scar. Babies have within them, as all people do in varying degrees, an ability to take pain and find a way of living with it. They have the wonderful ability to heal and scar. There are perhaps children who have grown up without physical scars. I doubt that there are any adults without psychological scars. It is not so intolerable that babies should have to suffer as that they should not be helped to get well. THE CASE HISTORY OF JERRY JONES

To bring many of these generalizations and principles into a sharper focus, it may help to look closely at a specific case. The child is eighteen-month-old "Jerry Jones" (not, of course, really Jerry Jones—his identity is thoroughly concealed, as is that of the people in all the case histories in this book). Which comes first, the caseworker or the child? In this instance, the caseworker. The problem of selecting a worker for a child is an interesting one. A supervisor tries not to assign cases on a merely alphabetical or geographic basis. A delicate skill needs to be exercised at the point of referral in picking up "the feel of a case" and combining that with a knowledge of the interests and talents of the individual workers. As a case develops, the supervisor may say happily to herself, "I was right. Miss A does have a very special feeling for withdrawn children . . . or guilty parents." Or, on the contrary, she may worry to herself, "Miss B is going to need a lot of help in '4

Placement of the Very Young Child this situation. There's something about Miss B and domineering foster mothers that does not go well together." What a caseworker brings to any individual client is the total warp and woof of her personality made up of a million tiny threads—her life experiences, her training, her reading, the influence of supervisors past and present, to mention only a few. What the client meets is a social worker. But to him she becomes a person. He will soon feel the professional quality of the relationship if it is there, but he will also feel he has met a woman. No one can say whether we are social workers first and people second during the nine-to-five hours of the clock. We are ideally a true compound and not a mixture. What the client meets is the "social worker-person." What he experiences as a client is influenced not only by his ability to respond to treatment, but also by the social worker's ability to give of herself. What Jerry Jones met was Mrs. Arthur. In discussing case histories it is not customary to include a description of the caseworker. But after reading Jerry's case history I was able to spend some time discussing the recording with his worker. This added immeasurably to my interest in, and understanding of, the case. When I explained my purposes to Mrs. Arthur, she was willing for me to include a sketch of her. As I reread Jerry's history now, I picture the casework activities as flowing between a pert, redheaded baby and a small, vivacious woman who told me she had become so fond of Jerry that she suddenly found her eyes filled with tears when he drove off with his adoptive parents. Jerry's Caseworker The sensitivity and skill that have gone into Mrs. Arthur's work with Jerry might make a reader, as they did me, feel suddenly humble. It was interesting to me to learn that though Mrs. Arthur was a warm, intelligent young woman, this kind of work was new to her. Mrs. Arthur was in her late twenties—small, gay, attractive. A nine-year-old foster child had referred to her as "one of them smiling-eyed ladies." At the time she began working with Jerry, she had recently 15

The Art of Child Placement come to a small, private adoption agency on a part-time basis while her own boys, ages three and five, attended nursery school. When I mentioned to Mrs. Arthur that I was planning to refer to her as a mother, she said, "Oh, should you?" She expressed the thought that unmarried social workers sometimes feel keenly—the unfair criticism now and again offered by clients, board members, and even other social workers that "one needs to be a mother in order to understand and work with children effectively." She and I talked about our opinion that this is nonsense. The mere physical acts of conceiving, delivering, and even caring for a baby do not make a woman a mother. Nor do they necessarily make her better able to understand children—her own or others. We agreed that the protest needs to be understood for what it is, an unwillingness to give the stamp of approval to anyone. Those who would classify child placement workers according to such broad rules subject them to double reproach: "If social workers have children, they ought to be home taking care of them. If they haven't they obviously cannot understand them." At the time Mrs. Arthur began her work with Jerry, she had had a good education in social work and a brief experience in a hospital setting, but almost no direct experience in the placement of babies. Her thoughtfulness in relation to her own small boys offered a short cut to her arriving at an "at homeness" with babies. She didn't have to read Arnold Gesell to know that an eighteen-monthold would enjoy taking crayons out of a box and putting them back in. It wasn't necessary that she have been a mother to have moved so smoothly and expertly into a casework relationship with a baby facing a hard new experience, but perhaps in this instance it helped. Mrs. Arthur approached her job with a deep conviction that it was important to do it well. In order to orient her thinking to the adoption work she was about to begin, Mrs. Arthur read what she could find in the literature of the field. She complained that what she found was little, scattered and hard to get at—magazine articles here and there, slim chapters in fat volumes, a few pam16

Placement of the Very Young Child phlets. Mrs. Arthur felt that The Role of the Baby in the Placement Process, an excellent pamphlet published in 1946 by the Pennsylvania School of Social Work, was the most useful and helpful of her references. That is Mrs. Arthur—no sexless, shapeless, colorless form known as "the worker," but a very real person. Background Note Jerry was born three months after the divorce of his parents. His father was in prison on a ten-year sentence for robbery. Jerry was cared for by an alcoholic mother who gave him good physical care and who appeared warm and affectionate when sober. Sometimes, however, he had been left alone for six-hour periods when his mother was drinking. When he was eight months old, his mother placed him in an independent foster home where he received poor care. At ten months, he was replaced by the county welfare board in a licensed boarding home. This foster mother gave him up in one week because he whined constantly and seemed to have an insatiable appetite for attention. He was then placed in the Lowry foster home where Mrs. Arthur became acquainted with him and began to prepare him for adoption. (This home was licensed by the County Welfare Board and "lent" to our agency to avoid another move for Jerry before adoptive placement. The cost of Jerry's care will be met by our agency until Jerry leaves.) Jerry was eighteen months old at the beginning of Mrs. Arthur's record, from which the following pages are excerpts. Interviews with Jerry February 12. Visit to the Lowry boarding home to observe Jerry. Jerry is an appealing child—dark red curly hair, dark brown eyes, and a well-shaped head. His complexion suggests that when he is older he will freckle. He has an engaging grin which breaks through suddenly with little warning. He is sturdily built, about average in height and weight. His frame suggests the word "stocky." '7

The An of Child Placement Mrs. Lowry said that in the three months Jerry had been in her home he had made a remarkable improvement. At first he was timid and withdrawn and seemed anxious. Now all traces of this behavior seem to have disappeared; while I observed Jerry for about half an hour, he seemed unusually outgoing for an eighteenmonth-old, running from Mrs. Lowry to Tommy, her four-yearold, and to me with much "bounciness." Mrs. Lowry said that Jerry is an easy child to look after and offers no problems in handling. He eats very well; in fact, he is something of a "stuffer." He would eat more than is good for him if Mrs. Lowry did not limit him. He goes to bed at a regular hour and sleeps soundly through the night. He acted interested in his toys and I thought he used his hobbyhorse with a good deal of imagination. Mrs. Lowry put a record on the phonograph, saying that both she and her husband felt that he had an unusual musical sense. It was delightful to watch Jerry "dance" to the music—hopping up and down, swaying sideways, changing his rhythm when the music did. The only remaining indication of Jerry's previous tensions is a tic, which takes the form of head-wagging. I noticed three or four times during my stay that he would start to wag his head back and forth in an automatic, compulsive manner. Mrs. Lowry said that this mannerism was much less apparent than when he had first come. Then he was a "head-banger," too; that is, he would suddenly, without any apparent provocation, bang his head against the floor. Mrs. Lowry was afraid he might hurt himself. It was curious, she said, that even when he banged hard, he did not cry. Mrs. Lowry said that the head-banging seems to have disappeared and that he wags his head only when he is in some way troubled. I felt as though perhaps my presence there might be threatening to him and that this might explain the head-wagging during the time of my visit. Mrs. Lowry said that Jerry is not quite as affectionate as some children of this age for whom she has cared, but that there are times when he likes to be cuddled. Just after she said this Jerry climbed onto her lap, gave her a big hug and kiss, smiled, and 18

Placement of the Very Young Child walked away. I was pleased at this because it showed me that Jerry, though his vocabulary is limited to a few baby words, understands a great deal of what is said. Jerry appears to be an attractive, normal child since he has been in a composed, stable household. Mrs. Lowry is the kind of person whom we should seek in an adoptive mother. She is willing to let him proceed at his own pace and has no need to press him. His previous head-banging and head-wagging should be kept in mind. They suggest that he is a sensitive child who responds rather sharply to insecurity. His adoptive home should be one with a minimum of pressures and a similarly relaxed, easy-going manner of handling. March 7. Visit to the Lowry foster home to begin placement preparations for Jerry. After I had settled down on the davenport, Jerry, who had been busily playing with his hobbyhorse and some other toys, began making overtures to me, handing me one of his toys and taking it back. He seemed to be quite cheerful, smiled a great deal, and did not give any evidence of the kind of tension he had exhibited on my first visit. Mrs. Lowry commented that Jerry was no longer stuffing himself but seemed to take only about what he needed now. We discussed this in terms of a child's need to have food as a symbol of security and love, and that frequently overeating is a sign of some kind of inner tension and anxiety. The fact that he now wanted only an appropriate amount was a good sign of adjustment. Mrs. Lowry was pleased that I had indirectly complimented her on the excellent home she had given Jerry. I discussed with Mrs. Lowry my plan to take Jerry on little trips in order to acquaint him with the agency and make placement easier for him. I said that though it might be hard for him to go off with me at first, but that in the end it would be easier for him to leave her if he had had this experience in getting used, with me, to what is new and strange. Mrs. Lowry seemed to understand all the steps involved. However, when I asked her to make a point each time I was coming to tell Jerry about it, she looked puzzled. "But he's just a baby, Mrs. Arthur. He wouldn't under19

