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SOME FACTORS ASSOCIATED WITH CONTINUANCE IN COUNSELING
AT FAMILY SERVICE AGENCY OF GENESEE COUNTY IN 1963

by

Janet Grace Cook

“J'-

In Partial Fulfillment of
Requirements for Master of Social Work Degree
Michigan State University

East Lansing, Michigan f
4"

4-“ ‘4m- .'

Joseph Heffernan, May 1964 ).Q.
Assistant Professor 3

 

:1—

4 ‘C {I

I’ .
r

\g

I1'03

TABLE OF CONTENTS

I. Introduction .
Purpose and Background . . . . . . .

Statement of the Problem.
Reason for the Study. . . . . . .
Background of the Problem . . . .

Survey of the Literature . . . .
The Study Focus. . . . . . . . . .

II. Methods of the Study . . . . . . . .

Collection and Analysis of Data. .
Definition of the Study Groups . . . .
The Sampling Method. . . . . . . . . .

III. Results of the Study . .

Factors Significantly Related. . . .

Table 1: Previous Contact at
Family Service Agency .

Table 2: Case Split Between
Two Workers . . . . . .

Table 3: Number in Counseling
From Same Family. . . . . .

Factors Not Significantly Related. . .

Table 4: Family Income.

Table 5: Education.

Table 6: Occupation .

Table 7: Age.

Table 8 Sex. . . . . . . . . .
Table 9: Marital Status . . . . .

Table 10: Chief Concern .

Table 11: Source of Referral.
Table 12: Number of Children. . .

IV. Discussion of the Findings . . . . . . . .

Previous Contact . . . . . . . .
Number in Counseling . . . . . . .

Case Split. . . . . . . . . . .

ii

4-\ DJI-‘H

10

l3

13
15
15

l8

l8

l8

19

20

22

22
23
24
25

26
26
27
28
29
3O

3O
32
35

{fflb-v’
i I ’

 

 

 

Conclusion .
Appendix .

Bibliography .

iii

41

42

45

CHAPTER I
INTRODUCTION

Purpose and Background

The problem upon which this research project was based was that
of the premature discontinuance by some clients of counseling service,
when it seemed that they were really in need of this service. The
purpose of this study was to determine which of a certain set of
twelve factors were significantly related to continuance in counseling
at Family Service Agency of Genesee County in 1963. The factors studied
included family income, education, occupation, age, sex, marital status,
client's statement of chief concern, source of referral, number of
family members in counseling, whether case was split between two
workers, previous contact at Family Service Agency, and number of
children at home. It was a comparative study, comparing those who
discontinued counseling after at least six interviews, with those who
dropped out after two to five, and with those who terminated counseling
after the initial interview.

Family Service Agency statistics indicate that many who come
once to the agency do not return for further interviews.1 In 1963,
of 833 families who had at least one interview, only fifty-three per

cent (443) continued beyond the initial interview, and only nineteen

 

1Family Service Agency of Genesee County, “1963 Casework Figures"
(hand-written statistical record in file).

_ 1 _

- 2 -
per cent (157) continued in counseling for six or more interviews.
This is not simply a local agency problem, however, as national
Family Service statistics indicated similarly that, in the previous
year, only fifty-four per cent (70,368) of 130,000 families interviewed
continued beyond that first interview and no more than twenty-four
per cent‘(3l,268) came in for at least six interviews.2

This poses a question as to whether the service was completed
in this brief period or whether there were factors which prevented
the clients from further utilizing the service. As only occasionally
could the service be completed in one interview, this writer feels
that it is important for social workers to be aware of factors that
may prevent the client from utilizing the counseling service and of
factors that may promote their using it. While these factors may be
both client-centered and social worker-and/or agency-centered, this
study assessed the level of association between twelve client-
centered factors and continuance in counseling.

Therefore, the reason for this study was to attempt to identify
factors significantly related to continuance in counseling, and thereby
aid social workers in gearing their approach to clients in such a way
that all these factors can be taken into consideration and the needs
of clients better be met. The writer also wished to rule out any of
the factors that are not significantly related.

The author's personal interest in this study stems from her
Second Year Field Work placement at Family Service Agency of Genesee

County.

 

2Family Service Agency of Genesee County, "1962 Casework Figures”
1963 (typewritten).

_ 3 -

There is a growing concern in the social work profession
regarding the high percentage of clients who discontinue casework
counseling after the first interview. The literature regarding this
problem has stated the growing need for individual agencies to
analyze their own casework services to learn more about possible
factors contributing to discontinuance of casework counseling after
the initial interview.

This particular problem became of interest to the writer through
several channels: casework class lectures and assigned readings by
Perlman,3 Stark,4 Shyne,5 and Pfouts and Rader6 on the intake process
in casework and the difficulty in maintaining clients beyond the initial
interview; through reading the statistical report on Family Service
Agency and Family Service Association of America previously mentioned;

7 and Catherine

through reading the student theses of Ruth Buckner
Farner,8 who in 1954 and 1962, respectively, did research on continuance

and discontinuance at this Family Service agency; through talking

 

3Helen H. Perlman, "Intake and Some Role Considerations", Journal
of Social Casework, XLI, 4, (April 1960), 171-177.

 

4Frances Stark, "Barriers to Client-Worker Communication at Intake",
Journal of Social Casework, XL, 4, (April 1959), 177-83.

 

5Ann Shyne, ”What Research Tells Us About Short-Term Cases in Family
Agencies", Journal of Social Casework, 38:5, (1957), 223-231.

 

6J. H. Pfouts and G. E. Rader, "Influence of Interviewer Charac-
teristics on Initial Interview", Social Casework, XLIII, 10, (December
1962), 548-52.

 

7Ruth Buckner, ”Factors Affecting Non-Return of Nineteen Clients
After Intake Interview in Family Service Agency of Flint, Michigan”,
Unpublished M.S.W. thesis, Wayne State University, 1954.

8Catherine Farner, "A Comparative Study of Factors Affecting
Continuance and Discontinuance of Clients", Unpublished M.S.W. thesis,
Michigan State University, 1962.

- 4 _
with the Executive Secretary of Family Service Agency, Miss Lorraine
Lull, who said she would like to have this problem studied further;
and through the writer's own experience at the agency which whetted
her interest to study more about this problem.

Though the problem is widespread throughout the field of social
work, this particular study of the problem was limited in setting to
the Family Service Agency of Genesee County. This is a non-sectarian
voluntary agency serving Flint and Genesee County since 1944, and
supported by the Red Feather Fund. The central purpose of the agency
is to contribute to harmonious family relationships, to strengthen
positive values in family life, and to promote healthy personality
development and satisfactory social functioning of various family
members.9 There is an open-door policy at Family Service Agency,
which means willingness to give individual consideration to all
client and community requests. The agency in 1963 was professionally
staffed by an Executive, six professionally trained caseworkers, a
psychiatric consultant, three case aids (college graduates but without
professional social work training), and several student social workers

from Michigan State University.

Survey of the Literature Relevant to the Study
There have been a number of studies and articles on continuance,
in casework and on short-term cases. Some dealt especially with
attributes of the caseworker, and others with factors regarding the

client. Quite a variety of factors have been examined with regard

 

9$cope and Methods of Family Service Agency. (New York: Family
Service Association of America, 1953), p.3.

- 5 -

to the client, including motivation and capacity to use casework,
specific psychological characteristics, and some more empirically
verifiable factors such as age and socioeconomic status. This writer
chose to study the latter type of factors.

Many authors discussed socioeconomic status, or some aspect of
this (social class, income level, occupation and education) as a factor
associated with continuance in casework, psychiatric, or psychological
counseling. Many stated that they found a relationship to continuance
that seemed to be significant. Regarding social class, eleven authors
found that the middle and upper class members were more likely to continue

- 0
than the lower class.10 2 Five writers noted a higher economic level

 

10Shyne, Journal of Social Casework, 38:5, (1957), 223-231.

 

11Perlman, Journal of Social Casework, XLI, 4, (April 1960), 171-177.

 

12Buckner, Unpublished M.S.W. thesis, 1954, p. 45.

13Lester K. Naden, "Worker-Client Perception of Presenting Problem
as Related to Client Decision to Use Service", Unpublished M.S.W. thesis,
Michigan State University, 1961, p. 70.

14R. Gibbey, B. Stotsky, E. Hiler, and D. Miller, "Validation of
Rorschach Criteria for Predicting Duration of Therapy", Journal of
ConsultingfiPsychology, 18:3, (June 1954), 175-192.

 

 

15$. Imber, E. Nash, and A. Stone, "Social Class and Duration of
Psychotherapy", Journal of Clinical Psychology, XI, (July 1955), 281-284.

