State of Illinois 
Dwight K. Green, Governor 
INSTITUTE FOR JUVENILE RESEARCH 
907 South ITolcott Avenue 
Chicago, 12, Illinois 
Cassius Poust, 
Director, the Department 
of Public ITel fare 
Horace E. Thornton 
Deputy Director, Educational 
and Correctional Services 
Sophie Schroeder SI Oman '9 II. D. 
Acting Superintendent, the 
Institute for Juvenile Research 
A Manual for Psychiatrists 
at the 
Institute for Juvenile Research 
Copyright 
1948 
Institute for Juvenile Research PREFACE 
This manual was compiled by the psychiatrists of the Institute for 
Juvenile Research and is designed primarily for the use of psychiatrists 
beginning their work here. The first sections deal more with orientation:to » 
the history and clinical structures of the Institute; the latter sections 
are concerned chiefly with clinical procedures. 
The manual should be used only as a guide since the complexity of 
interpersonal relationships contraindicates any rigid system of understand-' 
ing or dealing with a child ’s problem* Since our concepts change with time, 
it is foreseen that occasional revisions vail be necessary. 
Members of the Psychiatric Staff 
Fellows in Psychiatrv 
Harold A, Greenberg, M.D, 
Francisco .'Alarco, M.D, 
Irving D. Harris; M.D. 
Helen R, Beiser,'M,D, 
Bernhard Kaufman,'M.D, 
Robert P, Cutler, M.D. 
George L. Perkins, M.D, 
Harold R. Koff, M.D. 
David Rest, M.D, 
Robert R, Kuehnert, M.D, 
Harry H, Segenreich, M,D, 
Sam I. Stein, M.D, 
Maurice Rosenthal, M,D, HISTORY OF THE INSTITUTE FOR JUVENILE RESEARCH 
SECTION A 
The child guidance clinic attempts to make a modest and specific 
contribution to the welfare of children. Historically, however, it owes 
its existence to the broader concern of various groups, to the age-old 
and varied problems of delinquency, mental disease, and dependency. 
Child guidance clinics have attempted to provide guidance at those points 
where the understanding and service which other social agencies have 
mustered to meet a child’s need are not sufficient. Such an attempt 
might be presumptuous except for the fact that the clinics offer not 
merely one line of attack on these difficult problems, but a synthesis 
of techniques not often brought together elsewhere, and more effective 
in combination than they could be singly. 
The functions of the child guidance clinics are threefold: they 
study and treat patients; they seek to interest other community agencies 
in the prevention of behavior and personality disorders in children by 
promising methods of dealing with them when they occur; and they attempt 
to reveal to the community, through the first-hand study of individual 
children, the unmet needs of groups of children. This Institute also 
undertakes the systematic analysis of case material in the hope of con- 
tributing more exact knowledge of child behavior; and it provides train- 
ing for students of various professions. 
Although the term ’’child guidance clinic” was not coined until 
1922, the essentials of the clinic scheme had been finding their way 
into existence for more than a decade before that year. In 1915* Dr. 
William Healy wrote: 
’’The idea that the individual must be carefully 
studied in order that crime may be ameliorated has 
been steadily growing since the day of Lombroso.”# 
Dr, Healy’s own contribution to the growth of this idea had already be- 
come an outstanding one. He had concentrated study from the medical, 
psychological, and social point of view on youthful offenders, with the 
aim of searching out the causes of their misbehavior and finding ways 
of preventing them from developing into adult criminals. A Chicago 
child guidance clinic latter called the Juvenile Psychopathic Institute, 
founded by him in 1909, was unquestionably the pioneer in this field. 
To some degree, the way had indeed already been blazed by Lightner 
Witmer’s Psychological Clinic, established in 1896 at the University of 
Pennsylvania, but Dr. Healy*s procedure included new scientific approaches 
from both the medical and psychological angles, and the predominant interest 
in delinquency also set his clinic apart from previous organizations whose 
services had been primarily to education. 