The Art of Child Placement stand." I said that no one knows just how much a baby understands. We have seen two-year-olds begin talking in long sentences, which suggested that they understood a great deal before they began to talk. I told her I would like her to say to him in simple sentences, "Mrs. Arthur is coming to take Jerry bye-bye in the car. Then Jerry will come back to Mama." Mrs. Lowry agreed but looked dubious enough so that I didn't know whether she would actually help in this part of preparation for placement. I told Jerry we were going bye-bye in the car for a little ride. "We will come back to Mama," I said. He was pleased at this prospect and got into his wraps eagerly, but when we started to leave the house, he began to whine and cry. Since the snowdrifts were very high, I carried him out to the car while he sobbed all the way. Once we were settled in the car he sighed deeply; he did not cry but closed his eyes. We drove for some time without Jerry's making any sign that he was interested in anything. He merely sat quietly with his eyes closed, sighing deeply. I began to sing a nursery song, "I Love Little Pussy." Jerry gave a wan smile and moved a little closer to me. When we came to the village, we got out at the five-anddime store. At the entrance to the store Jerry trembled so violently that I had a hard time getting his mittens on. "It's all right, Jerry," I said. "We'll be going home to Mama." The trembling stopped as soon as he became interested in looking at some of the toys. I told him he could have one. After fingering several interestedly, he chose a little red truck. Jerry became quite excited at having been given the truck. He began to play actively with it, down the aisles and behind the counters. He made no response to my saying that now we should go see Mama. Finally, as I started slowly toward the door, he picked up his truck and followed me. During the ride home he seemed relaxed and happy, hugging his little truck as though it were a soft toy. When he saw the Lowry home, he gave a big grin and hurried in to show Mrs. Lowry his truck. As he waved good-by to me, I told him I would come again to take him for a ride. 20

Placement of the Very Young Child March 16. Visit to boarding home for the purpose of beginning to acquaint Jerry with the agency. (First part of recording deals with discussion with Mrs. Lowry of signs that Jerry is growing more secure, and Mrs. Arthur's evidence that he understands a great deal of what is said to him. Mrs. Arthur quite easily persuades Mrs. Lowry not to begin toilet training yet.) Jerry greeted me with a big smile today. When I said we were going bye-bye to a place where he would someday meet a new Mommy and Daddy, Jerry asked in baby talk to sit on Mrs. Lowry's lap. She held him for a while and then reached for his outdoor clothes and began to dress him. He made no protest. Mrs. Lowry carried Jerry to the car. When he saw she was not going to get in, he cried bitterly. I spoke comfortingly, saying that we would come back to the house. After we had driven a little while, Jerry settled back and began to play with the red truck I had been careful to bring along. I sang "I Love Little Pussy," which seemed to have a soothing effect on him. By the time we reached the agency Jerry appeared to be in a relaxed, good-natured frame of mind. As we arrived at the door I said, "Jerry, here is where you will some day find your new Mommy and Daddy." He looked at me questioningly, a troubled, anxious look appearing on his face. Once inside he began to wander about, looking in room after room. When Jerry seemed ready, I asked him whether he would like to go upstairs. He took my hand. In the playroom he settled down happily to play with a box of crayons. He wanted me to hold the box while he solemnly took the crayons out and put them back in again. He seemed to enjoy the small chair, the small table. When another worker walked in, he climbed quickly onto my lap and held me tightly. After a bit he wanted to explore the building some more. I followed him from room to room. When he went into the kitchen I poured him a glass of milk and gave him a cooky, which he took back to his little table to eat. The ride back to Lowry's is a long one (twelve miles). Another worker drove while I held Jerry on my lap. There was much less 21

The Art of Child Placement sighing on this trip than on the previous one. As always, Jerry brightened at the sight of the Lowry home. He greeted Mrs. Lowry excitedly and waved me a cheerful good-by. March 25. Appointment with Jerry cancelled because he was sick. April 6. Out to Lowry's to take Jerry to the doctor. Mrs. Lowry was getting Jerry into his wraps when I arrived. He gave me a puzzled look. I said, "Jerry, you and I are going for a ride to see a doctor. The doctor wants to see what a fine, healthy boy you are." He sighed deeply and followed me to the door in a dispirited fashion. Once outside, he began to sob. Because of the high snowdrifts I again carried him to the car. I said, "Jerry doesn't want to go with Mrs. Arthur, does he?" He cried harder. The sound of the motor distracted him from his grief and he began to imitate the sound. I imitated it, too. After he became quiet I sang our usual nursery song, and as always, Jerry moved up closer to me and relaxed. Jerry was pleased and interested by the downtown city sights. He particularly enjoyed the elevator ride, I tried to prepare him for the doctor's visit by saying that I would take off all his clothes so that the doctor could see what a fine, healthy boy he was. The doctor was gentle and considerate. Nevertheless Jerry cried angrily and hard until I had him dressed and we were outside the office. (A detailed doctor's report was included here.) We stopped at a store to buy a little bag of cookies, which Jerry munched in the car on the ride back to the foster home. April 9. Out to Lowry's to bring Jerry in for his psychological examination. Again we repeated much of the routine of our previous rides—singing the nursery song, imitating the motor of the car, pointing out objects along the way. Jerry was showing more signs of liking to go with me, fewer signs of fear. Today he did not cry as we left Lowry's. When we arrived at the agency, I said again, "Jerry, here is where you will someday find your new Mommy and Daddy," Jerry repeated smilingly, "Mommy, Mommy, Mommy." 22

Placement of the Very Young Child Once inside, he again explored the downstairs corridors before he was ready to follow me upstairs to the playroom. He was cooperative as I removed his wraps, and he settled down to play in the playroom where he was to have his psychological. (A detailed psychological report was included here.) On the ride back to Lowry's, I drove while another worker held him on her lap. Jerry has made real progress in relating to people. As long as he could see me, he was willing to be held by someone else. April 22. For some time my supervisor and I had been discussing the best type of home for Jerry. We felt that Jerry had shown us through his previous head-banging and head-wagging that he was a very sensitive child with a low threshold for insecurity. Because a new move would necessarily be frightening, we felt that his new environment should hold as few challenges as possible. I wanted a home with a comfortable, relaxed woman who had already had a successful experience at mothering and one in which sibling rivalry would not immediately be a challenge. We discussed our feelings with the homefinder, who suggested the McAlister family. The McAlisters have an eight-year-old daughter and have said that they did not feel that the child they accepted must be a tiny infant. April 27. Today there was a marked change in Jerry's attitude during our ride to the agency. He came with me without reluctance, happily, joyfully, clutching a big cloth dog. He was so active in the car that I had to stop four times to get him settled again. He tried to grab the windshield wipers; he got the glove compartment open and happily banged a flashlight against the ash tray; he reached for the wheel and tried to steer. He was so exuberant and happy that I had to tell him he must sit more quietly in the car. Twice I said, "No! No!" He looked at me quizzically and stopped briefly, but in a few minutes he would begin again to jump up and down. Once we had reached the agency I said again, "Jerry, here is where you will someday find your new Mommy and Daddy." He nodded knowingly and chanted, "Mommy, Mommy, Mommy." He came upstairs and settled down in the playroom to play again *3