 

16A. Winder and M. Hersko, "Effect of Social Class on Length and
Type of Psychotherapy in a V.A. Mental Hygiene Clinic", Journal of
Clinical Psychology, XI, 1, (1955), 77-80.

17N. Brill and H. Storrow, "Social Class and Psychiatric Treatment",
Archives of General Psychiatry, III, (October 1960), 340-44.

 

 

18George Levinger, "Continuance in Casework and Other Helping
Relationships", Social Work, 5:3, (July 1960), 40-51.

19J. D. Frank, L. Gliedman, S. Imber, E. Nash, and A. Stone, "Why
Patients Leave Psychotherapy", American Medical Association Archives of

Neurology and Psychiatry, 77, (1957), 283-299.

 

 

ZOJ. Coleman, R. Janowicz, S. Fleck, and N. Norton, "A Comparative
Study of a Psychiatric Clinic and a Family Agency: Parts I and 11",

Journal of Social Casework, XXXVIII, (1957), 3-8, 74-80.

_ 6 -

. 21-25 .
among continuers. Four other researchers observed that housewives,
managerial and professional workers tended to continue and that the
continuers tended to have higher level jobs and higher occupational

, 26-29 ,
achievements. These same ones noted that the continuers tended
to have more education, with more being college graduates and that high

school graduates tended to stay in treatment while less than grammar-

school education predisposed to dropping out.

 

21E. Rubenstein and M. Lorr, "A Comparison of Terminators and
Remainers in Out-patient Psychotherapy", Journal of Clinical Psychology,
XII, 4, (October 1956), 345-49.

 

22F. Auld and J. Meyers, "Contributions to a Theory for Selecting
Psychotherapy Patients", Journal of Clinical Psychology, X, (1954),
56-60.‘

23David Fanschel, "A Study of Caseworker' Perceptions of the
Clients", Journal of Social Casework, XXXIX, (1958), 543-551.

 

24August Hollingshead and Frederick Redlich, Social Class and
Mental Illness: A Community Study, (New York: Wiley and Sons, 1958),
p. 213.

 

25M. Lorr, M. Katz, and E. Rubenstein, "Prediction of Length of

Stay in Psychotherapy", Journal of Consulting Psychology, XXII, (1958),
321-3270

26Marouf Hasian and Franklyn Wosek, "A Comparative Study of
Psychosocial Characteristics of Parents of Sixty Families Who Continued
or Did Not Continue Recommended Treatment at Lansing Child Guidance
Clinic", Unpublished M.S.W. thesis, Michigan State University, 1959, p.25.

 

27Patrick Sullivan, C. Miller, and W. Smelser, "Factors in Length
of Stay and Progress in Psychotherapy, Journal of Consulting Psychology,
XXII, (1958), 1-9.

 

28Rubenstein and Lorr, Journal of Clinical Psychology, XII,

345-349.

 

29Frank, Gliedman, Imber, Nash, and Stone, American Medical
Association Archives of Neurology and Psychiatry, 283-299.

 

_ 7 _

Three others found educational level completed was unrelated

. . . 30-32 .
to continuance in counseling. One author found income status
unrelated33 and another found occupational level not associated
significantly.34

Thus, though there were some differences in the results and
procedures of the various studies, it seems reasonable to say that
the literature indicates a trend toward continuance in counseling
which is in quite direct association to income, education, class,
and occupation level. Some of the authors gave explanations as to
why they considered there was this association. Lower class attitude
towards social institutions is characterized by rebellion and a feeling
that these institutions do not understand or try to help them.
Professional help is more easily available to middle-class then lower-

class individuals and the former are more suited to it.36 Agency

community relations seem to be oriented toward middle-class clients.37

Low social class seems to be significantly related to lower estimated

intelligence, less education, tendency to see presenting problem as

 

3ON. Siegel and M. Fink, "Disposition of Applications for
Psychotherapy in an Out-patient Clinic", Social Casework, XLIII, 10,
(December 1962), 545-48.

31
321-327.

Lorr and Rubenstein, Journal of Consulting Psychology, XXII,

32Farner, Unpublished M.S.W. thesis, Michigan State University, l962,p.47.
33Ibid.
34Lorr and Rubenstein, Journal of Consulting Psychology, XXII,321-327.

35Winder and Hersko, Journal of Clinical Psychology, XI, 1, 78-79.

 

36Levinger, Social Work, 5:3, (July 1960), 44.

37Naden, Unpublished M.S.W. thesis, 1961, p. 70.

_ 8 _
physical rather than emotional, desire for symptomatic relief only
rather than over-all help, lack of understanding of psychotherapeutic
process, and lack of desire for psychotherapy.38
Regarding the factors of age, sex, and marital status, three

39-41 Another noted a

writers found them unrelated to continuance.

tendency for those over fifty to drop out.42 Another observed an

inclination for married females and for more of those in the twenties

. 43

age group to continue.
Three authors found that the chief concern presented by the

. . . . . 44-46

client was Significantly related to whether they continued.

. . 47 . .
Another said it was not. Among the findings of the former authors
were that over half of the clients with external problems but only

one third with psychological problems were continuers; that more of

the continuers had economic problems and were helped in this area;

 

38Brill and Storrow, Archives of General Psychiatry, III,
(October 1960), 344.

 

39Farner, Unpublished M.S.W. thesis, 1962, p. 48.

40Frank, Gliedman, Imber, Nash, and Stone, A.M.A. Archives of
Neurology and Psychiatry, 77, (1957), 287.

 

41Fanschel, Journal of Social Casework, XXXIX, p. 551.

 

42Hasian and Wosek, Unpublished M.S.W. thesis, 1959, p.23.

43Siegel and Fink, Social Casework, XLIII, 10, December 1962, p.546-47.
44

 

Hasian and Wosek, Unpublished M.S.W. thesis, 1959, p.23.

45Lillian Ripple, "Factors Associated with Continuance in Casework
Service", Journal of Social Work, 2:1, (January 1957), 93.

 

46Leonard S. Kogan, "The Short-Term Case in a Family Agency",
Social Casework, XXXVIII, (1957), 371.

 

47Farner, Unpublished M.S.W. thesis, 1962, p. 48.

- 9 -
but that there was no significant difference respecting the relative
frequency of problems involving either marital difficulty or parent-
child relationships.

Two found no significant differences with respect to the basis
of contact, or the stimulus for contact, between the continuers and

, , 48,49 ,
discontinuers. However, another writer observed that the referral
source was significantly related at the .05 level of significance to

. 50 . . .

continuance. They were more likely to continue if referred by
pastors, less likely to continue if referred by attorney or court,
but there was no difference between self-referrals and other agency
referrals.

Regarding number of family members in counseling, one writer
found that a greater proportion of those who discontinued after one
interview appeared to expect casework with other family members too.51
Another, in speaking of client-centered barriers to continuing, mentioned
attitudes of family members which impede client's efforts toward
solution and the burden of trying to involve resistant relatives in

, 52
serVice. In contrast, another researcher expressed that there was
53

too much emphasis on necessity of working with both marriage partners.

However, a researcher who studied discontinuers at the same agency eight

 

48Kogan, Social Casework, XXXVIII, (1957), 371.
49

 

Hasian and Wosek, Unpublished M.S.W. thesis, 1959, p. 30.
50Farner, Unpublished M.S.W. thesis, 1962, p. 50.
51Kogan, Social Casework, XXXVLLL, (1957), 371.

52Shyne, Journal of Social Casework, 38:5, (1957), 226.

 

53Buckner, Unpublished M.S.W. thesis, 1954, p. 45.

 

[Ill

 

- 10 _
years later, noted that families were more likely to continue when
two or more in the family were involved in counseling and also when
the case was split between two caseworkers, when more than one family
member came.54 The association was significant at a .05 level.

The above mentioned author also observed that previous agency
contact at Family Service Agency and no children in the home were
both conditions that were significantly related at .05 level to
continuance in counseling.55

In this survey of literature concerning factors in continuance
in counseling, there were a number of contradictions in the various
findings. Factors were found related in some studies and unrelated
in others. Some of this was due to the variety of kinds of agencies
on which the studies were based and differences in the levels of
significance which were accepted as indicating an association. The
factor on which there was the most agreement and also the most study
was the socioeconomic factor. There appeared to be a direct association
between continuance and higher income, education, social class,
and occupational level. In this present research project, this author
studied each of these factors as they were related or unrelated to

continuance at one family service agency.

The Study Focus
There was no hypothesis as such being tested, but instead the
study was focused on a set of certain recognizable characteristics,

of an empirical nature, of clients of Family Service Agency of Genesee

 

54Farner, Unpublished M.S.W. thesis, 1962, p. 50.

55Ibid.

- 11 -
County in 1963, to explore whether they were significantly related
to the client's continuance in counseling at Family Service Agency.
The level of significance which determined the acceptance or rejection
of each of these projected associations was 0.01. The dependent
variable was continuance.

