Nathan W. Ackerman

The Home Visit as an Aid in Family Diagnosis and Therapy

THE HOME VISIT has had a long and uneven history in social work and related fields. At different periods it has been used for different purposes, and has been focused on various aspects of the environment. At times it has been the only mode of contact with families in trouble; at others it has been criticized as constituting an infraction of privacy. This shifting attitude toward the home visit is primarily a result of dichotomizing the person and his environment. Originally the environment was stressed. When interest later shifted to the indio vidual, his environment was all but forgotten. In the exploratory study of family diagnosis, 1 in which the central effort is to relate the behavior of the family as a group to the behavior of a family member, the authors have found the home visit to be a valuable tool. When it has been used as an adjunct to psychiatric interviews and psychological examinations of family members, we have been able to assess more accurately the actualities of the psychosocial functioning of the family. Our particular use of the home visit reflects recent modifications in theory about the nature of emotional illness and the task of psychotherapy. We conceive of emotional illness as a phenomenon not confined to the behavior of a single individual but one that encompasses the individuals integration into a significant group. Rigid adherence to classical psychoanalytic theory and practice had resulted in emphasis being

The Diagnosis of Neurotic Marital Interaction

THIS PAPER is concerned with the means for evaluating the mental health of marital relationships. Within this context special emphasis is placed on the search for appropriate criteria for the psychosocial diagnosis of neurotic marital relationships. The mental health of family relationships is, in the main, an expression of social process. Unhealthy marital relationships, widespread as they are, are significant not only for themselves, but as the epitome and the very core of disintegrative trends in family life as a whole, and as forerunners of emotional illness in the offspring of such unions. The rate of divorce has now reached a point where there is one divorce for every three or four marriages. Even when marital conflict does not culminate in legal divorce, the disturbance often reaches such a critical point as to bring about an emotional divorce of the parents. The day-byday experience of psychotherapists, educators, and spiritual advisers affirms this as a crucial mental health problem in regard to both therapy and prevention. We live in an age of social crisis. We have reason to believe that the intrinsic value conflicts of our changing, culture have a direct bearing on the fate of family life and family relationships. It requires no great stretch of the imagination to realize that the survival or destruction of our kind of civilization will depend in no small part on how these value conflicts are resolved and what happens concurrently to the mental health of the family. It is the clear and present threat to our cherished values in family living which challenges us. The threat is a large one and it hits home, literally. Our anxiety is for ourselves and this impels us to take a stand on the issues involved. Naturally, it would be our wish to apply the dynamic insights of psychoanalysis to the mental health problems of marital relationships and family life. We must admit, however, that up to the present our scientific concepts are not yet adequate to the task, though we are making progress in this direction. We can readily discern some of the relevant developments in the behavior sciences: the emphasis on multidisciplinary research, the joining ef hands of psychoanalysis and the social sciences, the increased influence of the anthropological principle of relativity of behavior, the effort to move beyond Freud in linking the phenomena of biological maturation with the processes of social participation, the effort to correlate ego-dynamics with social interaction, the rediscovery of the ancient principle that behavior is determined not only by a persons view of his past, but also by his view of the future, and so on. In a recent lecture, Dr. Frieda Fromm-Reichmann made the statement that we are on the eve of a revolution in the development of our understanding of the principles of human behavior and the principles of psychotherapy. Of particular importance is the need to evaluate pathology of individual personality not in isolation, but within the frame of the psychosocial structure of the family, and to establish the specific dynamic relations of personality and family roles. Only as we can correctly merge the dynamics of individual and group behavior does it begin to be possible to deal effectively with the mental health problems of family and marital relationships.

The Principal of Shared Responsibility of Child-Rearing

assistance in the face of an irrationally perceived &dquo;enemy&dquo;. Therapeutic sexual permissiveness does not imply the same attitude of acceptance for neurotically inspired sexual activity as for the patient’s healthy socio-sexual functioning. If the therapist communicates an attitude of warmth and human regard for his patient yet reserves encouragement for integrated and organized sexuality, the effect is neither traumatic nor inhibiting but is deeply reassuring. In many instances, reactions of negativism and hostility to so-called interference with sexual acting-out are less in the nature of anxiety responses to

Mental Hygiene and Social Work, Today and Tomorrow

seems to me to be especially pertinent. I realize that I have not begun to do justice to the very concentrated and stimulating content of Mrs. Austins paper. I should like to say, however, that I am grateful for having had the opportunity to hear and to discuss this very provocative paper that underlines so well the importance of continued collaboration between the fields of psychiatry and casework, a collaboration that has already been so fruitful and mutually rewarding.

Family Healing in a Troubled World

The change that is needed in family living today is one that can happen only within a larger change, a creative rebirth of the entire social community

Concepts of Family Striving and Family Distress: The Contribution of M. Robert Gomberg

THE BRILLIANT CAREER of Dr. M. Robert Gomberg came suddenly to an end while he was on active duty. One hour after completing an address at the New York Academy of Medicine on the evening of April 24, he died of a heart attack. He was the main speaker at the dinner meeting of the annual Eastern States Health Education Conference sponsored by the New York Academy of Medicine, and his paper, Stabilizing the Family for Health and Social Effectiveness, 1 symbolized in the deepest sense Dr. Gombergs dedication to family welfare and to his ideals. He gave expression to his hopes and aspirations as to ways in which persons in the behavioral sciences, the social sciences, and social work could join hands in promoting health and integrity in family living. His ideas, delivered with clarity and forthrightness, received a warm ovation. It is sad for his friends and co-workers that Dr. Gomberg should have departed from life so young; yet we know he would not have wanted to die in any other way than at his work. Over a period of twenty years, Dr. Gomberg made many contributions to the practice and theory of casework and the related behavioral disciplines. We do not propose in this paper to summarize all his writings, but we shall isolate from them his concepts of family process, family stability and instability, and therapeutic intervention.

Book Review: Steps in PsychotherapySTEPS IN PSYCHOTHERAPY: DollardJohn, AuldFrankJr., and WhiteAlice. 222 pp., 1953. The Macmillan Company, New York, or Social Casework.

been achieved but we do not know how it came about. But a view of this collection of contemporary practice in child therapy from the historical side brings some things sharply in focus. The 30-year-old baby, child guidance, is coming of age. If we can judge by most of the case reports in this volume, the days of play therapy, of guided missiles, catharsis, and permissiveness are happily on the wane. The therapy that once was smuggled in at the zoo or the art museum by a therapist who presented himself as an omniscient friend to children has almost vanished from the clinical scene. In most cases the children in this volume are patients who understand the therapeutic purpose of their clinic visits; their therapists reveal themselves and their intentions without embarrassment, and the therapeutic work is conducted, with few exceptions, according to psychoanalytic principles. SELMA H. FRAIBERG Detroit, Michigan