The Art of Child Placement with the crayons and toys. After he had had a glass of milk and a cooky, we started home again. On the return trip Jerry was tired and irritable. This time he was so hard to control in the car that he fell forward and bumped his head on the dashboard. In my efforts to catch him and stop the car, we had a minor accident. As I investigated the damage done to the car, Jerry sensed my anxiety. He began to whimper fearfully and then to cry. The car was not seriously damaged and so we continued homeward. Because I was unhappy about the accident, I overlooked the importance of reassuring Jerry. It was interesting that he, sensing my withdrawal and anxiety, cuddled up close to me and kept smiling up softly from time to time saying, "Hi!" Toward the end of the drive I was less tense and better able to comfort Jerry. I told him he was a good boy and that I liked him very much. I said I liked to be with him. When I said good-by, I said, "I will come soon to take you to a place where you will meet your new Mommy and Daddy." April 50. The McAlisters were in the office to meet Jerry. (The report then gives Mrs. Arthur's interpretation to the McAlisters of Jerry's family background and history to date. Mrs. Arthur liked the McAlisters and felt they would make good parents for Jerry.) I had already brought Jerry in earlier this morning. He was playing in the playroom with another worker. The McAlisters were sitting in the conference room. I went to Jerry and asked, "Jerry, would you like to come with Mrs. Arthur and see your new Mommy and Daddy?" He went willingly. The McAlisters were obviously charmed by his beautiful coloring and his buoyancy of mood. I handed Mrs. McAlister the crayons since that was what Jerry had last been playing with. He immediately went toward her and began to play with her his wellloved game, that of taking crayons out of the box and putting them back in again. I guided the three of them back to the playroom. After I felt that Jerry was comfortable with them, I left the room. Jerry H

Placement of the Very Young Child watched me go but made no move to follow me. I came back in about fifteen minutes to find them happily playing together. Jerry had a little clown with a feathery hat. He was tickling the McAlisters with it and then tickling himself. There seemed to be a free and easy atmosphere. We all sat together for a while. It was obvious that Mr. and Mrs. McAlister were very pleased with Jerry. They mentioned his friendliness, his "nice sturdy legs," and the fact that he resembled certain members of their family. After a brief discussion it was arranged that they would return the next morning to meet Jerry at the agency and take him home. Another worker drove back to Lowry's with us. I held Jerry and talked a little about his new Mommy and Daddy. Though he seemed unduly fatigued, he retained his good humor on the long ride. May i. Out to Lowry's to bring Jerry to the agency for his adoptive placement. Mrs. Lowry had packed a little box of his favorite toys including his hobbyhorse, which he liked best. He was most attractive in a new outfit I had bought for him, and he was practically popping out of his skin with excitement. He took my hand, raced out to the car, and only on the insistence of Mrs. Lowry did he kiss her good-by. The ride to the agency was again marked by a provocative kind of teasing in the car. As we entered the agency, I said, "This is the place where your new Mommy and Daddy are. Now they will take Jerry to his new home." He entered the agency eagerly and went up to the McAlisters with a great deal of assurance and poise. They played with him while I prepared the medical report, the routine of Jerry's day as prepared by Mrs. Lowry, etc. When it was time to leave, Mr. and Mrs. McAlister gathered up some parcels one of which they gave to Jerry to carry, and started out to the car. Mr. McAlister opened the car door for him. After running up and down the boulevard a couple of times, Jerry got in the front seat, looking somewhat puzzled. Mr. and Mrs. McAlister got in beside him. Jerry gave me a quizzical look. I said, "Here are Jerry's new Mommy and Daddy. Jerry will go to a new home with them. Bye-bye, Mama. Bye-bye to Mrs. Arthur." I waved as they drove away. 25

The Art of Child Placement Observations on Mrs. Arthur's Techniques Mrs. Arthur's recording of her activities with Jerry illustrate many principles of good preparation of very young children for placement. She begins with a firm belief that Jerry can understand some of the things she is saying to him. She does not use baby talk in general, though she does often substitute proper nouns for pronouns as she says, "Jerry doesn't want to go bye-bye with Mrs. Arthur." She accepted his terms, "bye-bye" and "mama," for these were his own. She did not complicate their system of communication by creating her own baby talk. Mrs. Arthur offered Jerry two new words. She had noticed that he called the Lowrys "Mama" and "Dada." When she spoke of the McAlisters, they were "Mommy" and "Daddy." Mrs. Arthur felt on the basis of her observations that Jerry understood a good deal of what was being said by those around him. She did not know whether Jerry had any knowledge of what was happening to him in the highly specific sense that we as adults may know, but she did think that he knew almost from the first that a change was coming. At first, he fought against it. Later, he came to accept it. The whole approach she used indicates a recognition that change and strangeness are filled with pain. This was a pain that no one could really take from Jerry or have for him. He was able to experience separation from Mrs. Lowry in little, painful pieces as he went off with Mrs. Arthur on their trips. Presently, he was able to leave Mrs. Lowry without tears. The voyages were not always pure pleasure. There was the trying trip to the doctor. Mrs. Arthur permitted the strange man to frighten the baby, but afterwards she offered him the comfort of her person, her car, the reassuring bag of cookies. Jerry learned, too, through his voyages with his caseworker that strange places are not necessarily menacing. First there was the terrifying dime store. Who will ever know what association from a cloudy past brought on the violent trembling which made it hard to get the mittens on? But the frightening place yielded up a fine 26

Placement of the Very Young Child red truck and the strange woman took him back to his Mama as she had promised. Jerry had repeated pleasant experiences at the agency. At first, he approached it with some distrust. But no one forced him to it. Mrs. Arthur let him explore at will. When he was ready, she suggested going up to the playroom. There were the crayons, the milk and cooky. This was a place Jerry found in a sense for himself. No one carried him up to it and thrust him at it. Repeatedly his association with the woman and the building were comfortable. On his first visit, before he had felt the "safeness" of the place, when a stranger entered the room, Jerry was quick to grab the only familiar object—Mrs. Arthur. Several weeks later, he could comfortably meet the psychologist, later the other caseworker, and finally the McAlisters. The whole approach to the placement of Jerry underlines the belief that change is hard for babies but that if they can take it a little at a time it can be tolerable. Mrs. Arthur eased the pain of the unfamiliar at first by offering Jerry continuity and repeated ceremony in their relationship. There were variations in the patterns of their visits, but underlying all were the same social worker, the same car, the "I Love Little Pussy." Surely things which are so well known and unsurprising cannot be filled with too much danger. There is a principle of social work that Mrs. Arthur has gone to great pains to give obeisance to: "Imposed plans never succeed." How does one avoid imposing plans on babies? In this case it was partly through the innate courtesy of Mrs. Arthur's manner toward Jerry. She writes very naturally, "When Jerry seemed ready, I asked him whether he would like to go upstairs." Mrs. Arthur could not sit down with Jerry and offer him the McAlister home and give him an opportunity to refuse it. She could say, though, "This is where you will find your new Mommy and Daddy." She could let Jerry walk into the room and begin to play with the McAlisters. She could leave the room and give him an opportunity to follow her. When Jerry first saw an unknown caseworker, he climbed on 2

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The Art of Child Placement Mrs. Arthur's lap and clung to her. She permitted him this dependency and reassured him. Later, when he first saw the McAlisters, he went to them and stayed with them, allowing Mrs. Arthur to leave the room. The abridgement of Jerry's case history has minimized the casework with Mrs. Lowry in order to throw a sharp, clear light on a relationship between a baby and a social worker. Some pertinent parts, however, are left in. Mrs. Arthur found Mrs. Lowry a superb foster mother for Jerry's temporary placement. Mrs. Arthur was aware that it was while Jerry was with Mrs. Lowry that Jerry had worked through his most negative feeling against what had happened to him. He began with headbanging, and tapered off with head-wagging until he became so serene that he could go off with a social worker to a new future. Mrs. Lowry was, according to Mrs. Arthur, truly remarkable in that she could let Jerry progress at his own pace. The reason may have been that she was not too immediately caught up in his future. She knew from the first that she would lose him eventually. Mrs. Arthur kept that reality firmly before her as she took Jerry away frequently. Mrs. Lowry, like Jerry, began to experience separation in little pieces. Mrs. Lowry did Jerry a great service in letting him work out his feelings in a nonhostile, nondemanding milieu which, though warm, had the advantage of a certain detachment. The detachment was possible because the Lowrys had no vested interest in the young manhood of this boy. They wished him well, but they would not be there to be a part of his future. Some tomorrow would bring them a new baby which they could help, enjoy, let live—but not keep. This is the magic of the temporary home. It can be a great asset in preparing a child for placement. He can leave behind in it some of the old "badness," which came with him from the ugly past, when he moves into a fresh newness. While Mrs. Arthur did casework with Mrs. Lowry, a feeling of mutual respect grew up between them. It was easy for Mrs. Arthur to persuade Mrs. Lowry to postpone toilet training. Her reason for wanting training delayed grew out of her belief that 28

