would seem unnecessary to mention this, if some social agencies were not known to be very careless in the matter.

Wherever a confidential or social service exchange has been established among the social agencies of a community, the clerk can take the further step, at the same time, of telephoning to the exchange. In the absence of an exchange, other social agencies which have been mentioned by the client or which are likely to be interested can be inquired of, but the service that an exchange can render, as developed fully in a later chapter, becomes a great protection to everyone concerned, most of all to the client himself.1

When the exchange reports, in reply to inquiry, that certain other agencies which it names have also inquired about the client on such and such dates, their experience should be had before our first visit to his home, and preferably before our first full interview. The details of these consultations are also described under the heading of the Confidential Exchange; they need not detain us here, except to add that, where the data first given reveal no record and fuller data-names of relatives, etc.—are at hand little later, after the fuller interview, there should be a second inquiry of the exchange, and a second search, of course, of the agency's own files.

II. SCOPE

It might be said that the circumstances which modify a First Interview most of all are the case worker's own knowledge of. social disabilities, and his conception of the possibilities of social ⚫ treatment. But these are something more than circumstance; they are the medium, the surrounding atmosphere of all his endeavor. His attitude toward social disabilities and their treatment, plus his native instinct for the facts and values of human nature, are an important part of his social philosophy. Every item in the processes leading to diagnosis, from the first moment of the First Interview, through the unwinding of the last clue, to the final step of defining in as specific terms as possible the client's actual social situation, will be shaped by this knowledge and by this philosophy or will be marred by their lack. Formative in its influence also is

1 See section, the Confidential Exchange, in Chapter XVI, Social. Agencies as Sources.

the clear determination to make the treatment of which diagnosis is only a first step helpful.

Starting with these assumptions, what should be, in general, the objects and scope of a First Interview?

The establishment of a good understanding at this point has seemed to some workers so important and they have so overrated its difficulty that they have advocated confining the First Interview to expressions of friendly interest and sympathy, in the hope that the clues upon which outside inquiries depend may be gradually elicited later. But dodging the difficulty makes more difficulty. If a good understanding were our goal, this might be the way in which to begin; but our purpose is to get something done, and usually the saving of time is a most important part of getting that something effectively accomplished. The social diagnosis that is not made with a reasonable degree of promptness may be made too late. This view is emphasized by a case worker of long experience in a letter written to one of comparatively short experience, who, working in a family agency, advocated delay because clients so often in their first contacts with him seemed to have "framed up" their story. The adviser wrote:

Is not the made-up story you hear usually focussed upon today's situation, and is not a part of it really true? There are a few deliberate frauds who are clever enough to make up a long tale and have it hang together, but most people, well-to-do or poor, are not quick-witted enough for this. A kindly listener who hears what the applicant has made up his mind to say, and sympathetically draws him on to talk of other things, getting a story which runs back through all his life and looks forward to the future, has got something of which the made-up story forms a very small part. If the mind of the person in distress is all on the present, one may say, "Well, suppose I am able to arrange just what you ask, what about next week or month or year?" One secretary likes, when she can, to say to a man, "Now suppose you could arrange life just as you wanted it, what work would you really like to be doing?"-thus getting at a man's ideals and encouraging him by letting his mind dwell on them for a moment. Sometimes she is able to turn things that way or to some task more congenial than the old one. That for the future. As to the past, one of my friends has learned that the question addressed to a husband or wife of "How did you two happen to get acquainted?" will often lighten present distress by a memory of happier times, and also bring a flood of information as to the relatives on both sides, former home and occupation, the standard of living to which they were then accustomed, and so on.

From points which do not seem to them essential, and would not to the investigator but that earlier omissions have proved them so, one gets clues not only to

possible inquiry from others, but to the character and psychology of the family itself. Afterward what proves to be untrue may be ignored, and between the family and the investigator a common knowledge of what is true may be taken for granted.

Are you quite sure that your own attitude-the feeling that what the applicant is going to tell you when he first appears "is a story well framed up"- -one that will "not hold good upon investigation”—is as free from the suspicion that you deprecate as is the method I advocate? Guiding the conversation does not mean questioning, necessarily..

You remember I pointed out in the M-record that you had to go twice to the hospital and doctor because you had not got in the first interview with either of them all they were willing to tell. The same waste of time and energy is avoided by a full first interview with the family, and it is sometimes not so easy to get information in the second interview with a family-they believing that they have told before all that is necessary—as it is from a hospital or a doctor to whom one can more easily explain.

As to the family's attitude, it is often like that of a patient who for the first time finds a doctor who really gets to the bottom of his trouble, taking in not merely obvious present symptoms but showing unexpected insight into matters of whose relation to the trouble the patient has been unconscious. The patient goes away with new hope and fresh resolves to do his full part. Of course, not everything is gained in one interview. That is to be supplemented by outside inquiries, and when one can arrange for continued personal relationships, by the gradual unfolding that comes in these. Sometimes later interviews prove of equal value. But without exception in my experience, investigators who have taken your view as to the first interview have been the least successful in the average outcome as to their families.