Healy: The Individual Delinquent, Boston: Little Brown 
and Co,, 1920, page 25 Section A 
The Chicago Juvenile Court (Juvenile Court of Cook County), which 
the Institute undertook to serve, was itself a pioneer of only ten years' 
standing, which had been hailed as a contribution to the solution of the 
problems of juvenile delinquency. It had, however, found its efforts 
hampered by lack of any means of scientific analysis of the human nature 
with which it dealt. The separation of youthful from adult offenders, 
the provision by probation officers and co-operating agencies of a cer- 
tain amount of information about backgrounds and early histories, the 
substitution of humanly normal contacts for legalistic relations between 
culprit and judge, the probationary supervision of offenders - all these 
features of the new court, while sound in themselves, had failed to bring 
about so great a reduction in juvenile delinquency as had been hoped for. 
It seemed that the individual boy or girl who violated the law was usually 
a far more difficult person to understand and help than anyone had antici- 
pated. The Chicago Juvenile Court judge, Merrit W* Pinckney, realizing 
this, welcomed co-operation from a new quarter, and the director of the 
new clinic, while deeply interested in the research aspects of his job, 
gave himself unstintingly to practical case-by-case matters. Not until 
five years of service had been performed did he gather his main findings 
together into a book, The Individual Delinquent, which soon came to be 
regarded as authoritative the world over. 
Before this formulation reached the public, the work of the 
Chicago Institute had begun to exert an influence upon other communities 
through visiting psychologists, psychiatrists, social workers, and juven- 
ile court judges. While, from the first, the Chicago clinic recognized 
the importance of social factors in causation and cure, making a keen 
evaluation of all the background facts supplied by co-operating social 
agencies, and relying on their workers for collaboration, it did not have 
a regular full-time social worker on its paid staff. During the years of 
Dr. Healy's service in Chicago, however, social workers came to be employed 
by a number of State mental hospitals and clinics in New York and 
Massachusetts, while in 1912 and 1913 such workers were appointed to the 
staffs of two new hospitals of a more modern type - the Boston Psychopathic 
Hospital and the Henry Phipps Psychiatric Clinic of Johns Hopkins Hospital, 
which worked with children as well as with adults. Dr. Herman M. Adler, 
coming from the Boston Psychopathic Hospital, naturally introduced into 
the Chicago Institute the type of social work with which he was familiar, 
and the Judge Baker Foundation also added a social worker to its staff. 
In the four centers mentioned, what may be termed the foundations of 
scientific child guidance were laid.-M- 
Through the generosity of Mrs. William F. Dummer, the Juvenile 
Psychopathic Institute was supported as an adjunct of the Cook County 
Juvenile Court for five years and was housed in the old Juvenile 
Detention Home on Ewing Street, about a block from Hull House, Its 
#The preceding paragraphs were abstracted from Child Guidance Clinics, 
by George S. Stevenson and Geddes Smith, New York; Commonwealth Fund, 193h Section A 
prime objective was to discover the sources and possible prevention of 
delinquency, and its first officers, Mrs. Dummer, Mrs. Julia C, Lathrop, 
and Mrs. George R. Dean, wisely chose as its first director. Dr. William 
Healy, already becoming well-known through his work with problem children. 
From 191k to 1917, the Institute was a county agency supported by 
Cook County funds and was housed in the Psychopathic Division of Cook 
County Hospital. In 1917, Dr. Healy resigned to become head of the Judge 
Baker Foundation in Boston. That same year the Juvenile Psychopathic 
Institute was taken over by the State of Illinois as part of the newly- 
established Department of Public Welfare, and Dr, Herman M. Adler, 
Professor of Psychiatry at Harvard Medical School, accepted the appoint- 
ment of State Criminologist in Illinois and Director of the Juvenile Psy- 
chopathic Institute. Thus, the Institute came to represent the preventive 
work of the Division of the Criminologist. During a short absence of Dr. 
Adler when he was released to become a medical officer with the Armed Forces, 
for the duration of World War I, Dr. H. Douglas Singer, State Alienist, was 
Acting Director of the Institute, Until 1920 the clinic continued to be 
housed in the Psychopathic Division of the Cook County Hospital. 