Placement of the Very Young Child training is a trying experience for a baby and that it should not come at a time that he is coping with another knotty experience. She knew also that the relationship to the mother-person is the primary factor in successful training. When Jerry left Mrs. Lowry, he might regress (an occurrence common among replaced children) and then his new mother would start anew with the problem—one that might be charged with a special emotional tone if it were associated in Jerry's mind with two different motherpersons. The original record shows that Mrs. Arthur called Mrs. Lowry to tell her how Jerry had taken to his new parents and about his initial adjustment. This simple act of human thoughtfulness is often overlooked by social workers. It is as though they forget that when a woman sends out a child whom she has loved, some of herself goes with him. Until she knows that he is all right, a part of her is left floating, unanchored. One foster mother told me that it had seemed as though the child had died and she had failed to provide a funeral, but that when I reminded her that he was well and happy, the process took on meaning for her. She no longer felt as though he were dead; there was no longer the anxious feeling that she "owed" him that last uncompleted service. If one should hold the case of Jerry up to the strictest standards, one might wish that the visits had come closer together. One might wish too that Jerry had had one more experience—a visit to the McAlisters' home. Mrs. Arthur agrees vigorously. But the McAlisters lived three hundred miles away. As to the spread of time between visits, Mrs. Arthur thought it would have been better if they could have been moved closer together, and she would have preferred that the whole preparation had taken longer. She said, "In social work experiences, there is something terribly telescoped in what happens to people." The telescoping of experience is not all bad. The tempo at which a child can move into placement must be delicately estimated. The temptation to move too slowly is as great as that to move too fast. There was certain evidence that Jerry was ready— his ability to leave Mrs. Lowry without crying, his acceptance 29

The Art of Child Placement first of new people in his environment and finally of the McAlisters themselves, even his provocative teasing of Mrs. Arthur. Some day, when our tools are finer, we shall be able to tell more exactly when our clients are ready. No discussion of Jerry's case history could be complete without a reference to the automobile accident. This was clearly an unknown factor that forced its way into the "laboratory experiment." I am struck by the honesty and objectivity with which Mrs. Arthur reported it. Here was the person replacing the social worker. The car was new; the grill was smashed, and the man with whose car she collided was rude. Mrs. Arthur became a worried driver rather than a social worker. Jerry almost immediately sensed the change and responded in a new manner. Up until now he had felt the even, steady tone of the professional relationship. Finding this gone, and perhaps vaguely associating it with his own naughtiness, he became flirtatious in order to win Mrs. Arthur back. She came back to him soon and, recognizing that she had threatened him, gave him rather more assurance than usual. The casework in the adoptive placement of Jerry Jones falls short of perfection. But it is nevertheless a superior professional effort. It is an excellent example of the performance of a social worker who felt that a "small" job was worth doing well. It is an honest piece of work.

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CHAPTER 2

Establishing a Relationship with the Gradester

THE child who is no longer a baby and not yet an adolescent may be a very special placement problem. Any child, of course, finds placement a trying experience. But the child in this age group has his own peculiar characteristics, and his social worker must understand them thoroughly. She needs not only to know the generalized truths about this group but also to appreciate what effects separation will bring. She needs to know those parts of placement which are especially confusing and painful and what she can do to help. She needs a knowledge of the defense mechanisms that children use in order to face their ordeals. Sound preparation for placement, the kind she worked hard to achieve with younger foster children, is still the sine qua non of her job. Following close on its heels is the need for a meaningful relationship with the child. A thoughtful look at this most helpful tool, the relationship, is the core of this examination of the grade school child in placement. WHAT ARE THESE CHILDREN LIKE?

There is no pat name for this age group of children. I have called them gradesters; Benjamin Spock has called them "the 31

The Art of Child Placement middle-aged children;" psychiatrists refer to them as "the latency group." A Mexican mother in John Steinbeck's Tortilla Flat classified the youngest among her large brood as "the creepers" and "the crawlers." One might call this group "the walkers" and "the talkers." Their advanced skills in these areas separate them sharply from the babies. In these skills lies the source of the social worker's highest hopes and greatest despair. Because they are "walkers"—perhaps "runners" would be more apt—they can move toward what they want and away from what they find distasteful. Because they can talk, and talk well, they can use their tongues to disguise true feelings which would be too painful to bear if they were recognized. They can use their tongues as weapons to cause hurt both to those who have hurt them and to those who wish them well but who awaken a memory of a parent who inflicted pain. Nevertheless, in their ability to talk lies the social worker's greatest hope. Through speech the unknown can be shorn of some of its terror; anxiety can be dissolved; bitter, brooding anger can come out instead of staying inside to sicken and fester. Through the words of children it is possible to learn the source of their pain. Through the speaking of the words, the children can become healthier. Through understanding the words of the social worker, the child can begin to accept the relationship that is the most important tool the worker has for the aid of a troubled child. The gradester at the beginning of the road between babyhood and adolescence has much of the baby about him. Shocking experiences like separation may cause some children to back up into babyhood with clinging, dependence, and loss of bladder and bowel control. Others may be pushed into adolescentlike behavior, rebelling against adults, trying ineffectually to ape them before they are ready. When separation from security forces children off the stretch of road that is normal to their age, the social worker needs to recognize clearly that they have strayed. Later, when they find their way back to where they belong, she will know that they are no longer profoundly troubled. 32

Relationships with Gradesters Writing about children in this age group, Helen Ross and Adelaide Johnson say: He [the child between six and ten] is a fairly happy, contented person at this time and he has tremendous energy to turn to learning about things around him; he is usually voracious for information. He has great need for physical activity and he seeks companionship with his own age. He has little interest in the other sex, as such, preferring to play with his own kind, with whom he is usually competitive. Grownups are important to him as providers and protectors, but what he wants most of all is acceptance by his age group . . . the period from nine to ten through twelve is a distinct phase in the life of a child, a transition from easy going, well-balanced latency period to the stormier time of the adolescent period. . . . Girls of eleven and twelve are usually more nearly ready for the boy-girl relationship than the boys. . . . Toward the end of pre-adolescence we observe in boys and girls increasing uneasiness over any display of affection from the parents. Though this is a source of pain to the parents, it is an indication of the normal onset of puberty and the child's need to defend himself against his earlier emotional attachments to the parents.1 Spock, too, has done some thoughtful writing about this period of childhood. He develops in a little more detail Ross and Johnson's theories on the child's need for group life and the pattern of this behavior: This is the age when clubs and gangs begin. A group of boys who are friendly to start with, who feel the same way about things, decide to form a club. They work like beavers electing officers, making badges, drawing up rules, deciding who will be admitted, finding a meeting place, deciding what the secret will be and how they will preserve it. It may superficially appear like a childish pastime, but if we look carefully we can see serious social impulses at work. These kids are proving to themselves that they can run a part of their own life on a cooperative basis without the supervision of adults, that they can decide who is and who is not socially acceptable, on the basis of their own codes of behavior. These codes become very strict indeed. The child who provokes 1 Helen Ross and Adelaide Johnson, A Psychiatric Interpretation of the Growth Process (New York: Family Service Association of America, 1949; pamphlet), p. 9.

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The Art of Child Placement fights unnecessarily or who uses unfair methods is frowned on, also the child who avoids a fight when fighting is the honorable course.2 Spock comments also on the child's feelings of loneliness during this time: There are at least two reasons why the child is particularly affected by loneliness during this period. First, his own unfolding emotional pattern keeps telling him that friendships are his concern; second, his nature is also succeeding in detaching him emotionally, to a degree, from the parents whose closeness to him has always provided nine-tenths of his security. Nature, one might say, expecting him to conform to the normal pattern, counts on the warmth of his outside friendships to make up for the loss of the intimate dependence on parents. But since he lacks for certain reasons the ability to become thick as thieves with his contemporaries, he finds himself in "No Man's Land."3 Secure gradesters appear to be in a period of emotional rest. They have left behind them the enormous emotional involvement typical of the littler child trying to work through a comfortable tie to his parents. They have not yet arrived at the turbulence of adolescence in which they will need with great fanfare to emancipate themselves from these previously acceptable ties. Ideally, they have accepted as suitable their relationship to their parents so that they need no longer "sweat and strain" at it. They are therefore free to look to the rest of the world of people—first people of their own age, later others—and to approach them experimentally. Tentatively they begin to play-act the business of living in the world. They begin with one friend, then add another. Here is an interesting business, "threeness" in friendships! Having mastered this complex experiment, they can move on to the more difficult and fascinating business of group or gang life. The healthy, happy gradester feels secure about his parents. He sees and accepts where he stands in relation to them. This leaves him free to turn his attention outward, away from himself and 2 Benjamin Spock, "The Middle-Aged Child," Pennsylvania Medical Journal, 50:1046 (July 1947). 3 Ibid., 1049.

