Qualifications of the
Psychiatric Social Worker
c. June 1-8, 1919 — Forty-Sixth Annual Session, National Conference of Social Work, Children’s Section, Atlantic City NJ
There is nothing more difficult to make concrete and definite than the qualifications relative to age, intelligence, training, experience, personality, etc., that fit and unfit one for a particular vocation. That is why vocational guidance or vocational tests, except in the most general sense, are not the most reliable and satisfactory thing in the world. No sooner do you have one trait selected as necessary for a particular field than an exception is pointed out inthe group already working successfully in that field. Human nature has such unaccountable ways of compensating for apparent handicaps that our predictions in any individual case may easily fail. Nevertheless, despite variation in individual cases, it ought to be possible, even with our relatively brief experience in the field of psychiatric social work, to arrive at some very general conclusions regarding those qualifications, personal and otherwise, which seem to point most definitely to the potentially successful psychiatric social worker.
Before we can go very far in describing the desirable candidate for psychiatric social work, we need to be sure that we agree on the kind of work that we expect her to do. Briefly, do we mean by psychiatric social work just ordinary social service which only happens to be directed toward the mentally ill, plus a background of familiarity with hospital organization, psychiatric terminology and mental symptoms, and a cleverness in guessing at the diagnosis of a case which is as superficial as it is irritating, or do we mean something fundamentally different, a new way of approaching all case work which has evolved in the psychiatric field largely because any thorough going attempt to deal with the definitely mental case required it.
In my experience, both types of social service are now to be found in the field of psychiatric social work. I am not interested in describing the qualifications of workers in the first group because I believe any experienced social worker, public health nurse, or medial social service worker is already sufficiently equipped and needs no further training. She can pick up the tricks of the trade very easily in the clinic or hospital. I do not wish to belittle this type of social service, I believe it has a place, but I see no reason to give it a special name because it happens to be attached to a hospital for the insane, or a clinic for mental and nervous diseases. My conception of the new case-work which perhaps has always been the unconscious method of the born case-worker, but which owes its coming to consciousness largely to mental hygiene and psychiatry, is that of a social technique such as may be had in any good training school combined with an understanding of human psychology which enables the social worker to deal with the personalityof the patient in his social setting as intelligently and constructively as the psychistrist deals with it in the hospital.
Demands a Practical Psychology
This does not imply a knowledge of mental disease in terms of diagnosis, symptoms or classification, but it does imply a first-hand, work ingpsychology which will be able to carry out in social treatment the psychiatric’s interpretation of a patient so far as it can be done in terms of personality. Such a psychology will also give the worker her basis for dealing with the maladjusted individual who may be classified as normal and who is not a hospital or clinic case. All of which is simply one way of saying that in the last analysis the social worker who goes beneath the surface of practical, commonsense, social adjustments, and kindly human treatment, must become a kind of working psychologist, not the laboratory, research, or clinical type, but something more human, vital and practical. Knowledge of social life is inadequate if it is not combined with knowledge of mental life. Back of the social framework is the make-up of the particular individual, his way of adjusting to people and things and the possibility of improving that adjustment.
This does not imply a knowledge of mental disease in terms of diagnosis, symptoms or classification, but it does imply a first-hand, working psychology which will be able to carry out in social treatment the psychiatric’s interpretation of a patient so far as it can be done in terms of personality. Such a psychology will also give the worker her basis for dealing with the maladjusted individual who may be classified as normal and who is not a hospital or clinic case. All of which is simply one way of saying that in the last analysis the social worker who goes beneath the surface of practical, commonsense, social adjustments, and kindly human treatment, must become a kind of working psychologist, not the laboratory, research, or clinical type, but something more human, vital and practical. Knowledge of social life is inadequate if it is not combined with knowledge of mental life. Back of the social framework is the make-up of the particular individual, his way of adjusting to people and things and the possibility of improving that adjustment. Real case work, psychiatric or otherwise, can not be done from the outside and the inside work requires the type of person, the experience and preparation which should be expected of one who, even as the psychiatrist, accepts responsibility for adjusting the mental and social life of other human beings.
