T 120. APPENDIX I FIRST INTERVIEWS HE three analyses of First Interviews which follow have been selected from a larger number submitted in response to the questions given on p. The first is with a patient in a medical-social department, the second with a deserted wife in the office of an associated charities, and the third was held in the home of a young wife, a colored woman, who had just lost a child. Care has been taken to change these interviews in minor details, which leave unchanged their value as interviews but perhaps make the identification of the persons interviewed less possible. 1. ANALYSIS OF INITIAL INTERVIEWS WITH A PSYCHONEUROTIC PATIENT Patient is brought into Social Service Department by doctor from Male Medical Clinic, who tells worker that the case is clearly one of apprehension. Boy, sixteen years old, is physically sound. He lost his mother when very young, is unhappy, and has given up his work, because he became afraid he was sick. What he needs is a friend, somebody who will care and who will get him started. During this conversation patient is sitting on the bench. He is a handsome boy, with a very attractive smile, looks a little embarrassed, but gets up with a friendly smile when doctor introduces worker to him. Is greeted cordially, worker shakes hands and asks him to wait a few moments while she finishes a conversation with another patient. Boy has evidently a real admiration for the doctor. In a short time patient is invited to sit by worker's desk. Worker explains to him that the doctor has not time enough to go into It is very helpful to have doctor introduce patient to worker. He thus shows patient that he trusts worker and that he believes in her power to help patient. Worker can inspire confidence in patient by her manner, which should always be cheerful and at ease. all the details of his case, but wishes a study of it made, and that she and he will study it together. Patient assents. It is then explained to patient that he must be prepared to answer a great many questions and to tell everything he can think of about himself and his family. Is told that if worker had known him all his life she would know how many brothers and sisters he had, and where he had been to school, but that now he has come to her out of clear sky. He is like a figure standing in front of a white screen. He has no background. As nobody in real life stands in front of a white screen, patient must paint in the details. He understands and says he will be glad to help and will answer every question. As it is late in the morning patient is invited to come in again next day and is told that the necessary study may take several interviews. When patient comes in again record is begun by asking him where he has been previously treated. He had never had a doctor until the year before when his brother's doctor saw him a few times. This puts the emphasis upon the objective point of view and makes patient a little less self-conscious. Again manner plays an important part. This is said as if worker and patient were about to begin an interesting game. This relieves patient's embarrassment if he feels any. Patient is evidently amused and interested and says he will be glad to come again. Worker helps patient to concentrate his attention upon this "study" by the businesslike way of writing down his answers to questions, or the narrative he gives unassisted. This places social record on same plane as medical record in his mind (a part of his treatment), since it is taken in same manner, and shows him that doctor considers it all important. This rule is broken only when in a more confidential part of the story patient needs the help of an encouraging look, or undivided attention from worker. After initial record is made, taking notes is usually unnecessary, though worker never hesitates to take them if anything important is told. It keeps in patient's mind the fact that doctor is in touch with case. It is then explained to patient that the study of his case necessitates his telling all he can remember about his family. He is asked about his grandparents. The only one he knows anything about (the others having died in Austria) is his father's father, who is alive and in this country. Patient has apparently no affection for him, and says he is "cross and quick-tempered" and hard to get along with; does not stay long with any of his children. Is pretty well physically. His father is a teacher. Does not seem to know how to describe him until worker asks several questions. Then says, "He is a good-natured man, sometimes gets his temper up," but is good to his children. Came to the U. S. eighteen years ago; has lived in Dever since; was married when he was seventeen. Is honest; much thought of among his fellow-countrymen, but earns a very small salary. In Austria his position was very different. Is unable to help his sons much. Mother died when patient was only three. He can remember nothing about her. This fact seems to have taken a certain hold upon his imagination. Patient has three brothers and a sister and there is evidently much affection among them. They are all older than he and while his sister was at home she looked out for him. He tells of their education, occupations, and marriage with very little questioning. About five years ago his father married again and patient has not been happy with his stepmother. Just at present he is living with a sister of his mother. As patient complains of pain in his side, he is told what a habit pain is a vicious circle, "attention creates sensation, sensa While at first puzzled to know what is wanted, patient is very responsive. Fatigue in attention is avoided by the many interruptions which come to worker. Though these interrupt narrative they have their uses. Patient shows little interest in ancestry. Great care is taken to ask questions which describe opposing traits so that patient may not have answers to questions suggested to him. Patient unconsciously finds in this loss excuse for many of his weaknesses. After patient understood what sort of description was necessary in his father's case he described the others quite easily. tion causes fear, fear increases attention," which must be broken through at the point of fear, because patient is afraid the pain means something serious. As the doctor has pronounced him physically sound, patient is urged to rest his faith in this statement. He is reminded of his relations to other people and the possible effect of his discouraged attitude upon them. He is going out of town to visit one of his brothers for a few days, but will come again on his return. He is asked to write down anything he can remember of his life. Immediate effect is seen in a postal received from patient the next day in which he writes, "I am feeling fine." Five days later patient comes again. Had felt perfectly well till "yesterday when the old pain had appeared again," and he is feeling a bit discouraged. He brings a written statement of some facts in his lifehis proneness to stay by himself, his industry at school, his lack of all intellectual interests outside of his school work. Family are very poor and patient does not get on well with his stepmother, though he stayed at home after all the others went away, because he wanted to get an education. Record is taken up again and family history is continued. Patient tells of his father's and mother's relatives; then of what he had done since school; his habitshow he spends his time, what he eats, etc. His not having earned anything for four months is not a real source of worry to him, as his family are all good to him. His responsibility toward others is suggested to him from the beginning. This is intended to keep his interest in the study alive. This leisurely way of taking the record is designed to suggest to patient that he must not expect to overcome his bad habits at once. Thoroughness is much more important than speed. A patient is very apt to respond quickly, but when he feels his old sensations come again, discouragement follows. Document is read and patient is encouraged to write more, and more fully and freely. This is to increase his personal interest in study and gives him opportunity to express his own views without chance of suggestion from worker. These facts make rough sketch of patient's background. |