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Relationships 'with Gradesters them, to the world about him. His curiosity is lively. He is serene when facing little separations, like going to camp, or visiting relatives, because he really wants to know and experience other people, other places. Braveness, curiosity, hard and industrious play are a few of the hallmarks of the secure gradester. If a placement worker is given a well-adjusted gradester to place—which rarely happens—she meets a child chronologically and emotionally better geared to uprooting than she does in the well-adjusted baby or the adolescent. Because such a child has worked through an acceptance of his role as a child who loves and is loved, because he has accepted certain restrictions, and because he is comfortable with these feelings, he can, if gently helped, transplant them successfully to a riew soil. THE EMOTIONALLY DEPRIVED GRADESTER IN PLACEMENT

Unhappily, the social worker who finds herself facing a truly secure gradester needing placement has an atypical experience. Frequently the seeds of family disease which blossomed into the need for placement were sown long ago and have operated to a greater or lesser degree all through a youngster's infancy and early childhood, so that the social worker finds herself facing a child who deviates perhaps sharply, perhaps only a little, from the secure, outgoing pattern ideally characteristic of the gradester. She will need to be aware of these deviations, what has gone into them, and what she can do to help her young client back to the part of the road where he belongs. That is the part between babyhood and adolescence, the stretch in which he feels sufficiently secure in his relationships so that he can swing along much of the time with "the kids in his own gang." Because of the emphasis in the developmental literature on group activities and the eagerness with which gradesters seek out friends, a placement worker might quite logically decide that a group setting in an institution would be best. The question of which child needs institutional rather than foster home care is a complex one which will be dealt with later. But it needs to be said now that the child's normal leaning toward groups at this 35

The Art of Child Placement stage in his development does not necessarily make group living his appropriate modus vivendi. Gradesters still need their parents. They are usually able to turn to their groups because they are secure in the knowledge that their parents are right behind them where they can reach out and touch them if need be. Take away the parents and you take away the foundation of security that frees them to relate to their own age groups. Separation from parents is a painful experience for gradesters as well as for younger children. To them it may mean a kind of punishment for badness, a demonstration of the inadequacy of their own parents, a terrible dramatization of the rejection they have long suspected and sensed. Dorothy Hutchinson has given sensitive expression to the feelings of children about separation. She writes: Under normal conditions separation of the child from a loved parent is usually a maturing experience. Growing up is growing away from home and familiar associations. In child placement, however, separation is something quite different. Here it seldom by itself means growth for a child, but usually the reverse. So humiliating and frightening is the experience to many children that they revert desperately to behavior that is no longer appropriate. It is as though this indulgence was seized on as their only insurance against the hurt. . ., . Separation is a healthy experience when the child is ready for it. The obstacle in child placement is that he is seldom ready. In the normal situation, the child has received emotional satisfactions sufficient to liberate him for new experiences with new people. His affective appetite, in some measure, is appeased. But the foster child has almost never been accorded these satisfactions so essential for his growth, neither the love and admiration of a mother and father happily married nor the assurance of their continuous presence and reliability.4 The gradester facing placement will react negatively in direct proportion to the degree of deprivation he has known in the earlier stages of his development. If a social worker were asked to place a secure, healthy gradester suddenly orphaned she would be given 4 Dorothy Hutchinson, "The Parent Child Relationship as a Factor in Child Placement," Family Journal of Social Casework, 27:47 (April 1946).

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Relationships 'with Gradesters a sharp picture of the meaning of separation as an isolated entity. She would find in this child a kind of "pure" pain not confused by questions of the worth of himself and his family. He would be wounded, but with a reasonably adequate set of foster parents his wound would heal cleanly and quickly. Soon he would be back with his own age group playing hard, vigorously sampling the exciting business of getting ready to grow up. You would not expect him to stay very far away from the typical behavior pattern of other children of his age who were developing normally. There would soon be a marked resemblanc between his relationship to his foster parents and that which he had formerly had to his own parents. The phenomenon is a little like that of a healthy child who is physically injured or who gets a disease. All the good health of his past marshals its forces to bring about his recovery. The well-adjusted orphan can profit to a degree by the help of a social worker in placement. But he does not begin to need her as much as the deprived child does. The deprived child approaches the crisis of placement without a backlog of psychological good health. When he reaches into the past for nourishment and security to see him through this emergency, he finds only a profound psychological deficiency. He approaches the need for sudden strength with psychological rickets, scurvy, and beri-beri. There is no inculcated strength on which he can draw. He is asked to give up what he never has had. He is expected to develop a relationship to new parents when he has not learned from his own parents what this relationship should be. His confusion is pathetic. Perhaps in his mind's eye he has always dreamed of the very thing his social worker is offering him—a nice home, loving, parents, respectability. (In the mind of the gradester respectability and conformity are completely intertwined. They mean his chance to be "like other kids.") But, when faced with this gift he has always wanted, he does not know how to accept it. How can a child react with trust toward adults when adults have always let him down? How can he accept a gift when gifts have never been 37

The Art of Child Placement freely given in his past? "There's a catch to this," he says to himself. Or, as one thirteen-year-old looking back on her placement of a few years ago said, "I wondered what kind of clip joint this [the children's agency] was." The response of the deprived child faced with an offer of placement is one of suspicion, confusion, and pain. He reacts with negativism, with defense mechanisms, in ways which are inappropriate to his situation. In a sense, he is out of touch with his reality. Neither he nor his foster parents nor his teachers nor his own parents can understand why he acts as he does. If he is asked "why," his confusion is aggravated. He gives strange answers and comes to believe them himself. His foster mother, gentle and troubled, asks, "Johnny, why did you hit our baby?" He hesitates. She presses for an answer. He says, "I hit her because she was crying and noisy, because her nose was running, because I hate babies." Johnny cannot say, "I hit her because I'm sure you love her. I hit her because she is having all those things I never had. I hit her because she is your own child and I'm just a boarding child." The naive social worker may carefully dictate into her record, "Johnny hates babies. Perhaps he should be moved to a home where there are no babies." Among the many problems that the deprived gradester in placement has to cope with is the horde of well-intentioned adults who keep saying, "Tell me why?" It's a little like seriously requiring a six-year-old to give you the sum of 97 and 48. Adults expect answers. After all, gradesters can talk. The child is asked an impossibly difficult question. Desperately he will give some answer—a twisted, queer little answer, feeling confused and inadequate as he does it. Pathetically he will come to believe his silly little answer and may come to act as though it were true. This is one reason why children need trained, skilled social workers. If the implications of placement were not so threatening, if children responded in a simple, straightforward, logical way, foster parents and a group of well-intentioned volunteers could run the placement program in America. 38

Relationships with Gradesters But deprived children facing terrifying experiences get jerked off the normal road to healthy adulthood. They have to respond defensively in ununderstandable ways. Their devaluation of themselves and their parents strongly influences their total adjustment. A score of twisted mechanisms hides the potentially healthy child that lies within each young body. A gradester in placement needs his social worker. She can offer him and those around him the understanding which is the main step toward acceptance. She can, through her relationship, help him give up his twisted mechanisms. She can help him to speak the words and do the acts that will heal his wounds. But she cannot help him unless she can understand what is happening to him. THE TRIANGLE OF PLACEMENT

Describing the role of the placement worker, Inez Baker has said, "The worker represents, the link between the foster family unit and the natural parents, and is the balance wheel for the unique triangle of parents, child, and foster parents. The casework role is one of helping the child find and maintain his relationships within the triangle, to the end that he may develop normally. When the unhappiness of any member of the triangle threatens the balance of any other, the potentialities of the placement as a growing experience for the child are also threatened. Hence the worker must be sensitive to the needs and the concerns of all members."6 For a worker to maintain her position in relation to three sets of clients—the foster parents, the own parents, the children—a very high skill is required at times. It is not easy to talk about the social worker's job in relation to any one set of clients without becoming involved with another. Singling out parts of the many-faceted business of child placement for scrutiny is difficult. Whoever tries to pull the problem together is faced by the fact that placement is an unwieldy sort of something to take hold of and explain. Approach it as a unit, and you find that it has twenty or more angles to it. Try to pluck out 5

Inez M. Baker, "The Caseworker Helps the Child Use Boarding Home Experience," Child Welfare, 28:4 (May 1950).