Psychology and Psychiatry
Now is there any reason why this kind of social psychology with individuals as it might be called, should be definitely linked with psychiatry? Cannot one deal with mental life without knowing all the symptoms of the various mental diseases? The reason it has been so limited is undoubtedly because in social service with the mentally diseased, the necessity for understanding the make-up of the individual has been force upon us and because psychiatry has done so much to make psychology a practical tool for altering mental conditions. The reasons for continuing to keep it linked with psychiatry are that there is no way of obtaining so vital an understanding of normal behavior as by studying the abnormal and because thus far psychiatry has the only, psychology which attempts to reach scientifically the emotional and instinctive roots of human behavior for the purpose of making over the person who is failing in his mental and social life.
Relation to All Case Work and to Psychology
From this it would seem that social psychiatry is in the position, not so much of supplying a new branch of social work, as of offering the psychology and the field work of the graduate course for all case-workers who wish to go beyond the level of intuitive psychology in dealing with the personality of the patient. I realize that this conception of psychology differs very markedly from the definitions which are sometimes given by psychiatrists or even psychologists; the former tending to limit psychology to the field of mental testing, the latter clinging to the normal or to the idea of pure science as opposed to practical applications. There is no reason why there should be a split between normal and abnormal psychology. If functional mental disease is not fundamentally related to normal mind, if the processes of normal mental life cannot be seen working out in exaggerated forms in the behavior of the mentally ill, then mental disease is a foreign body which cannot be assimilated in our thought. Surely there is only one psychology of human behavior applicable to all minds, sick or well, and the psychiatrist found it first because he was actually forced to it by the necessity of getting some instrument for altering the behavior of his patients. The psychologist in the laboratory was not thus pressed.
If the psychology of tomorrow were to be limited to the field of mental testing for its only practical interest, then psychology might well be wiped out and psychiatry substituted. If psychology has no concern with human life beyond the testing of the intellect, it is not very much more useful than Greek to the social worker. At all events, what is meant by psychology in this discussion, whether you choose to label it psychiatry or psychology, is that science or art of untangling and reconstructing he twisted personality, of changing human behavior so that it adapts the individual to his environment, which is the basis not only of mental case-work and ordinary social case-work, but will eventually be ome the basis of educational method for normal and abnormal alike.
If one accepts this point of view, the question to be discussed is what qualifies an individual to do the psychological social case-work which is essential in social psychiatry and desirable for intensive case-work everywhere? Let us suppose we have before us the practical problem of passing on candidates for training course in psychiatric social work. On what basis shall we accept or reject — if we are free to choose the most suitable?
The first point that is suggested is the matter of educational requirements.Is a college degree essential? Certainly the intellectual grasp, the appreciation of scientific method, the acquirement of a thought-out philosophy of life, the understanding of social problems and the training in psychology which the college degree ideally represents is highly desirable. As a matter of fact, a degree may or may not indicate adequate preparation.
Certainly this most subtle and difficult of all case-work requires not only an intellectual ability above average, but an intellect which has been trained to tackle problems first hand and which has been equipped with a background of familiarity with the main trends of modern thought. The college graduate may not come up to these requirements, and the individual without the college degree may be found entirely adequate. It seems to me unfortunate to make the college degree a fixed arbitrary requirement if we can find any other way of determining whether the candidate is intellectually and educationally qualified.
Is it not possible to use a general intelligence test to exclude those whose intellectual capacity is not equal to this type of work and depend on case history as to education and previous experience, together with some form of written examination which will show up the candidate’s general point of view, method of approaching a social problem and capacity for dealing with it at least theoretically. If this is possible, and the Pennsylvania School for Social Work intends to try it out next year, the intellectual qualifications can be settled without reference to any particular educational label and a high standard can still be maintained.
Intellectual ability with adequate training and background is certainly not the only requisite for the psychiatric social worker. W e have stil to consider the age, personality and previous experience which fits an individual for the very delicate task of tampering with other people’s minds and lives. Shall we accept the youngster just out of college, or must she have had some working experience. If so, what kind? Is the able, well trained young person with a year or two of secretarial or business experience likely to be the one we are looking for or must a certain kind of experience be required? Again, should there be an upper age limit? Oughtt we to exclude a woman over forty from our training course? Some of us have seen children of twenty or twenty-one just out of college, who having completed a course in psychiatric social work were foundering about helplessly, chiefly because of immaturity and a general unfamiliarity with life, and have thought, “Heaven forbid that we shouldaccept the inexperienced collegegraduate for psychiatric work.” Then there has been the older woman whose rigidity of mind prejudiced attitude, and assurance born of successful experience have seemed to be insurmountable handicaps to learning a new type of work.