Here, then, we have the attitude: a cheerful willingness to listen to the present symptoms which seem so important to the one interviewed, but a quiet determination to get below this to a broader basis of knowledge, by carrying the client's mind forward to hopes and possibilities ahead, and backward to the happier, more normal relations of the past. And since, if we would help him, we must break through the narrow circle of our client's own view and get into the wider one of those who know and understand him, we must depend upon the First Interview for those clues which are most likely to supplement and round out his story. "I never mean to leave a family," says a case worker of long experience, "until I have some clue or other for obtaining outside information, no matter how long it takes me to get it."

1

1 Emergency interviews may seem to present an exception to this general statement. They are discussed later, p. 131.

It would appear, then, that the objects of a First Interview are fourfold:

1. To give the client a fair and patient hearing.

2. To establish, if possible, a sympathetic mutual understanding a good basis, that is, for further intercourse.

3. To secure clues to whatever other sources of information will give a deeper insight into the difficulties of his situation and their possible solutions.

4. To begin even at this early stage the slow process of developing self-help and self-reliance, though only by the tonic influence which an understanding spirit always exerts, and with the realization that later the client's own level of endeavor will have to be sought, found, and respected.1

These apparently separate and sometimes apparently conflicting tasks are four parts of one purpose. We wish to serve, and we desire to influence in order to serve, but influence exerted in a mistaken direction would be worse than futile; we wish to serve, and we desire to know in order to serve, but knowledge is an impotent thing in the hands of one who has lost, through impatience, the chance to use it. Consideration of this aspect emphasizes the difficulty. The way out of the difficulty is to see clearly that frank and informal talk can be a help both in winning a common understanding and in securing clues to the coadjutors who can help us to understand still better. How soon the ground already won can be lost without their co-operation any candid examination of social case records would prove only too conclusively. Social work is team work. It must be conceded that good will and patience will not always bring the needed data; it is possible to waste time by pushing stubbornly and immediately for every available clue. In a small minority of interviews, it is better to trust to finding more clues outside in the course of following up the few that are grudgingly

1 "The study of defectives and failures brings home to us most forcibly a fundamental fact of economics,-that certain persons are adequately endowed for small demands, but are bound to fail under an excessive demand. There would be far more happiness and real success in mental hygiene, if more people would realize that at every step, every person can do something well and take a satisfaction in doing it, and that this satisfaction in something done is to be valued as ten times greater than the satisfaction taken in mere thought or imagination, however lofty." -Adolf Meyer: What Do Histories of Cases of Insanity Teach Us Concerning Preventive Mental Hygiene During the Years of School Life?

revealed; and, with a still smaller remnant, treatment has to begin in an experimental way before any evidence can be brought to light upon which a plan of treatment can be solidly based.

III. METHOD

1. The Approach. As often happens, the best description of method comes to us from practitioners in other fields. Dr. Adolf Meyer in an unpublished document instructs the psychiatrists who are his students as follows:

For any examination, the mode of approach is absolutely decisive of the result. The reserve of the patient is usually a factor to be reckoned with, or, if not the reserve, at least the unwillingness to show a clear picture of decidedly peculiar experiences. It is, therefore, necessary to gain the confidence by treating the patient "as a sensible man or woman," and, wherever the patient does not speak freely, to begin with questions about whether they have all they need for their comfort, to pass to some of the least irritating topics, such as will most likely elicit a pleasant answer and create a congenial starting point. In perfect privacy and, as Head says, with the choice of a quiet confidential hour and the precaution of changing the subject when irritation begins to adulterate the account, and before the patient has been exposed to the influences of the ever present blasé fellow patient, the statements can usually be obtained quite fully, often with a feeling of relief in the patient, and a distinct gain in the relation between physician and patient. That any chances for self-humiliation must be eased with verbal suggestion and that any appearance of obnoxious ridicule or dictation or correction and unnecessary argument must be avoided, should not require special insistence. It certainly requires a great deal of knowledge of man to choose the right moments and it is to such an extent a matter of inborn tact, that it is doubtful whether any written rules can do more than bring out in a more definite order that which one has already.

Privacy, absence of hurry, frequent change of topic, with some deliberate padding to ease the strain, particularly "when irritation begins to adulterate the account," and yet through all a clear conception on the part of the interviewer that a certain goal must if possible be reached, and a slow, steady, gentle pressure toward that goal-this, in brief, is our program. Giving the client all the time he wants often leads to that fuller self-revelation which saves our time and his in the long run. Pressure of work! Lack of time! How many failures in treatment are excused by these two phrases! But, wherever else the plea of lack of time may be valid, it is peculiarly inappropriate at this first stage, for no worker ever has leisure enough in which to retrieve the blunders that result