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The Art of Child Placement one angle to examine and you find that angle inextricably interwoven with four others. When a child placement worker tries to integrate the various forces in her triangle and keep them in careful balance, she realizes that a knowledge of child psychology—important as that is—is not enough. She goes back to her generic training in social work to help the parents and foster parents. The child welfare worker is more than a children's specialist. Her skill and specialization, which grow constantly with every thoughtful placement she makes, are in the area of separation and union as they affect adults and children in relation to each other. A social worker explaining her role to a nine-year-old was trying to show him that she stood in the middle. The child, his mother, and his foster mother would all talk with her, she said. She would try to help them to understand each other in a way like—she groped for words. He spoke up sagely, "Like a mechanic who goes around squirting oil here and there, wherever the parts start to rub." This is an oversimplification, but it is important to realize that this is how we may appear to the children with whom we work and perhaps to the interested adults around them. Squirting the oil of casework is a high art. It is needed in all placement situations. No social worker can expect success if she ignores one corner of her triangle. Whenever own parents, foster parents, and a child are concerned with a placement situation, a highly skilled social worker with an ability to focus individually on the parts of the whole is needed. THE CHILD'S TIE TO HIS OWN PARENTS The child's tie to his own parents is the number one problem of placement. It may make placement an impossible way of living for the child. A guilt-filled mother who half gives up her child and half holds onto him, who expresses her ambivalence toward her responsibility by blowing hot and cold, brings to the agency a thoroughly confused, anxious child. Such a child may neither have nor give up his mother; such a child can neither totally accept nor reject substitute parents. 40

Relationships 'with Gradesters The literature of the field puts enormous emphasis on the intake interview with parents and children. It is impossible to stress sufficiently the full importance of the first steps, because they often have within them the seeds of failure or success for months and years to come. An all too common error is to take children from their parents before the children are prepared for placement. The result can be that it will seem to the child that a force outside the control of his parent or himself imposed this monstrous plan upon them. Surely he and they were blameless. The obvious "force" on whom to blame the separation is the social worker and the agency. The child begins his placement with hostility against his worker. As social workers have sharpened their techniques, a pattern has grown up in which, whenever possible, it is the parent who plans and interprets the placement. The social worker thus becomes the agent who carries out the plan made by the parent because the parent has asked this service of her. Jessie Taft wrote in 1940 that the idea that "the parent must initiate and be responsible for accepting and actually taking the steps in the placement process in order to give the agency a sound basis for placing the child is a new concept in child care. In this view, the movement toward placement starts with the parent who applies to an agency for help in making a plan for his child. The agency enters into an exploratory process with him so that he may move step by step, if this is possible at all, into the beginning experience of giving his child into care and relinquishing to a foster home many of the responsibilities that he has previously carried."6 As the child sees his parent taking these steps, he comes to understand that this is the parental plan. The worker should coordinate her work with the child so that he, too, can take some of the steps in placement as his mother moves toward it. Many of the rules for preparing much smaller children for placement hold in work with gradesters. The more the plan can be part of his • Jessie Taft, "Foster Care for Children," Annals of the American Academy of Political and Social Science, November 1940, p. 180. 41

The Art of Child Placement own doing, the less it has in it of "something done to him," the better the chances for success. Situations that arise in child protection sometimes make the cooperation of the parents virtually impossible to get. At these times the social worker will need to give more of herself to her child than in situations where she is clearly acting as the agent for his parent. She may not allow the child to suffer in silence, because to leave unpleasant facts unsaid will mean the child is alone and unsupported when he needs her most. She then makes herself into another ineffectual, nonunderstanding adult. She denies the child help with his suffering, the giving of which is her raison d'etre. Dorothy Hutchinson writes, "To avoid talking with a child about his problems is to deny them. Although at first the child may be unable to discuss these troubles of his own accord, it is reassuring to have a worker talk to him in a realistic, matter-offact, and accepting manner. . . . To leave the child alone with his feelings about what has taken place or to avoid them by just building up a rosy future is to miss the child's real suffering and to lose out on a critical opportunity for forestalling the dangers of denial, fantasy and repression."7 It is early in his placement that a child's feelings about his parents are most accessible to his worker. If she neglects to help him speak of these emotions, if she permits them through silence born of delicacy to become repressed, she will have done him a great disservice. Years later a psychiatrist may have to work hard to bring out what the child was feeling about his parents at the time of placement. If the child's attitude toward his parents is characterized by shame, guilt, ambivalence, or confusion at the time of placement, the placement begins with one important strike against it. OTHER PROBLEMS OF CHILDREN IN PLACEMENT

In the preceding chapter, I suggested that the social worker try, through empathy, to visualize what sudden change means to a 7 Dorothy Hutchinson, "The Request for Placement Has Meaning," Family, 25:130 (June 1944).

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Relationships 'with Gradesters baby. Social workers should make a conscious effort to empathize whenever they are trying to help children through difficult situations. The enormous and terrifying changes that go with placement can easily become almost commonplace to a placement worker with a large caseload unless she stops to empathize. I start such a process with a thought of what uprooting means to adults. Most of us have never experienced a real uprooting. Usually we have taken our families with us when we have moved to strange new settings. As adults we approach change with varying degrees of serenity, depending on our basic security and our appetite for adventure. A great deal depends, too, on whether we are leaving behind some things which have been unsatisfactory. Today we could learn about imposed changes by talking with displaced persons. We have seen their haunted faces in newspaper photographs. We cannot look at them without feeling ashamed that we have so much security and they so little. But seemingly similar experiences are never really similar. Even though one could magically create identical situations, if different individuals experienced them it would not be the same. Still, there are common elements that we can guess and feel. Think for a moment what it would mean to you if you were a gradester in placement. This is not too difficult, for conscious memories carry most of us back into this age period. First, there is the monstrous experience of realizing that your mother and father no longer have a place for you in their lives. All the negative things you have thought and felt about them flash back. Surely they could have taken no more terrible revenge. You have been banished. Or perhaps it is not revenge. Perhaps it is you and your badness that makes it quite impossible that your own parents can continue to live with you. (It is better to think this than that they are bad.) You are to be sent to live with strangers. The terror of the unknown wells up in you. It's better not to think about it. But you must think about it. Day after tomorrow it will happen. The 43

The Art of Child Placement social worker will come. Your things will go into her car. Your parents will talk about the weather, and do you have enough socks, but they will not look at you. And then you will leave. You leave your house, your bed, the kid next door, the school you always went to. You will visit your parents, they have said. Imagine, visiting your own parents. Like a stranger who doesn't belong. Of course, you don't belong. This business makes it all pretty clear. You act brave. You aren't sure whom you're trying to fool— yourself, you guess. And then the social worker says a surprising thing when you are alone in the car with her. She says, "It's hard, terribly hard, isn't it?" For the first time you look up straight at her. The look on her face shows that she really knows. It's funny, the way she is the only one. She says, "It's all right to cry." You know she means it and you do cry and it's still terrifying, but part of the awful feeling of fullness in your stomach, your throat, your cheeks is gone. You begin to think now less about what you have left behind and more about what you are going to. The social worker will answer your questions. Somehow you cannot ask her what you really need to know. You cannot say, "Will they beat me?" Instead you ask lamely, "Is the house big?" But as she talks you realize that she has tried to find people who will not be too hard on you. You recognize that there's something different about her from most people. "She's on my side," you think with surprise. You ask her, "When will you come back?" She smiles and tells you just exactly when, and you feel a little safer. By "feeling through" such a situation, almost any adult can come to a better understanding of the terrors which a child in placement feels. Placement holds many specific problems, all of which grow out of the initial problems of separation and change. The new home has standards that are necessarily different from the standards of the home from which the child came. If they are too strikingly different, they may be the more terrifying. 44

Relationships with Gradesters The child gets the feeling that the privileges which the new home offers him are his only if he behaves. He feels that he is in his foster home on "sufferance." At any moment he may be asked to leave, especially if he does the wrong thing. He may have to prove this suspicion to himself by testing the foster parents. If they're going to throw him out the first time he drops his "company manners," he'd better find out right away and get it over with. Are these people really wanting a boy like him, or would they chuck him out the door if he broke that silly blue vase the woman is so proud of? And how will they feel about his parents when they come to visit? His mother looks pretty messy next to this woman. Will they see that she is really even prettier? And what's all this about always having wanted a boy like him? Don't they know that he's not for sale? He's got parents—he has got parents! There's no way to list the myriad of problems faced by a child in placement. But the basis for the problems is easy to locate. Most children in placement are rejected children. They have faced separation, which was frightening. They are being asked to change themselves, which is dangerous and humiliating. Rejection, separation, and change—these are the bedfellows of the child in placement. Is it any wonder that he wets his bed, cries out in his sleep, wakens looking dragged out? THE RELATIONSHIP—THE CASEWORKER'S WAY OF HELPING

The child's relationship to his caseworker normally begins at the point at which he meets her. I say "normally," because he may already have experienced conditioning factors that will alter his "set" toward her. These may have been remarks of his parents, who have already met her, or biases positive and negative about "welfare workers" picked up from neighbors or schoolmates, or other preconceived impressions received from movies he has seen or stories he has read. The usefulness of the relationship begins at the point at which the child begins to sense that the worker is a truly different kind of adult. When he senses further that she is trustworthy, under45