This study focus emerged through a deductive process of reasoning
from the author's survey of literature and as indicated earlier, there
was much contradiction of findings among those who have previously
studied this subject. However, the following twelve recognizable

56 of clients were considered to see whether

empirical characteristics
or not they were significantly related to continuance in counseling

at Family Service Agency of Genesee County:

1. Family income--wages and salaries received by client
and spouse.

2. Education of client--amount of formal schooling, in
elementary and junior high, high school, and college.

3. Occupation of client--present employment.
4. Age of client at intake.
5. Sex of client.

6. Marital status at intake--married, single, divorced,
or separated.

7. Source of referral--directed to or told of agency
by whom.
8. Chief concern or reason for coming, as stated by the

c1ient--kind of problem which he says he is seeking
help with from the agency.

9. Number of family members in counseling--number who
had interviews at the agency.

 

56A thirteenth factor "race” was originally included in the design
but was eliminated as there was insufficient information as to the race
of the clients.

_ 12 _

10. Whether case was split between two caseworkers, if
more than one family member in counseling (or at least
planned that it would be after intake, in such cases
as clients did not return after initial interview).

11. Previous contact at Family Service Agency--whether
previously came to this agency for interview(s).

12. Number of children at intake, at home--how many
children client has living at home.

The study focus is limited by the number of characteristics
or factors which were chosen for the study. Other factors could be
operating and/or be of more importance. Also, statements of findings
or interpretations should not be considered as explanations of causality,
but merely statements of significant associations between above factors
and continuance in counseling at Family Service Agency.

Following are operational definitions of several of the terms
used in the basic study focus: c1ients--those people who have sought
professional help with their problems at Family Service Agency and
who came to the agency for at least one interview; counseling--
interviews at the agency with a member of the social work staff of
the Family Service Agency, regardless of the type of problem or
content of the interviews; significantly related--associated to such
a degree or level that the possibility of the association occuring by
chance alone is only one in one hundred; continuance--returning to
the agency for interview(s) beyond initial interview; longer-term

continuance—-continuing for six or more interviews at the agency.

CHAPTER II
METHODS OF THE STUDY

Collection and Analysis of the Data
The data collected was regarding the aforementioned charac-
teristics of clients at Family Service Agency of Genesee County.
The source of data was from the case records, specifically from the
yellow statistical cards for 1963. It was supplemented when necessary
by information from the intake interview guide and caseworkers'
appointment books. This information is usually secured during the
initial interviews, and as only information is elicited which is
necessary for treatment with the client, sometimes the cards were
not completely filled out. (This is a limitation of this source of
data.) The cards are filed alphabetically, according to the year.
The data was pre-coded and placed on summary sheets according
to the factors and the length of continuance. The factors were
divided into the following classifications:l
Family Income (gross annual)
$4,000 or less
$4,100 - $6,000 ,
$6,100 - $8,000 :

$8,100 - $10,000
$10,100 and above.

 

1Complete description of alternations and classifications
will be provided in the Appendix.

_ 13 -

- 14 _
Education (completed)

No years of high school
Partial high school
High school

Partial college, college, or graduate professional training.

Occupation (The classifications are a combination of
Hollingshead categories, Bureau of Census
Socioeconomic Index, and author's own.)

 

Unskilled workers

Semi-skilled workers

Skilled workers

Owners and managers of small business, clerical and
sales workers, semi-professionals, lesser and
major professionals

Housewives

Retired and students

Unemployed.

Age Sex

19 or younger Male
20 - 39 Female.

40 or older.

 

 

Marital Status Source of Referral
Married Self, friend, or relative
Single Minister or doctor
Divorced Lawyer or court
Separated. Other social agency

Others, including school.

Chief Concern

 

Marital relationship

Parent-child relationship

Individual personality adjustment

Mental illness

Other, including economic, substitute care of child,
and others.

 

 

Number in Counseling Case Split?
One Yes
Two or more. No.

Previous Contact at Family Service Aggncy

Yes
No.

- 15 _
Number of Children Living at Home

None
1 -
4 _

7 or more.

3
6

The data was then placed in tabular form, with a table for each
of the twelve independent variables, such as income and age, and the
dependent variable throughout was continuance--the number of interviews
before discontinuing counseling, as one, two to five, and six or more.
The statistical method of chi square was used to test for
significant associations. When the probability that the association
was attributable to chance was less than one out of one hundred,
then that finding was considered significant in this study. Thus,
the level of significance which determined the acceptance or rejection
of the projected association between each characteristic and continuance

was 0.01.

Definition of Study Groups

The previously mentioned characteristics or factors regarding
three separate groups of clients were compared. After selecting the
sample from the total file of statistical cards, the cards were then
separated into the three groups: those of clients discontinuing
counseling after the initial interview, those of clients continuing
two to five interviews, and those of clients continuing for six or
more interviews. The factor of how long they continued was the

dependent variable in the study.

The Sampling Method2

The universe studied and sampled from consisted of people served

by Family Service Agency of Genesee County in 1963. This, of course,

 

2Complete description of any change in sampling procedure and
size will be provided in the Appendix.

_ l6 -
represents only a portion of all the people and families in Genesee
County and Flint with problems; it represents only those who have
sought professional help with their problems at Family Service Agency.
The size of the universe studied was eight hundred thirty-three
individuals and families who terminated during the year plus two
hundred twenty-three who continued on into 1964. (Another two
hundred ninety-three contacted the agency only by telephone or
correspondence, or someone contacted on behalf of the family.)

Of the eight hundred thirty-three who discontinued, forty-seven

per cent terminated counseling after the initial interview, thirty-
four percent after two to five interviews, and nineteen per cent
following six or more interviews.

The method of choosing the sample was the following: using
the table of random numbers, a random sample of three hundred forty
cases was selected from all the cases in the file for 1963. The
writer expected that this likely would result in a representative
proportion of each of the three groups.

The sample selected consisted of three hundred forty randomly
chosen families and individuals, and after eliminating seventy-two
of these which were telephone, correspondence, or on behalf of family
contacts only and two on which the information was too slight,
there were two hundred sixty-six families and individuals remaining
in the sample. This consisted of one hundred twenty-four (46%) who
keptcme interview, one hundred three (39%) in which the family had
two to five interviews, and thirty-nine (15%) in which one or more

family members came for at least six interviews.

- 17 _

However, this writer was interested in studying the individuals
who made up the families rather than the families as a unit, and thus
the sample was broken down into three hundred fifty individual clients
who came in to the agency for at least one interview during 1963.
There were two or more in counseling from eighty-three of the families
selected.

Thus, the final sample consisted of three hundred fifty individuals,
two hundred sixteen (62%) of whom were dropouts after one interview,
ninety-six (27%) who continued for two to five interviews, and
thirty-eight (11%) who continued in counseling for six or more

interviews.

CHAPTER III

RESULTS OF THE STUDY

Factors Significantly Related at .01 Level
TABLE I

PREVIOUS CONTACT AT FAMILY SERVICE AGENCY

 

_l—
1

 

 

 

 

 

 

 

 

 

 

 

 

 

H Don't
Number of Yes No *_ Know Total
Interviews Number Percent Number Percent Total Number
One 20 44% 182 65% 202 14
Two to Five 14 31% 74 26% 88 8
Six or More 11 25% 24 9% 35 3
Total 45 100% 280 100% 325 25 350
2
X = 11.43 P = .01

There was a significant trend toward longer continuance when the
individual had had previous contact at Family Service Agency. Of the
forty-five individuals who had sometime previously been to Family Service
Agency for at least one interview, only forty-four percent discontinued
after the initial interview, while sixty-five of the two hundred eighty
newcomers to the agency dropped out. Twenty-five percent of the group
with previous contact at the agency continued for six or more interviews,
while only nine percent of the first-timers continued for that long. The
chi square test for the significance of this association indicated that the

probability of it being attributable to chance was only one out of a hundred.

(.01)
_ l8 _

- 19 -

TABLE 2

CASE SPLIT BETWEEN TWO WORKERS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

' Don't

Number of Yes No Know Total
Interv1ews Number Percent Number Percent Total Number
One 19 35% 70 65% 89
Two to Five 23 43% 26 24% 49 2
Six or More 12 22% 12 11% 24

~ :
Total 54 100% 108 100% 162 g 2 164

2
X = 13.62 P = .01

There was a significant trend toward continuance when a case involving
two or more persons from the same family was split between two caseworkers.
While only thirty-five per cent of the fifty-four individuals in split
cases dropped out of counseling following the initial interview, sixty-
five per cent of the one hundred eight individuals in cases in which both
family members were seen by the same caseworker discontinued after the
first interview. 0f the split cases, twenty-two per cent of the individuals
continued for six or more interviews, while only eleven per cent of the
individuals in cases that were not split came for at least six interviews.
The chi square test for the significance of this association indicated
that the probabilfly of it being attributable to chance was less than

.01--less than one out of one hundred.