In August 1920, several months after Dr. Adler returned to the 
Institute, the name of the Clinic was changed to Institute for Juvenile 
Research, a title which represented more nearly its objectives and aims, 
for it was the hope of the staff that cases could be carefully selected 
and studied intensively with the purpose of finding out why children mis- 
behave, In this same year, 1920, the Clinic was moved to a State building 
at 721 South Wood Street. 
In 1923, the first (rural) community clinic was organized. Under 
this policy, about thirty locally controlled clinics were established* 
The Institute co-operated in their organization with the understanding 
that the people of the community must be ready and desirous of such a 
clinic and willing to give themselves to assure its success. The Institute 
for Juvenile Research has been sending clinical teams to these clinics 
which have acted merely as consultants and advisers.. 
In 1926, the Institute, because of its rapid growth, was moved to 
larger quarters in a State building at 907 South Lincoln Street (now 905 
South Wolcott Avenue). In this year, research under the new Behavior 
Research Fund Staff began. This was a five-year project which was financed 
by public subscription. One of the outgrowths of the Behavior Research 
Fund was the formation of the Chicago Area Project, This project was 
founded as a corporation in 193k to develop a program for the treatment of 
delinquents and the prevention of delinquency by utilizing the social forces 
inherent in the life of the community. The Project is part of the Illinois 
Department of Public Welfare, but is, in part, privately endowed. It has 
been associated with the Institute for Juvenile Research and has had 
Clifford R. Shaw as Administrative Director since its inception. Section A 
In 1930, Dr, Adler resigned as State Criminologist and Director 
of the Institute, having served in this capacity for thirteen years. 
He was succeeded in both offices by Dr. Paul L. Schroeder, who had 
worked with him for six years as Chief of the Psychiatric Service, In 
that year, the Institute moved into the new building at 907 South 
Wolcott Avenue which had been built for it by the State of Illinois and 
where it is housed today. 
In the summer of 19kl, the Institute, by legislative action, was 
separated from the Division of the Criminologist and became a separate 
division under the Department of Public Welfare, Dr. Schroeder was 
appointed Superintendent to continue as its head. Under the new law the 
Institute's duties are defined as follows: 
’’The Division herein created shall conduct 
scientific studies, diagnose and promote the treatment 
of children who are delinquent, mentally ill, mentally 
defective, or socially maladjusted, or who are in danger 
of becoming so, to the end that delinquency, crime, 
mental disorders and other forms of human maladjustment 
may be prevented. In the administration of this Act, the 
Division shall make personal examination and social 
studies of such children and shall make its services and 
treatment available to children in the custody or under 
the control of the Department of Public Welfare or of any 
court, school, public or private social agency, or parent 
or guardian.” 
The budget allowance for the Institute in 19U8 provided for 19 
psychiatrists, lU psychologists, and 8 social workers (a few of these 
positions to be filled by persons not working in the Institute building). 
This does not include other professional workers or students. According 
to the Secretary of the American Board of Psychiatry and Neurology, the 
Institute for Juvenile Research is the largest child guidance clinic in 
the United States. 
In January, 19U2, the Institute was given charge of a children's 
ward in the Illinois Neuropsychiatric Institute, It was supervised at 
first by Doctors Stanislaus Szurek and Adelaide Johnson, They were suc- 
ceeded, in turn, by several others, and in January, Dr. Harry 
Segenreich was placed in charge. 
This ward is the only state facility for the treatment of normally 
intelligent children who present seriously handicapping neuroses, behavior 
disorders, psychotic, or pre-psychotic patterns. Since only a very few 
children can be afforded this treatment, the service to the general public 
is primarily educational and informative; the result of an experimental 
approach, a research technique, and a teaching program. The detailed 
functioning of the ward is described elsewhere. SECTION B 
ORGANIZATION OF THE INSTITUTE FOR JUVENILE RESEARCH 
a. Administrative 
Although the Institute for Juvenile Research has been in existence 
for many years, in 19U3 it became a separate division under the Department 
of Public Welfare, The Bill passed by the Legislature reads in part as 
follows: 
"Section 1. There is established under the authority 
and supervision of the Department of Public Welfare a 
Division to be known as the Institute for Juvenile Research, 
Upon the taking effect of this Act, the Director of the 
Department of Public Welfare shall appoint a qualified 
person as Superintendent of said Division, and such other 
employees and assistants as may be necessary to provide a 
proper administration of this Act," 
The Superintendent of the Institute for Juvenile Research is re- 
sponsible for the administration of the several divisions, or departments 
in the Institute, These include: 
1, The Administrative section (stenographers, clerks, typists), 
2, The Psychiatric Division (Fellows, staff psychiatrists). 