The Art of Child Placement standing, and eager for his happiness, and that the difference which he feels but could not describe in her is something he likes, a truly helpful relationship has begun. Her differentness means more to the child because of its contrast to the sameness of other adults. So far his contacts with other adults have been with people who represent, in varying degrees, authority—his parents, his teachers, perhaps the neighborhood cop. Even mothers of friends and neighbors into whose yard he wanders have a certain authority about them implicit in their relationship to a child. The successes of these other adults at understanding youngsters' feelings vary widely. Mothers and fathers seem to try especially in times of stress to understand. They try by great and often somewhat stubborn effort to draw the answers out of their children. "Why do you hate school?" "What made you think you could help yourself to the money in the sugar bowl?" "How much candy and pop did you eat that now makes you sick?" The angry, anxious faces trying to understand press upon the guilty child. He begins to have his most uncomfortable time with adults when they are trying to understand. He cannot appreciate that they are anxious and hostile because they have an enormous stake in his behavior. He cannot know that his failures are all intertwined with their feelings about themselves. Probably he has also known times when they sought his reasons more gently, but the chances are that he didn't like that either. Perhaps they found him crying in bed. They were gentle and sympathetic then, but still they asked him to tell them 'why. To put his lonely, nebulous feelings into words is often too difficult. This probing for explanations, whether angrily or gently, is one thing the gradester has come to expect of the adults around him. Another is their way of talking. Mostly they haven't talked to him in just the same way they talk to each other. Mostly a few words to him have sufficed. His mother does not sit and gossip with him for a whole hour the way she does with his father, the neighbors, her friends. If the teacher "keeps him after school," a fifteen-minute discussion constitutes a very long .conversation. 46

Relationships 'with Gradesters It seems as though most adults have little to say to children—a few commands, a few questions, some lectures, a spontaneous laugh at their jokes or mistakes, but no long talk for the comforting pleasure that can lie in talk. Sometimes it seems to the child that he doesn't like talk just for talk's sake, and he wonders at the muffled voices that bumble deep into the night as he lies awake in his bed. Time and talk are given by adults to children in sparing, necessary pieces. Talk involves, "You do this!" "I'm going to do that!" or, "Don't you ever do that again, young man!" This is true unless the adult is a "nagger." In that case she merely repeats her same brief theme with the kind of monotony that drives the child to shut her words out of his consciousness. The gradester has already begun to learn, too, that there is give and take in relationships. He has learned it first from his contemporaries. It is beginning to appear in his relationship to adults. "Johnny, run to the store and get a loaf of bread. While you're gone I'll make you a nice, cool drink." Or, "We could begin to think about a bicycle for you, if we thought you could get home on time for supper each night." Before a social worker knows how to be different to a child, she has to know how other adults have a sameness about them. To a gradester, adults are people of authority primarily interested in talking with each other. There is warmth and coldness in them. They are nice if the child is nice; if he is not, they are angry and punishing. There is give and take in the relationship. They expect things of him—good behavior, conformity, doing things for himself and for them that weren't expected when he was littler. They are somewhat interested in how he feels about things, but this interest has a brief attention span. And they look to him for answers that are hard to give. None of these characteristics seem to fit the social worker who is trying to establish a relationship. She is, or should seem to be, in no hurry. (If a social worker communicates her pressures and busyness to a youngster at the point of establishing a relationship, he will feel rejected.) She will chat with a child at great length. 47

The An of Child Placement Each thing he says interests her. If he chooses to be silent, she can be comfortable being silent with him. She never says things like, "Come on, I haven't got all day." She may say, "We have an hour to spend together. See—that means until the minute hand gets all the way around to here." Setting time limits is acceptable. Rushing a child to speak so that one can get on to other business is destructive. Probably the most interesting thing to the child about the social worker is that she doesn't try to pull answers out of him but seems nevertheless to understand what he is thinking. It's surprising when she says, "You don't like to think about leaving home, I know." Her face is gentle, kindly. She encourages him to talk about his feelings, but doesn't say, "Tell me why." She doesn't exactly tell him why either, but it feels a little as though she has. She helps him to say what he is feeling, and somehow it is easier because miraculously she seems to know before he says it. In expressing his feelings he comes with sharp surprise to a most unadultlike quality in her. If he dares early in his relationship to mention ugly, hateful feelings, it seems to be all right with her. Instead of "What a nasty idea for a little boy to have about his own mother!" he hears, "It make you feel angry and hurt when your mother does these things." Among the emotionally underprivileged children needing placement, few have ever met an adult, have ever dreamed that one existed, who was like this. Bad thoughts—ugly, angry, hostile thoughts—have been "shushed" in children from the time they could speak. Here in the social worker the child finds an adult who encourages him to bring his black thoughts out. She seems neither to condone nor deny them. She accepts with him the fact that they exist and that it is all right to talk about them. This is surprising and intriguing to most children. But what is truly astonishing is that if the child's black thoughts should turn to her, if an angry word against her should slip out, she does not become angry. Actually, she helps him say these words. She may say, "You are really angry with me today. You feel that I'm the one who is going to take you away from home, don't you?" 48

Relationships with Gradesters He begins to feel excited about telling her his feelings. He notices also that even when she is aware that he has done something bad, she never lectures. She helps him talk about his feelings about the bad thing, but does not punish, or tell him not to do it again. Nor does she seem to like him less. He begins to know that here is a truly remarkable and predictable adult. If she makes a promise, she will keep it no matter what. If he talks mean or acts bad, she will still like him. He feels as though she feels that he's important. She listens more thoughtfully than anyone ever has. She can understand how a boy feels about his problems. She wants to help. As time goes by and she passes his tests, he comes to know that she is on his side, that she will "stay by him." With a full understanding that the social worker is a truly different kind of adult comes the beginning of the helpfulness of the relationship. With some children it comes much more slowly than with others. Probably the ease with which it comes is directly related to the kind and quality of his previous relationships with other adults. Sadly, it must be admitted that there are children so damaged that they can never form a relationship to any adult. But to give up trying is like deciding before one is absolutely certain that a child has an incurable disease. Ideally, a social worker should not begin to move into placement with a child until he has achieved a relationship with her. Practically, she may at times find herself in the very act of moving a child before she has had an opportunity to work with him long enough. A child placement worker should resist, in every professional way she knows, being pushed into a series of emergency placements. If a child has been in a bad setting for months and years, no matter how bad it is, the "emergency" necessitating his removal before a relationship is begun actually does not exist. It is better to leave him where he is, however unpleasant that may be, until he is ready for the move. If, however, she does find herself meeting a child who needs placement immediately, the very act of placement is pregnant with opportunities for the beginning of a relationship. The child recog-

49

The Art of Child Placement nizes the social worker as the person who will stand between his past and his future. She knows the home from which he came and the home to which he is going. She will be there to help him bring together his feelings about the two. Anette Garrett describes the caseworker's role as "a delicate one in relation to the child. . . . She often becomes a liaison person attempting to keep the reality factors under control. She is the one person who sees the situation as a whole and attempts to keep the balance between rivalries and anxieties of relatives, child, and foster parents. . . . Particularly when there is no plan of adoption and when the permanence of a placement is uncertain, the agency worker may legitimately become the one secure bulwark in the child's uncertain life, the one person who always stands back of him, attempts to understand him and provide security for him."8 The child going into placement needs by his side a worker in whom he has confidence. He continues to need her long after placement has been achieved. Dorothy Hutchinson, speaking informally to a group of placement workers in 1950 of a child in a foster home, pointed out an episode in the record in which the child through his actions showed his acceptance of his foster home as his true home. She said, "Now he's really placed. He was just living at this house for the first six months." The child especially needs his worker at frequent, regular intervals that he can count on until he is "really placed." Until that time he carries hurt, angry feelings that need to be helped to come out. Esther Brandzel writes, "The child expresses only little bits of emotion at a time, and will bring up only part of his feelings at any one time. By being on the scene frequently, she [the caseworker] helps the child to express as much as possible of his negative feelings about placement, about her, and about the parents, and she lets him feel the agency at least will take care of him even if he is angry."9 8 Anette Garrett, Casework Treatment of a Child (New York: Family Welfare Association of America, 1949; pamphlet), p. 20. 9 Esther S. Brandzel, An Experimental Use of the Temporary Home (New York: Child Welfare League of America, 1946; pamphlet), p. 19.