- 20 _

TABLE 3A

NUMBER IN COUNSELING FROM SAME FAMILY

 

 

 

 

Don't
Number of One Two or More Know Total
InterViews Number Percent Number Percent Total Number
One 125 68% 89 54% 214 2
Two or More 59 32% 75 46% 134 ’1
Total 184 100% 164 100% 348 2 350

 

 

 

 

 

 

 

 

 

x2 = 7.02 P = .01

 

There was a significant trend toward continuance when two or more
from the same family were involved in counseling. While only thirty-
two per cent of the one hundred eighty-four individuals who were the one
member of their family receiving counseling at Family Service Agency
continued beyond the intake interview for at least one more interview,
forty-six per cent of the one hundred sixty-four individuals whose
marital partner, parent, child, or sibling also came to the agency,
continued for more than one interview. The chi square test for significance
of this association indicated that the probability of it being attributable
to chance was only one out of a hundred--.Ol.

However, this factor was significantly related at the .01 level

to continuance only beyond intake but not to longer continuance.

- 21 -

TABLE 3B

NUMBER IN COUNSELING FROM SAME FAMILY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Don't
Number of One Two or More Know Total
InterViews Number Percent Number Percent Total Number
One 125 68% 89 54% 214 2
Two to Five 45 24% 51 31% 96
Six or More 14 8% 24 15% 38
Total 184 100% 164 100% 348 g 2 350
2
X = 8.01 P = .02

While the relationship is still in the direction previously mentioned,
the level of significance of the association is .02. Thus, the probability
of the association being attributable to chance is two out of a hundred.

These findings are based upon the computation of the probability of
a specified factor occuring with respect to three groups. The purpose
was that of testing the significance of the degree of association between

them. What was demonstrated

As such, no hypothesis was being confirmed.
was that other things being equal, any difference that was found probably

did not occur by chance.

- 22 -
Factors Not Significantly Related at .01 Level, with Continuance.
TABLE 4

FAMILY INCOME (ANNUAL)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Number of $4,000 $4,100- $6,100- $8,100- $10,100- “Eon't Total
Interviews or less 6,000 8,000 10,000 or above now
U 4-1 U U U

u c u c u c u c w c u

o m o o w m m w m o .4 m

.o o .n o .n o .o o .n o m .o

E *4 E H E H E H E H u E

a o s m s m s o n w o s

z: a. 2: 94 :z 91 z: n. z: e. 34 2:
One 49 69% 48 54% 48 60% 12 38% 15 65% 172 44
Two to Five 18 25% 27 30% 23 29% ll 34% 17 31% 86 10
Six or More 4 6% 14 16% 9 11% 9 28% 1 4% 37 1
Total 71 100% 89 100% 80 100% 32 100% 23 100% 295 55 350

2 _ _
X - 16.97 P - .05

There was not a significant association, at .01 level, between
continuance in counseling and whether family income was less than
$4,000, $4,100--$6,000, $6,100--$8,000, $8,100--$10,000 or above.
The chi square test for significance of association revealed a .05
level of significance, but this was not sufficient to be accepted in this
study. However, that the incomes of sixteen per cent of the three

hundred fifty individuals was not known by this researcher may have

affected the results of the study of this factor.

-23-

TABLE 5

EDUCATION ( COMPLETED )

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Number of Not High Partial High -At Least i Don't T 1
Interviews School High School School One Yearof I Know ota
College 1
u u u u l '
H C H C: Ll C: H G I H
w w 8 8 8 8 8 8 T. 8
‘8 3 E i: 8 8 5 a: 8 8
g g g m z m z 91 H 2
One 8 62% 27 53% 39 56% 10 50% 84 132
.g
'hvo to Five 5 387. 16 317. 24 357. 3 15% 48;? 48 g
H |
Six or More - - 8 16% 6 9% 7 35% 21 1 17
Total 13 100% 51 100% 69 100% 20 100% 053 “'197 1 350
l 1’ .
2
X = 10.698 P = .10

There was not a significant association, at .01 level, between
continuance and whether the client completed none, some, or all of high
school education or least one year of college. The degree of probability
of a strictly chance relationship was .10--ten out of a hundred. However,
the reliability of this finding is questionable, as the education completed
by fifty-six per cent of the clients in the sample was not noted on the
statistical cards, and, therefore, could not be studied. This may have

affected the results of the study of this factor.

 

 

 

 

ll IF!!!" [I

_ 24 -

 

 

 

TABLE 6
OCCUPATION
'~ (I)
m u
HQ. g:
m H o m
H m u U
U m m m s
:0 cu c1 :11 HT} 3
w 3 w H o - . o m m o
o m 6 Hi -H m H > a x g
H H H U m H m -H w o
u > H x m m m o 3 m H
c H -H m H m m-H m H m u H
5 w x H H w m H m -H E - m
o H m E -H o c m 5 u m a u
E c c m x H m H o m a o o
H D m m m z D m M D O H
u u H u u u u
H c H c H a H c H c H a H s H
wamq’q’i‘s’SBSBSESTSB
o n o u
E H E H E H E H E H E H a H u 5
D o S m 5 m s m 5 m D o 5 m o 5
zmzmmzmzmzmzmt—«z

 

One 49 63% 23 53318 62fl10 53% 67 61% ll 58%17 65% 195 21

Two-
Five

0"

25 32% 14 33%16 21% 5 26% 28 25% 32% 8 31% 92 4

Six °r 4 5% 6 147 5 17% 4 21% 15 14% 2 10% 1 4% 37 1
More

 

Total 78100%43 10fi29100%19 100% 110100% 19100%26100% 324 26 350

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

x2 = 10.797 P = .70

Very little association was found between continuance and the occupation
of the client. Unskilled, semiskilled, and skilled employment were
compared with clerical, sales, professional or managerial work, housewives,
students and retired, and unemployed. Any relationship between them
and continuance was found to be attributable to chance at a probability
of .70--seventy out of a hundred.
Thus, none of the above measures of social class or socioeconomic
status indicated a significant relationship, at a .01 level, to continuance
in counseling. However, family income came quite close to being significant,

with a .05 level, and perhaps should be studied further.

_ 25 _

TABLE 7

AGE OF CLIENT (AT INTAKE)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Number of ' Nineteen Twenty— Forty ' Don't
Interviews ‘ and Below Thirty-nine and Above! Know Total
4 I 1 I
l H u l 4.1 i
1 H c H c 3 H c . H
CDT 0) 0) OJ . (U (.U I r—( (U
a] o n o 1 n o | m n
E H E H a H 1 u E
a! m a o ‘ a o o 5
z; m z m z m 1 H z
I l 1
l 1 ;
One 13 I 50% ‘ 109 63% 49 63% 171 45
I 5
Two to Five 11 g 42% 46 27% 1 20 26% 1 77 19
Si): or More 2 i 8% 17 10% 9 11% 1 28 10
s E
Total E 26 1 100% 172 100% 78 100% 276 74 350
' I
2
X = 3.626 P = .50

There was not a significant association between continuance and
whether the client was a teen—ager, was in the twenty to thirty-nine
age group, or was age forty or above. Any association had the probability
of .50 of being due to chance. That the age of twenty-one percent of
the clients in the sample was not known may have affected the results

of the study.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

- 26 -
TABLE 8
SEX OF CLIENT

Number of Male Female Don't Total
Interv1ews Know

Number Percent Number Percent Total Number
One 79 56% 134 65% 213 3
Two to Five 47 33% 49 24% 96
Six or More 15 11% 23 11% 38
Total 141 100% 206 100% 347 3 350

x2 = 4.007 P = .20

There was not a significant association between continuance and

whether the client was a man or a woman.

being attributable to chance was twenty

out of a hundred (.20).

The probability of any association

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TABLE 9
MARITAL STATUS (AT INTAKE)
: I 1
Number of Don't 3
. 1 i' 0
Interviews Married ;Single :Divorced Separated 2 Know g; Total
U' 4.1 : Tu 4.1 g
H G‘H c: {H c: H c: 1 H
8 85.8 81.2 8 8 8 8: .8
E H IE H I E H e H H ! a
3 m I: m 1 s w 5 w o t 3
2 Ha ’2 1H J.2: m z a. 511 z 5
One 149 62% f12 46%513 72% 13 47% 187 26 3g
7 i '
Two to Fivef 61 25% ;12 46%: 5 28% 11 39% 89 7 1
Six or More 32 13% i 2 8% - - 4 14% 38 - g
' i ,1
Total .242 100% :26 100% 18 100% 28 100% 314 33 3; 350
x2 = 8.129 P = .30
1Not included in study because of too few cases on which to base

assumptions.