After all, within reasonable limits, doesn’t it boil down to a matter of the particular individual and the kind of personality she possesses? If we arbitrarily exclude all candidates below twenty-five or over forty, we may shut out someone ideally qualified. What we are after is not any particular age but certain qualities which we fear to lose in the over young or over-old. Certainly no one who is not intellectually and emo tionally mature could be expected to enter into the emotional problems of others with understanding and confidence. Yet that is what psychiatric case-work implies. Maturity is not entirely a matter of age. It is some times lacking at thirty and present to a surprising degree at twenty in persons whose emotional experiences have been rich and conscious.
It seems to me that when we accept for training a girl just out of college or any girl of twenty-one, it should be either on the basis of evident emotional maturity or with the understanding that the student realize her limitations and gain experience in life and in the simplest problems of ordinary case-work before presuming to enter the psychiatric field. It may even be better to recommend to such an immature young person a preliminary social work training and experience before under taking what should be only advanced training for the experienced worker. With the immature woman of mature years the case is more difficult because it is not so easy to detect the immaturity in the first place and because one must decide whether the lack of development is something which the course itself may be expected to alter, or whether it is a sign of a fundamental inability to make adult adjustments, in which case the candidate should become a patient rather than a worker. What can be used as a standard of maturity is difficult to say, but most of us have a feel for it and think we are able to size people up roughly in that regard, on the basis of a personal interview . This, combined with the candidate’s way of dealing with the human problem presented in the written examination ought to give a basis for judgment. The type of difficulty apt to be en countered in older women, rigidity, prejudice, unadaptibility, complete satisfaction with previous acquirements, must also depend on the personal interview and written examination for detection.
Previous Experience and Training
Given a well qualified person as to intellect, training and maturity, wha weight should be placed on previous working experience. Everything else being equal, surely the candidate who had had experience in allied lines such as psychology, sociology, or social case-work, would be preferred to the inexperienced applicant. My own belief is that the person without previous case-work experience is sadly handicapped and must make up for her lack by a longer apprenticeship in the simplest form of case work. In other words, it is not possible to begin case work at the top. But it is conceivable that a wide and intimate acquaintance with people might be a substitute for previousexperience informal case-work. Other types of social work, contact with social problems, practical work in psychology, all of these would certainly increase the potential value of the candidate for the course in psychiatry, but I doubt if any of them could be called pre-requisites.
There has been a tendency in the past to consider nurse’s training essential or very valuable for psychiatric social work. It seems to me that nurse’s training in so far as it is directed solely to the understanding and care of the diseased human body is in itself no preparation for under standing the mental problems with which psychiatry is primarily concerned. This does not imply that the knowledge of physical health which the nurse possesses isnot valuable asinformation oruseful inpractical situations, but simply that it has no direct hearing on the peculiar con tribution which psychiatry has to make to social work. Insofar as the most modern hospitals are training their nurses in public health work and medical social service from the beginning and are consciously teaching the psychological approach which should beused by the nurse in treating all classes of patients, they are giving a training which is preparatory to psychiatric social service,but such training is still far from universal.
As to the nurse who combines with her training, experience in wards of a hospital for the insane, if she possesses the other qualifications, her first hand knowledge of mental patients ought to give her a great ad vantage, but it does not in the least qualify her to undertake psychiatric social work with no other preparation. Without training in social technique, in all probability without anything but the most intuitive and unconscious psychology, and without understanding of social problems, she can have nothing to contribute to the work of the psychiatrist beyond the kind of thing she has done on the wards. This is not adequate for the supervision of the patient in his social setting where the doctor no longer knows or controls the details of the environment and cannot supply the knowledge and intelligence necessary to continue the after care of a patient by any definite set of instructions which can be carried out literally and accurately. That is, psychiatric social work as here in defined must be enlightened, conscious and intelligent. It cannot be merely an exact and faithful carrying out of orders on the basis of military discipline. The psychiatric worker must make a real contribution, must supply the social knowledge and technique the psychiatrist necessarily lacks and must be capable of extending his usefulness beyond the clinic or hospital by intelligent interpretation of his ideas.