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Relationships 'with Gradesters Many writers in the field are quick to point out that the caseworker should not be fooled by the "company manners period" of what appears initially to be a good adjustment. It is usually a few weeks or even months before the child in placement begins to dare to act out in the foster home. It is then that both he and the foster parents particularly need their social worker. It is then also that the child's repressed feelings are closest to the surface and most easy to get at. It is hard to overemphasize that the child needs his worker intensively and frequently until he is "really placed." It is helpful if the child's appointment times can be scheduled in a regular pattern—for example, at four o'clock every Wednesday. Then, if problems arise, he can say to himself, "I need wait only until Wednesday to talk to Miss Thompson about this." From Wednesday to Wednesday the child can plan his interviews, and progress will often come more smoothly than in the unplanned, unscheduled interviews. Wednesdays may come to be little islands of security in a frightening new life. After the child is "really placed," he will still need his worker, though not as frequently. With a child making a serene, happy adjustment—one who seems to have worked out his major conflicts concerning separation from his parents—interviews could be scheduled at one-month intervals, and in the best examples of successful placements even at three-month intervals. But it is my firm belief that because of the triangle aspects of placement and the unnatural experience of uprooting that every child in placement experiences and re-experiences, he should have access to his worker until he is adopted, returned home, or emancipated as a young adult. EXCERPTS FROM THREE CASE HISTORIES

To try to isolate the essence of a relationship is no mean task. It may be possible to catch it in a framework of words and say, "There! That's what it is!" But it is more understandable if it can be seen as a working, functioning thing. That is the purpose of the excerpts from three case histories 5'

The Art of Child Placement which follow. They show graphically three quite different gradesters in placement. In each the worker and the child are engaged either in forming relationships or in putting relationships to productive work. Many of the problems already discussed—the child's slow acceptance of a worker, his struggle to understand the worker's role, the worker standing behind the child regardless of his behavior, and others—are shown more sharply than many thousands of words of generalities could bring out. The excerpts are included as pictures might have been used in another sort of book. The problems the children present are interesting, as are the techniques their workers employ. The recordings are presented without critical evaluations. Each reader will find himself making his own. Ralph BACKGROUND NOTE

Ralph is a troubled ten-year-old—aggressive, instinct-driven, and full of sharp, mostly unverbalized feelings that his mother rejects him. Because of his behavior and because his mother cannot accept the lack of status implicit for her in foster home placement, he has been placed in an institutional setting. Ralph has recently made sexual overtures to .several of the girls in the institution. His new worker, Mr. Roberts, feels that Ralph needs help in accepting transfer from his former worker, and also that Ralph needs help in his feelings about sex. Mr. Roberts has access to consultation with a psychiatrist. TWO INTERVIEWS

April 28. This was the day that Ralph and I planned to "explore" the capitol. When I stopped for him, I found he was having difficulty with Miss Jones, the counselor. He wanted to go without a sweater but Miss Jones said he had to wear one or else wear his heavy coat. I said we could not go until Miss Jones said we were ready. He became very upset, arguing with everyone in the home, but he finally did put on his sweater. After our shopping we went into a restaurant. Ralph conducted himself very well at first, but soon began spilling water on the 52

Relationships 'with Gradesters tablecloth and chairs. I said he was wondering if I was going to allow him to spill water like this. He said, "Yes!" and continued to do it. I said firmly that he would have to stop spilling the water and wipe it up. I took the glass of water away, gave him some napkins, and helped him. For a while he ate nicely, but after a bit he began spilling his food. I said that I knew that ordinarily he could eat better than that. He agreed and there was no further difficulty with his eating. After we finished our lunch, Ralph and I went to the state capitol. During this period and on the way home Ralph posed several questions about my function. This discussion was spread over a period of an hour and a half. Ralph would interrupt the discussion by various means, but would bring us back to the same subject later on. He began by asking where my office was. Was it in the same place as Miss Line's? (Miss Line was Ralph's last social worker who had left a month earlier.) He wondered where Miss Line had gone and whether she had gone for good and would ever be able to come back. He wondered whether she was still on the earth or had gone to Heaven. He asked what social workers were supposed to do. I explained that I was interested in helping him become happy. I knew that since he had left his mother he had been unhappy and in difficulties. "How come you know so much about me?" he asked belligerently. I explained that Miss Line had told me a great deal about his problems and troubles and that she had also left me a long written note telling about him. He wondered why I had to know all this and why Miss Line had to tell "everything she knew." I commented that maybe he did not want me to know about him. He did not answer so I asked whether he thought I would not like him so well if I knew all about his difficulties. He said Yes to that. Later he began to question how soon I would be leaving. I said I would be leaving sometime, but I would tell him three or four weeks in advance. I also added that I would bring his new worker before I left so that he would get to know her ahead of time. He asked who his new worker would be, and said he thought he 53

The Art of Child Placement would like a woman worker best. He then returned to questioning about how long I would see him and needed reassurance that I would not leave suddenly. Ralph again expressed considerable resentment that the workers and counselors knew all about him. He added that it was Miss Line and Miss Jones whom he did not want knowing about him. This indicated to me that he feels rejected because of his behavior. Although Ralph did not express any hostility toward Miss Line because of her leaving, I sensed that he did feel rejected, and that her sudden withdrawal seemed to him a desertion because of his "badness." I think he was wondering whether he should allow himself to become involved with me if I, too, were to leave suddenly. I feel that when I leave I must be careful to tell him several weeks prior to my going, so that I will be there to handle any feelings of rejection he may have because I had to leave. May 4. Ralph greeted me enthusiastically and wanted me to come with him to his room. I gave him the clay I had brought with me. After he had changed his clothes, he wondered what to do with the clay. He threw it at me rather hard as if he wanted to hit me with it. When I failed to catch it, he said I was rather slow. I said that he could not throw clay at me, and suggested he make something from it. He was unable to do anything with the clay so I made a crude person with body, head, legs, and arms. He then, rather enthusiastically, said he had an idea, and he used the rest of the clay to throw at the model which he named "the man." For the next twenty minutes he mutilated the model which I had made and another which I had formed when he hau totally disfigured the first. He said he was destroying the man. He liked to destroy things, he explained. After saying this, he pounded the figure with his fist and crushed it with his fingers. After Ralph finished playing with "the man," he made the clay into a blocklike shape and jumped on it and battered it. Next he formed it into a doughnut shape and wondered whether I knew what it was. When I asked him what it was, he said that anyone could tell it was a doughnut. He put the "doughnut" to his mouth and stuck his tongue in the hole.

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Relationships 'with Gradesters Ralph said he no longer wanted to play with the clay but wanted to go to the store to buy a comic book. I said that we could go to the store on my way to the streetcar when we were through talking. This was agreeable with him, but he did not know what to do next. I suggested he might like to draw. He thought that was a good idea. He rather deliberately and patiently drew a picture resembling a woman's breast. I asked him if he were interested in talking about the picture, and he said Yes. I said I felt that perhaps he was interested in finding out about the difference between boys and girls and he said, enthusiastically, Yes! When he used one of the more vulgar expressions to refer to the genitals, I interjected the more acceptable term, explaining that we were talking about the same thing. He used his own terms freely, however. During the first part of the discussion I focused my talk upon the development of the baby in the mother. Ralph expressed some feeling about discussing this because it was "dirty." I assured him it was all right for us to discuss this because I knew he was interested in the subject and needed to know about it. He wondered why boys were different from girls and whether boys could have babies. Ralph, who had been very attentive, suddenly said, "I'm going crazy talking about this." He asked whether it was not sinful and whether we should not die from it. I recognized that this strong anxiety came from some previous discussion with someone, possibly one of the youngsters at the home. It might have been in connection with his intimacy with one of the girls in the home. I said, "No, we will not die from talking about sex and the differences between boys and girls." He asked next about the functional purpose of the boy's penis and the part boys played in having babies. I thought that Ralph himself was aware of the sex act by the manner in which he worded his question. I handled the matter by explaining the process of fertilization. Ralph was well aware of copulation and wondered what it was usually called. I said that usually I used the word "intercourse," and he said he knew another word, which he gave. He wondered, 55

The Art of Child Placement using a more vulgar term, whether it was wrong for a boy to have intercourse with a girl. I said that sometimes boys and girls want to find out about one another, and wondered whether he felt it was wrong. He did not feel it would be wrong if the girl were willing. Ralph went on to tell about a girl who lived in the home with whom most of the boys had had sexual relationships. (This was almost certainly fanciful. There may have been some sex play but certainly not what Ralph was claiming.) He told of several girls with whom he had had sex play relationships. He again questioned whether it was sinful and whether he would die from it. I reassured him he would not, and described the normal social process of a boy and girl deciding upon marriage, telling him that after they were married they then planned on having children and having sexual intercourse. He wondered whether they had fun and I assured him it was natural for a man and his wife to have intercourse and to enjoy it. He asked why I did not have a sexual relationship with one of the women counselors in the home, and I explained that I did not do so because I was not the husband of this woman. Ralph speculated as to whether he would marry. He decided he did not want to because it was dirty. He then reconsidered and thought he might because there was a girl living in the next block whom he thought he would like to marry. Ralph turned the discussion to his sister. He said he did not know at first that she was his sister but felt she belonged to a neighbor. He wanted to kill her to get rid of her. He explained that she was born when he was only four and he did not feel she belonged to his mother. He changed the subject abruptly, saying that he was going to go home in three weeks. He was going to help his mother fix up her house so he could go back. He did not like it at the home and was not going to stay. When Ralph indicated his willingness to interrupt the interview, I said the time was about up. On the way downstairs he asked me to tell the other counselors what we had talked about.

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