.- 27 -
In Table 9, there was not a significant association between continuance
and whether the client was married, single, divorced, or separated.

Any association had the probability of .30 of being attributable to

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

chance.
TABLE 10
CHIEF CONCERN
Number of . Parent- Individual Mental Don't
'Interviews Marital Child Personality Illness Other Know Total
Adjustment
JJ JJ U JJ JJ

H a H a H d H a H a H

OJ OJ OJ OJ OJ OJ OJ OJ OJ 8 1:4“ g

E 3 '8 3 8 B “E 3 E H u e

5 OJ .‘3 OJ :3 OJ :3 OJ :3 OJ 0 :3

z m z m z m z 44 z m 64 2
One 107 58% 30 65% 3O 54% 8 80% 41 77% 216 -
Two to Five 54 30% 12 26% 16 28% 1 10% ll 21% 94 2
Six or More 22 12% 4 9%‘10 18% 1 10% 1 2% 38 -
Total 183 100% 46 100% 56 100% 10 100% 53 uxm 348 2 350

2
X = 13.756 P = .10

There was not a significant relationship between presenting problem
of marital, parent—child, or individual personality adjustment or mental
illness, or other concerns such as economic, substiune care of child and
others, and whether client continued. The probability of an association

due to chance alone was .10.

-23-

TABLE 11

SOURCE OF REFERRAL

 

 

 

 

 

 

Number of Se1f, Doctor, Attorney, Social Other,. Don't .
. Friend, _ , including Tota.

Interv1ews Relative Minister Court Agency School Know

4.) U U u U

H c H o H a H a H a H

OJ OJ OJ OJ OJ OJ OJ OJ OJ OJ 1-4 OJ

L o n o n o a o .o u m n

g H E H E H E H E H u E

w a o a o s o s o o s

z m z m z m z a. z m H 2

One 78 55% 36 72% 27 64% 27 55% 25 59% 193 23

Two to Five 42 30% 12 24% 13 31% 12 25% 15 36% 94 2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Six or More 22 15% 2 4% 2 5% 10 20% 2 5% 38 -
Total 142 100% 50 100% 42 100% 49 100% 42 100% 325 25 350
2
X = 12.527 P = .20

There was not a significant association between whether source
of referral was self, friend, or relative, doctor or minister, attorney
or court, a social agency or social worker, and all other, including
school personnel, and whether the client continued. The probability

of any association being attributable to chance was .20.

_ 29 -

TABLE 12

NUMBER OF CHILDREN (AT HOME)

 

 

Number of

One - Four -

Seven

Don't

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Interviews None Three Six or More Know Total
I 1
' u 4.1 u 4.1
H C H C: Li C“ H C H
OJ OJ OJ OJ OJ OJ OJ OJ H OJ
HO O H0 U .0 0 HO 0 CU .0 i
E H E H E H E H H E
5 OJ :3 OJ :3 OJ :3 OJ 0 '3 5
One 40 60% 119 63% 44 59% 6 60% 209 7 3
Two to Five 20 30% 48 25% 23 31% 3 30% 94 2 E
Six or More 7 10%. 22 12% 8 10% 11 10% 38 — i
. 4 L
¥ I .
Total 67 100% 189 100% 75 g100% 101100% 341 9 5 350
Jr 1 l 1 x
2
x = 1.079 P = .99

There was virtually no relationship between continuance and whether

the client had no children at home, one to three, four to six, or seven

or more .

CHAPTER IV
DISCUSSION OF THE FINDINGS

The significantly related factors to continuance that were included
in this study were previous contact at Family Service Agency and
whether the case was split between two caseworkers. Also, whether
more than one family member was involved in counseling was significantly
realted to continuance after intake but not so significantly related

to longer continuance.

Previous Contact at Family Service Agency

The clients who had previously come to Family Service Agency
tended to continue in significantly greater proportion than the newcomers.
This is logical on the basis that the ones who had previous contact
at Family Service Agency were more aware of the service available and
of how they could be helped by it, due to their previous contact.
Thus, when they returned for further counseling it was more likely to
be with a clearer idea of how to utilize the services of the agency
to help cope with their present concerns.

A logical explanation would be that the clients who returned after
previously coming are more likely to be ones who felt helped before
and who have a positive attitude toward the agency and toward the
caseworker who counseled with them previously. This was pointed out
also by Catherine Farner, whose M. S. W. thesis has been previously

mentioned, who recently did a further study on continuance. She

- 30 -

- 31 _

found that the number of agency applications prior to present
application was significantly related to continuance. Clients with
more previous applications prior to present applications are more
likely to continue beyond intake interview. She felt that the attitude
of these clients had been mostly favorable toward their previous
contact with the agency.1 (The caseworkers' handling of these clients
and their concerns would be involved in this, too.)

In taking a look at the figures and percentages involved, we
can see that while a significantly greater proportion of former
clients than newcomers continued (fifty-six percent of former and
thirty-five percent of new), it is still obvious that forty-four
percent did not continue even though they had returned following
previous contact with the agency and that thirty-five percent continued
beyond intake without previous contact. Thus, though previous contact
helps to explain, due to its significant association with continuance,
why perhaps some clients continue, it does not explain why forty-four
percent did not continue. Many other factors undoubtedly enter in to
affect this. While previous contact and continuance are significantly
associated, this does not imply that given the former, the latter
will necessarily follow. A partial explanation would perhaps be
that sgmg of the clients were able to get the kind of help they were
seeking in the one interview, and thus did not continue. Also, others
may have a positive attitude toward the agency and a quite clear idea

of how the service offered can be of help to them, even though it is

 

. Catherine Farner, ”Factors in Continuance and Discontinuance in
Casework Treatment”, Unpublished research at Family Service Agency of
Genesee County, 1964, chapter 2.

- 32 -

their first time at the agency. This writer would speculate that the
attitude and motivation of the client are at least part of what makes
this factor significant. However, in this research, that was not
studied and thus the explanation given is really only speculation.
This writer suggests that further research be done to find what there
is about previous contact that is significantly associated with
continuance. To be aware of this could be very helpful to social

workers in counseling with their clients.

Number in Counseling from Family

The trend toward continuance when two or more family members are
in counseling has been noted. Forty-six percent of the clients who
had another family members also in counseling continued beyond intake
interview, and this proportion was significantly greater than the
thirty-two percent who continued from the group who came alone. However,
a question arises regarding the fifty-four percent who did not continue
in spite of having another family member come also, even though this
is a proportion significantly less than the sixty-eight percent of the
one-from-family group who dropped out of counseling after the intake
interview. Other factors must also be involved.

However, that more than one member in counseling does have a
strong relationship to continuance can be logically explained by
pointing out the apparently greater interest and motivation of family
members to work out satisfactory solutions to their Lproblems, and
the support that they lend each other by both indicating some feeling
of responsibility for and involvement in the problem by seeking help

with it. However, two or three of a family coming for counseling does

- 33 -

not in itself necessarily indicate such greater motivation and self
awareness. There may instead be an unhealthy degree of dependence
upon each other and/or a projection of the problem onto each other.

Catherine Farner, mentioned previously, found in her recent study
that the more family members in treatment, the more likely that the
client will continue in treatment. In attempting to explain this, she
cross-tabulated a number of factors, and discovered that it is the
caseworker involved in the case that is significant more than the
number of family members in treatment. The continuance rates of some
caseworkers' clients greatly reflected a difference between whether
one or two were in counseling, while that of others did not. This
seemed to reflect the caseworker's capacity to work with either one
or two members of a family.2

A number of authors have discussed the matter of number of family
members in counseling. Gomberg states, "We believe that because of
emotional interaction in marriage it is logical that treatment,
wherever possible, be made available to both partners. There is a
technical question regarding the matter of proper timing for involving
the second partner of the marriage in treatment. While experience
demonstrates that, by and large, it is sound to see both partners,
there are times when it is contraindicated."3 Hollis says, "Increasingly
in interpersonal adjustment problems, work is under way with two or

more people in a family at the same time. The ultimate goals are often

 

2Ibid, chapter 2, page 3.

.3M. Robert Gomberg, "Present Status of Treatment Program", Neurotic
Interaction in Marriage, edited by V. W. Eisenstein, New York: Basic
Books, Inc., 1956, p. 284.