The value of previous experience as a teacher is also somewhat doubtful in my mind. It is the exceptional teacher who escapes the in-elastic dogmatic attitude toward life, which our public school systems seem to favor. That the right kind of teaching in the right kind of school would be thebest of psychological preparation for psychiatric work, could hardly be denied.
Personality of the Psychiatric Worker
Our discussions if tsitself down then to the following general and tentative conclusions. Given adequate intellectual ability and educational back ground for dealing constructively with the problems of human personality plus emotional maturity, all other qualifications such as age, previous experience, etc., are to be decided on the basis of the personality of the particular candidate with the single exception, that experience in simple case-work either be a pre-requisite or shall be covered adequately in the course itself.
One reason why it is so essential to have a fairly clear conception of the kind of personality that is fitted for psychiatric work is that the very nature of the field attracts persons who are interested in insanity of mental difficulties because of their own problems. It is possible to get a class with too large a percentage of potential patients ifsome care is not taken in sizing upthe make-up of the candidate. This does not mean that only the most sane and normal make the best workers in this field.
Persons who are so simple, childlike and extroverted that they hardly know the meaning of personal life or emotional problems are too objective, too unselfconscious, too normal, if you will, for our purposes. They are unaware of their own mental life, they are likewise blind to the mental life of others. They should deal with things, not people.
On the other hand, the individual who is caught in the subjective phase, whose entire attention is turned upon her own conflicts, the painfully selfconscious person is in no condition to throw herself into the life of another with a genuine objective interest in all of its difficulties.
Such a person is not free to work. The question is, is she so com pletely involved that nothing short of a psychiatrist can help her, or is it possible that the course itself will enable her to work out her own problems and eventually make her an even more valuable worker because of the experience. It is a matter either of attempting to decide on the potential capacity of the candidate for adjusting or of rejecting all badly adjusted applicants. If the man who has had mental difficulties of his own and overcome them makes the best psychiatrist, as they sometimes say, may it not be equally true of the psychiatric social worker.
But you say, shall our courses undertake not only to train workers but to adjust their personal lives? Unless we limit our students to the rare group of individuals who seem to have a genius for living, and who adjust themselves without undue conflict in a normal spontaneous development, and to the group of those who have consciously and successfully taught themselves to adjust to life, we shall be obliged to give time in our course to straightening out personal problems. Social psychiatry brings these problems to consciousness inevitably, and interestis bound to center there until the studentcanworkherwayout. True, she is not much good at case-work until she has settled herself, but in my experience, there seems to be no way of avoiding this period of subjective interest among students who are drawn from an imperfect world where most people are unadjusted and un familiar with mental hygiene. It seems to me this stage of absorption in the personal application of social psychiatry should be allowed for and the objective direction of attention not be expected until later.
It is difficult to list the personal qualities which render a candidate for the psychiatric course seriously undesirable and it isextremely difficult to pass judgment in concrete cases. Perhaps if we could draw a picture of the type of person who is born for the job, we should have a kind of norm by which to measure our applicants.
The born psychiatric worker, as I see her has to be a maternal sort of person even if she is only twenty. She has to have a genuine liking for people and their troubles. It won’t do for her to be at bottom cynical, carping or critical. She needs a warmth and spontaneity and whole-heated interest that renders the making of good contacts simple, natural and inevitable. I am inclined to think that she ought to be a settled person, a fairly satisfied person, who has a philosophy of life which she has tried out and can pass on with conviction and whose basic attitude toward life is a sober optimism. Without this, she will find it not so easy to throw her interest into the problems of every patient with perfect objectivity. The restless, unfulfilled, seeking, pessimistic individual cannot tear her attention loose from her own troubles long enough to manage other people’s. Finally, the ideal psychiatric worker, like the old family physician, must be the person who has the strength to carry the patient, the poise which gives him confidence, the sympathy that means real understanding, the open mind which is always ready to try a new plan, the wisdom which allows the patient to work out his own salvation as far as he can, and the unending patience which is the rock on which he depends.
The personality that has strength and healing in its touch makes not only the great physician but the great social worker. The student who combines such a personality with the intellectual ability to use it to the best advantage or approximates such a combination is a safe risk for our course in psychiatric social work.
Source: Proceedings of the National Conference of Social Work, (Chicago: Rogers & Hall), 1920, p. 593-599.