 

I. If... .IIIIIIIIIl {551111111 1

 

_ 34 -

common to the several people involved, but the intermediate objectives
usually vary."4 Scherz noted that "A family member more readily
commits himself to treatment when others in the family share respon-
sibility for the problem. The problem can be defined and clarified
more quickly in multiple—client interviews because projections and
distortions of reality are more easily identified and thereby are
made accessible to modification."5

The writer also notes that the significance of number in counseling
decreases when the clients continuing for six or more interviews are
compared with those who discontinued before that. This could indicate
that for those who are sufficiently motivated to keep coming for six
interviews, it is not that all-important that another of their family
be involved in counseling too. They are able to get some help for
themselves, even though the mate or child involved in the concern does
not come.

Thus, though it has been determined that the number in counseling
is associated with continuance, this does not give the reason why.
This writer suggests that further research be done to find what there
is about the number in counseling that is associated with continuance.
Various explanations have been given and speculations made by this
writer and by others who were quoted, but a more clear-cut explanation

substantiated by research findings is needed in order for this information

to be truly helpful to social workers in counseling with their clients.

 

4Florence Hollis, Casework: A Psychosocial Therapy, New York: Random
House, 1964, p. 213.

 

5Frances H. Scherz, "Multiple-Client Interviewing: Treatment
Implications", Social Casework, 43:3 (March 1962), p. 121.

 

 

_ 35 _
To insist on two or more from the family coming for counseling does
not appear to be the solution to the problem of discontinuance, as
there are obviously other factors involved also. However, neither can
we ignore the significant association of number coming to continuance.
A more Comprehensive study of this factor is needed. Meanwhile, also,
social workers would do well to evaluate their own skill in working
with individuals and families to see how this may relate to their

own rates of clients' continuance and discontinuance.

Whether Case Was Split

Splitting a family case between two caseworkers was significantly
related to continuance in counseling at Family Service Agency of Genesee
County, but this significance was much greater regarding continuance
beyond intake than regarding continuance for six or more interviews.
Number in counseling and whether the case was split are closely tied
factors, as the latter only occurs when two or more family members are
in counseling at the agency.

The subject of whether one or two caseworkers Should carry a
family case is a controversial one among writers in the fields of
psychiatry, psychology, and social work. Following are several
excerpts from those who advocate not aplitting the case between
workers:

Hollis said, ”It is now widely accepted that in cases of

marital difficulty, for example, there are very great advantages

in seeing both the individuals involved, for diagnostic purposes

at least and whenever possible for treatment also. Some therapists

refuse treatment altogether unless such interviews can be arranged.

Others, of whom the writer is one, would certainly favor interviewing

all persons involved in a major way in a problem, but would not

insist on it if the client is strongly opposed or if the others
concerned are unwilling to participate." 6

 

6Florence Hollis, Casework: A Psychosocial Therapy, New York: Random
House, 1964, p. 173.

-36-

Ackerman stated, "It is apparent that in some circumstances
the increased strength or health of personality of one family
member becomes a threat to another . . . It is by no means rare
to see one member of the pair get better in individual treatment
as the other gets worse . . . This can occur when only one member
of the family pair is in therapy or when both are in therapy
with separate workers. Yet professional opinion varies widely
on the solution to this problem. When neurotic family pairs
need psychotherapy, the most efficient form of integration of
the psychotherapies would seem to be achieved in the mind of a
single therapist. Strong objections have been offered to such
practice, however. The premise seems to be that two members of
a family, interdependent but mutually distrustful and competitively
destructive, would vie with each other for the therapist's favor
and that this rivalry would jeopardize therapeutic control.
Therefore, the argument goes, provisions for separate treatment
are preferable. But this argument overlooks the difficulty of
integrating the two therapies and the further problems that arise
out of the failure to relate the psychotherapy of the neurotic
pair to the total dynamics of family life. . . . Indeed, as the
principle of separate treatment is generally applied at present,
it is most difficult to pursue the goal of integrating the two
therapies. Both in child and family guidance centers and in
private psychiatric practice, effective collaboration is extremely
rare . . . Thus, the two therapeutic experiences tend to get
dissociated, and although the intrapsychic conflicts of each
person may be ameliorated, successful readaptation to family
relationships nonetheless fails . . . It seems increasingly
apparent that individual therapy cannot be the sole answer to
the mental health problems of our time. When each member of a
family is given individual treatment and these therapies are not
related to one another, the effects on the family are all too often
indirect and nonspecific . . . Whatever the outcome, it is still
therapy for individuals based on individual diagnosis and aimed
at goals of individual improvement, . . . not a therapy of family
relationships."7

Gomberg wrote, "At present we lean toward the practice of
one worker carrying both partners, unless there are sound
indications to the contrary. While it is technically ore
difficult and complicated, there are many advantages."

Beatman said, "Where a caseworker is carrying both partners
in a marriage, this requires an ability on the part of the worker
to relate to each of the partners separately without becoming

 

7Nathan Ackerman, The Psychodynamics of Family Life: Diagnosis
and Treatment of Family Relationships, New York: Basic Books, Inc.,

 

 

(1958), pp. 268, 269, 273.

8M. Robert Gomber, "Present Status of Treatment Program", Neurotic

Interaction in Marriage, edited by V.W. Eisenstein, New York: Basic Books,
Inc., 1956, p. 285.

 

a...

h

.rn

 

- 37 _

over-identified with either. While this is more taxing than working
with only one member of a family, it often leads to good results."

Speaking more or less in favor of splitting cases between workers
are the following:

"Approaching family diagnoses and family casework treatment
places tremendous responsibility on the caseworker to have and
continuously develop knowledge of human growth and development
and dynamics of behavior to understand family interaction. This
knowledge enables the caseworker to distinguish between symptomatic
behavior which is observable and the underlying cause of the
action observed . . . Therefore, we believe we can see one partner
and on the basis of theoretical knowledge and experience begin
to develop a sound psychosocial diagnosis and casework treatment
plan and goal."10

Sholtis said, "The use of two workers and the selection of
the husband as the primary client are alternative means for treating
the small number of cases in which the husband initiates contact
with the agency and demonstrates greater motivation for marital
counseling then his wife. If a woman caseworker treats both
partners, she usually finds herself in competition with the wife.
When the wife experiences so much conflict about becoming dependent
on a rival that she cannot use help, she may sabotage the efforts
of her husband and the worker. Under these circumstances the
wife should be assigned another workers, with whom she does not
need to compete for her husband; thus allowance is made for
appropriate dependence and hostile aggression is reduced. As a
result of the gratification of her dependency needs the wife's
energy can be channeled constructively toward improving her
behavior. It is preferable, however, to assign one male worker
to the case if the husband is the primary client. This approach
avoids this kind of transference problem . . . If the case cannot
be assigned to a male worker, then the proper management of the
case indicates the assignment of two women workers, one for each
partner. . . Most treatment failures in marital cases are thought
to result from unresolved difficulties in transference and
counter-transference, stimulated by the formation of the oedipal

 

9Frances Beatman, "Evolution of Treatment Methods", Neurotic
Interaction in Marriagg, edited by V.W. Eisenstein. New York: Basic
Books, Inc., 1956, p. 266.

I)Lorraine Lull, Catherine Farner, Ruth Spurlock, Fonda Williams,
Warren Kennison, M.D., "Marital Research Study of Interaction", Family
Service Association of America Research on Treatment of Marital Problems,
1964, p. 5. (Unpublished contribution to the research by Family Service
Agency of Genesee County.)

 

 

 

-38-

triangle between the worker and the husband and wife. Problems
of seXual competition and erotization may be avoided by assigning
a worker whose sex is the same as that of the more motivated
partner." 11

Hamilton stated, ”The question of separate workers for parent
and child rests on consideration as to the age of the child, the
degree of parental involvement, timing, and other factors. . . .
Indications for division of a case are strengthened whenever
there is a condition of overt hostility and aggression between
parent and child. Some children because of insecurity about their
parents' attitudes toward them, may not be able to form a
relationship with the worker who sees the parent. The strongly
ambivalent attitudes of the adolescent toward all parental figures r -
usually make it desirable for him to have his own worker. A t .i
practical consideration also is that a very punishing or rejecting
mother may arouse counter-transference in the worker, who sees
the child suffering. Unless the worker is mature, self-aware,
and constantly on guard, this is likely to influence treatment
negatively for the mother by breaking the inner current of .
permissiveness and acceptance, even though controlled on the i 1
surface. After division of the case, treatment must always be 14”}
closely coordinated, since sooner or later resistance to taking
help will develop and be reflected in the child's behavior or in
actually blocking the child from continuing in treatment."12

1. ‘lhOAI’

 

In Farner's research, she found that ”when the case is split at
intake, the client is more likely to continue beyond the intake
interview. . . However, as I broke the sample down according to
caseworker, I learned that it was the particular caseworkers involved
in the splits that make this significant."13 For example, one of
her tables shows that there was no significant difference between
continuance of Split cases and continuance of single cases for Caseworkers

B, F, and G; Caseworker C has a Significantly higher rate of continuance

 

1Helen's. Sholtis, "The Management of Marital Counseling Cases,"
Social Casework, XLV:2, (February 1964), 76, 78.

12Gordon Hamilton, Psychotherapy in Child Guidance. New York:
Columbia University Press, (1947), 310, 313.

13

 

 

Catherine Farner, "Factors in Continuance and Discontinuance in
Casework Treatment”, Unpublished research for Family Service Agency of
Genesee County, 1964, chapter 2, p. 2.

_ 39 _
if case is split with another worker than if case is carried by Worker
C alone; Caseworker A has significantly less long term continuance
with a split case than with Single cases.

Other articles related to this topic, which the reader may be
interested in reading, are by the following authors: Weisberg,15
Pollak,l6 Scherz,l7 Beatman,18 Sherman,19 Shereshefsky,20 Klein,
Bardill and Bevilacqua.22

Thus, there apparently are a number of pros and cons regarding
splitting cases. One of the pros is that of continuance. In this
writer's study, there was a Significant association between the case
being split and the client continuing beyond intake, and between the
case not being split and the client discontinuing. Sixty-five percent

of the split cases continued beyond intake, while sixty-five percent

of the cases not split discontinued.

 

l4lbid.

15Mirium Weisberg, ”Joint Interviewing with Marital Partners",
Social Casework, XLV, 4, (April 1964), 221-230.

16Otto Pollak, "Entrance of the Caseworker into Family Interaction”,
Social Casework, XLV, 4,(April 1964), 216-221.

 

 

17Frances H. Scherz, "Exploring the Use of Family Interviews in
Diagnosis”, Social Casework, XLV, 4, (April 1964), 209-216.

 

8Frances Beatman, "The Training and Preparation of Workers for
Family-Group Treatment", Social Casework, XLV, 4, (April 1964), 202-209.

19Sanford Sherman, "The Sociopsychological Character of Family-Group
Treatment", Social Casework, XLV, 4, (April 1964), 195-202.

20Pauline Shereshefsky, "Family Unit Treatment in Child Guidance",
Social Work, 8:4,.(October 1963), 63-71.

 

 

 

21Alan F. Klein, "Exploring Family Group Counseling”, Social Work,
8:1, (January 1963), 23-30.

 

22Donald Bardill and Joseph Bevilacqua, "Family Interviewing by Two
Caseworkers", Social Casework, XLV, 5, (May 1964), 278-283.

 

51
m7

 

\aa 1.".

- 4Q -

Whether the case was split and number of family members in
counseling are closely tied factors as the former only occurs when
two or more family members are in counseling at the agency. However,
in studying this factor, the writer only included the families where
two or more were clients and thus the related factor of number in
counseling and its own significant association to continuance was held
constant.

On the basis of the literature, this writer sees several possible
explanations for the Significance of split cases. Among them are some
caseworkers' difficulty in working with two members of the same family

and their relative success with only one, the clients' transference

 

than-a— ..

feelings which may be a sabotaging factor in some cases which are not
split and which may not be as stirred up in a split case, the clients'
assurance of confidentiality as worker is not seeing other family member
when case is split, less chance of negative counter-transference being
stirred up when case is split. Some of the authors felt that very
effective treatment can be carried out in split cases while others
lamented what they felt to be less clear diagnoses and less integrated
treatment plans for family members. Certainly, as continuance in
counseling is a very necessary base for effective treatment, social
workers would do well to consider the advantages of splitting cases.
However, this writer feels that splitting cases should perhaps 22E be
the routine plan any more than not splitting them should be. The decision
to share a case with another worker should be based on several factors,
including the diagnosis of the clients and the Skill of the caseworker.
This writer suggests that further study of this factor is needed
in order for social workers to see more clearly what there is about split

cases that is significantly associated with continuance in counseling.

 

 

CHAPTER V
CONCLUSION

The focus of this study was upon a set of twelve recognizable
empirical factors regarding clients of Family Service Agency of Genesee ff}
County in 1963, to explore whether or not they were significantly
associated with continuance in counseling at Family Service Agency.

Of these, nine--family income, education, occupation, age, sex,

 

I

marital status, chief concern, source of referral, and number of E_;'
children at home--were 325 found to be significantly associated
with continuance. Previous contact at Family Service Agency and
splitting cases involving two or more family members were found to be
factors significantly associated with continuance, at the .01 level
of significance. Also, two or more family members in counseling was
strongly associated with continuance, at the .02 level of significance.

Quite a variety of viewpoints on these factors were quoted from
a number of authors, and this writer speculated regarding possible
reasons for the significance of these factors. To be truly helpful
in applying these findings to social work practice, one needs to know
more about the particular aspects of these factors that are significantly
associated with continuance in counseling at Family Service Agency of
Genesee County. This writer speculated that the attitude and motivation
of the client and the skill of the caseworker in working with individuals
and families are an important part of this. However, more comprehensive

study of these factors is needed. Also, undoubtedly other factors are

also associated which were not studied in this research project.

- 41 _

 

APPENDIX

CHANGES IN FOCUS AND METHOD

The purpose of this study has remained the same throughout.
However, the writer has made a few revisions in various parts of the
project, and these will be discussed here.

A thirteenth factor, race, was originally included in the design
but was eliminated as there was insufficient information as to the
race of the clients. Only rarely was it noted on the statistical
cards.

In breaking down the factors into classifications, the writer
made some revisions that became necessary as the project proceeded.
Race, of course, was eliminated as mentioned above. The two lowest
income groups, both considered by the writer to be marginal income
for a family, were combined. Another reason for cmmbhing the two
lower groups was that the writer could not be absolutely sure in some
cases as to which of the two groups certain clients should be placed,
due to the nature of their income, as welfare, unemployment compensation,
support orders, and so forth. The seven original classifications
of educational level completed were combined into four classifications,
due to the sparsity of cases at both extremes. Elementary and junior
high became ”not high school" and partial college, college, and graduate
professional training became "at least one year of college". The

classifications of "partial high school" and "high school graduates"

_ 42 -

 

 

- 43 _
remained in the study. Regarding occupational classifications, the
writer had originally used Hollingshead's categories, but this had
to be revised. The writer consulted the 1950 Bureau of Census
Socioeconomic Index for Occupations, as printed in a book by Albert J.

Reiss, Jr., Occupations and Social Status, as a gUide to reclassifying

 

the occupations.1 The professional, managerial, clerical and sales
occupations were combined into one group. The clientele of Family
13:1
Service Agency in the sample did not represent persons from the two

upper strata of Hollingshead's categories. Also, it was necessary to

make a separate grouping for housewives, who were the largest single

category represented in the sample, and for retired persons, students,

 

if! E_v__.__
I

and unemployed. Regarding the age classifications, the sixty or older
group was combined with the forty-fifty-nine group to make a forty or
older group. This was done because, having only nine individuals in
the dey'or older group, the writer felt a valid assumption on
continuance of this group could not be made. Regarding marital status,
there were only three widows or widowers in the sample. The writer
could not make a valid assumption on continuance on the basis of so

few people. Also, this group didn't naturally combine with any of the
other marital status groups, and thus was not included in the study.
Regarding number of children, only two clients had ten or more children
at home. As this was too small a group on which to make assumptions
regarding continuance, it was combined with the seven-nine children group,

to make a group for those with seven or more children.

 

Albert J. Reiss, Jr., Occupations and Social Status. New York:
Free Press of Glencoe, Inc., (1961), 263-275.

 

- 44 _

The size of the universe studied was slightly different than that
stated in the research design. This was due to the writer using 1962
statistics originally as the 1963 ones were not yet available when
the design was written. However, the research was completed using
1963 statistical cards on clients, and 1963 statistics are stated in
the research report. The size of the sample selected was increased
from three hundred cases to three hundred forty cases to allow for the
elimination of some cards due to insufficient information or telephone
contact only. However, the number of such cards was greater than
expected, leaving only two hundred sixty-six families to be studied.

The writer decided to study the individuals in the families rather

 

than the families per se, and thus the sample included three hundred
fifty individuals, as there were two or more in counseling from
eighty-one of the families selected. This change in focus from families
to individuals was made because it is really the individuals who keep
the appointments at the agency, and sometimes one mate may come for
fifteen counseling interviews while the other comes only for two.
Also, the factors studied, as age, sex, education, and so forth, applied
much more to individuals than to families.

It was necessary for the writer to survey the literature again
before discussing the significance of the factors of previous contact
at Family Service Agency, split case, and number in counseling. These
additional references are included in the Bibliography along with the

references which were consulted in writing the research design.

BIBLIOGRAPHY
Books

Ackerman, Nathan W., The Psychodynamics of Family Life: Diagnosis and
Treatment of Family Relationships. New York: Basic Books, Inc.,

1958, 268-274. E}

 

 

Hamilton, Gordon, Psychotherapy in Child Guidance. New York: Columbia
University Press, 1947, 1947, 310-314.

 

Hollingshead, August, and Redlich, Frederick, Social Class and Mental E
Illness: A Community Study. New York; Wiley and Sons, 1958. ‘

 

 

Hollis, Florence, Casework: A Psychosocial Therapy. New York: Random
House, 1964, pp. 173, 213.

 

Scope and Methods of a Fami1y Service Agency. New York: Family Service
Association of America, 1953.

Articles in Books

Beatman, Frances L., "Evolution of Treatment Methods", Neurotic Interaction
in Marriage, edited by V. W. Eisenstein. New York: Basic Books,
Inc., 1956, 262-269.

 

Gomberg, M. Robert, "Present Status of Treatment Program", Neurotic
Interaction in Marriage, edited by V. W. Eisenstein. New York:
Basic Books, Inc., 1956, 269-290.

Journal Articles

Auld, F., and Meyers, J., "Contributions to a Theory for Selecting
Psychotherapy Patients", Journal of Clinical Psychology, X,
(1954), 56-60.

 

Bailey, Margaret, "Family Agency's Role in Treating Wife of an Alcoholic",
Journal of Social Casework, XLIV, No. 5, (May 1963), 273-79.

Bardill, Donald, and Bevilacqua, Joseph, "Family Interviewing by Two
Caseworkers", Social Casework, XLV, No. 5, (May 1964), 278-283.

- 45 -

- 46 -

Beatman, Frances, "The Training and Preparation of Workers for Family-
Group Treatment", Social Casework, XLV, No. 4, (April 1964),
202-209.

Brill, N., and Storrow, H., "Social Class and Psychiatric Treatment",
Archives of General Psychiatry, III, (October 1960), 340-44.

 

Coleman, J., Janowicz, R., Fleck, S., and Norton, N., "A Comparative
Study of a Psychiatric Clinic and A Family Agency: Parts I and
II, Journal of Social Casework, XXXVIII, (1957), 3-8, 74-80.

Editorial Notes: "The Family as the Unit of Treatment", Social Casework,
XLV, No. 4, (April 1964), p. 230.

:-
Fanschel, David, "A Study of Caseworkers' Perceptions of their Clients", 1_
Journal of Social Casework, XXXIX, (1958), 543-51.

Frank, J. D., Gliedman, L., Imber, S., Nash, E., and Stone, A., "Why
Patients Leave Psychotherapy", American Medical Association
Archives of Neurology and Psychiatry, 77, (1957), 283-99.

 

 

Garcea, R0: and Irwin, 0°) "A Family Agency Deals with Problem of r“'
Dropouts", Journal of Social Casework, XLIII, No. 2, (February
1962), 71-75.

Gibbey, R., Stotsky, B., Hiler, E., and Miller, D., ”Validation of a
Rorschach Criteria for Predicting Duration of Therapy",
Journal of ConsultingyPsychology, 18:3, (June 1954), 185-92.

Hollingshead, A., "Social Stratification and Psychiatric Disorders",
American Sociological Review, 18, (1953), 163-69.

Imber, S., Nash, E., and Stone, A., "Social Class and Duration of
Psychotherapy", Journal of Clinical Psychology, XI, (July
1955), 281-84.

 

Klein, Alan F., "Exploring Family Group Counseling", Social Work, 8:1,
(January 1963), 23-30.

Kogan, Leonard S., "The Short-Term Case in a Family Agency", Journal
of Social Casework, XXXVIII, (May, June, July 1957), 231-38,
296-302, 366-74.

 

Krause, Merton S., "Predicting Client Discontinuance at Intake”, Journal
of Social Casework, XLIII, (1962), 308-12.

 

Levinger, George, "Continuance in Casework and Other Helping Relationships",
Journal of Social Work, 5:3, (July 1960), 40-51.

 

Lorr, M., Katz, M., and Rubinstein, E., "Prediction of Length of Stay
in Psychotherapy", Journal of Consulting Psychology, XXII, (1958),
321-27.

 

 

 

- 47 -

Lowry, Fern, "The Caseworker in Short Contact Services", Journal of
Social Work, 2:1, (January 1957), 52-57.

 

Perlman, Helen H., "Intake and Some Role Considerations", Journal of
Social Casework, XLI, No. 4, (April 1960), 171-77.

 

 

Pfouts, J. H., and Rader, G. E., "Influence of Interviewer Characteristics
on the Initial Interview", Journal of Social Casework, XLIII,
No. 10, (December 1962), 548-52.

 

Pollak, Otto, "Entrance of the Caseworker into Family Interaction",
Social Casework, XLV, No. 4, (April 1964), 216-221.

5?

Ripple, Lillian, with Alexander, E., and Polemis, B., "Motivation,
Capacity, and Opportunity as Related to Use of Casework
Services”, Social Service Review, (June 1955), 172-94.

Ripple, Lillian, "Factors Associated with Continuance in Casework
Service", Journal of Social Work, 2:1, (January 1957), 87-94.

Rosenblatt, Aaron, "Application of Role Concepts to Intake Process", 1
Journal of Social Casework, XLIII, No. 1, (January 1962), 8-15. 1,

 

 

Rubenstein, E., and Lorr, M., "A Comparison of Terminators and Remainers
in Outpatient Psychotherapy", Journal of Clinical Psychology,
X11, 4, (October 1956), 345-49.

 

Scherz, Frances H., "Exploring the Use of Family Interviews in Diagnosis",
Social Casework, XLV, No. 4, (April 1964), 209-216.

Shereshefsky, Pauline, "Family Unit Treatment in Child Guidance",
Social Work, 8:4, (October 1963), 63-71.

 

Sherman, Sanford, "The Sociopsychological Character of Family-Group
Treatment", Social Casework, XLV, No. 4, (April 1964), 195-202.

Sholtis, Helen S., "The Management of Marital Counseling Cases", Social
Casework, XLV, No. 2, (February 1964), 71-79.

Shyne, Ann, "What Research Tells Us About Short-Term Cases in Family
Agencies", Journal of Social Casework, 38:5, (1957), 223-31.

Siegel, N., and Fink, M., "Disposition of Applications for Psychotherapy
in an Outpatient Clinic", Journal of Social Casework, XLIII, 10,
(December 1962), 545-48.

 

Sullivan, Patrick, Miller, C., and Smelser, W., "Factors in Length of
Stay and Progress in Psychotherapy", Journal of Consulting
Psychology, XXII, (1958), 1-9.

 

 

Stark, Frances, "Barriers to Client-Worker Communication at Intake",
Journal of Social Caseworker, XL, No. 4, (April 1959), 177-83.

 

- 48 _

Weisberg, Mirium, "Joint Interviewing with Marital Partners", Social
Casework, XLV, No. 4, (April 1964), 221—230.

Winder, A., and Hersko, M., "Effect of Social Class on Length and
Type of Psychotherapy in a V. A. Mental Hygiene Clinic",
Journal of Clinical Psychology, XI, 1, (1955), 77-80.

 

Unpublished Material

Buckner, Ruth, "Factors Affecting Non-Return of Nineteen Clients After
Intake Interview in Family Service Agency of Flint, Michigan".
Unpublished M.S.W. thesis, School of Social Work, Wayne State F‘
University, 1954. -

Family Service Agency of Genesee County, "1962 Casework Figures", 1963.
(typewritten)

Family Service Agency of Genesee County, "1963 Casework Figures", 1964.
(hand written record in file)

 

Farner, Catherine Balz, "A Comparative Study of Factors Affecting
Continuance and Discontinuance of Clients in Casework Treatment
in Family Service Agency of Genesee County". Unpublished
M.S.W. thesis, School of Social Work, Michigan State University,
1962.

Farner, Catherine Balz, "Factors in Continuance and Discontinuance in
Casework Treatment". Unpublished research for Family Service
Agency of Genesee County, 1964.

Hasian, Marouf, and Wosek, Franklyn, "A Comparative Study of Psychosocial
Characteristics of Parents of Sixty Families Who Continued or
Did Not Continue Recommended Treatment at Lansing Child Guidance
Clinic”. Unpublished M.S.W. thesis, School of Social Work,
Michigan State University, 1959.

Lull, Lorraine, Farner, Catherine, Spurlock, Ruth, Williams, Fonda,
and Kennison, Warren, ”Marital Research Study of Interaction",
Family Service Association of America Research on Treatment of
Marital Problems: Report on Family Service of Genesee County's
Part in the Research, 1964.

Naden Lester K., "Worker-Client Perception of Presenting Problem as
Related to Client DECISION. to Use Service", Unpublished M.S.W.
thesis, School of Social Work, Michigan State University, 1961.

 

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