3, Psychological Division (Students, staff psychologists), 
lu Social Service Division (Students, child guidance coun- 
sellors, supervisors), 
5, Sociology Department (community workers, sociologists). 
In addition there are the Psychophysiological Laboratory and the 
Recreational Therapy section. 
Some explanation regarding the functions of these divisions may 
ne necessary. 
The functions of the psychiatric, psychological, and social service 
divisions are mainly in the fields of diagnosis and treatment of individual 
child problems. The sociology department is quite separate. It deals with 
community problems concerning juvenile delinquency and handles them on a 
local community basis. The Psychophysiological section aids in the diagnosis, 
principally by means of electroencephalographic studies. 
Besides the service functions of the Institute for Juvenile Research, 
various research projects are carried out by the separate divisions, either 
singly or collaboratively. Section B 
b, Clinical 
Our sources of referral are parents, schools, doctors, social 
agencies, health departments, and courts. Whatever the source of referral, 
an application must be filled out and forwarded to us. It has been found 
more effective and more productive of successful handling if the applica- 
tion is filled out by the parents. This is so because little can be done 
for the child without the co-operation of the family. Applications filled 
out by social agencies and teachers carry the element of coercion and fre- 
quently raise parental antagonism. 
Since public agencies are usually aware of our services, it might 
be informative to describe the course of a private or family referral, A 
mother is concerned about her boy and happens to hear about our services. 
She usually either calls up or drops into our clinic, and an intake social 
service worker talks with her. During the conversation an explanation of 
our services and of the mechanics of application is carried out. Besides 
this, the intake worker strives to make the contact therapeutic by vary- 
ing amounts of reassurance and acceptance. The waiting period is explained 
two to three months between application and examination; two to five months 
between examination and treatment. At this time written permission is 
secured from parent to obtain pertinent information from doctors, schools, 
and social agencies. 
After the application is in our hands, the intake committee de- 
cides whether we will see the case. Since we are a public agency, there 
are few instances in which we would decline to examine the child. The 
application and other material then go into the files and are again 
pulled out when the case is to be scheduled for diagnostic examination. 
The scheduling is done by a group of three individuals, one from each 
department (psychiatric, psychological, and social service). Although 
usually each department participates in the diagnostic study, frequently 
there are variations such as the following: if the child has already had 
a psychometric examination, e.g,, from the Bureau of Child Study, it is 
not necessary for us to repeat the examination. In such a case the psy- 
chology department is not scheduled for participation in our diagnostic 
study. Also, if a social agency has already provided us with an exten- 
sive history on the family, it is not necessary for a social history to 
be taken by our own social service department. If the child is grossly 
retarded and presents few or no emotional problems, it will not be necessary 
for a psychiatrist to see the child or the parents. After the case is 
scheduled the case folder goes to the administrative section where letters 
of appointment are sent to the fanily. Usually the social history and 
psychometric tests are done on one morning and two weeks later the psy- 
chiatric examination is made. 
When the psychiatric examination is completed a diagnostic staff 
meeting is held in the afternoon. In this staffing, recommendations as to 
disposition are made. If placement of the child outside of the family is 
recommended, then frequently a conference is arranged with the referring Section B 
agency, or with the agency which will handle placement, in order to ac- 
quaint them with our evaluation of the case. If treatment at the Institute 
for Juvenile Research is recommended, then the case folder goes to the 
treatment intake committee, where the advisability of treatment is gone 
into again and assl gnment to one of the three departments is made. Then 
two to five months thereafter, depending upon the emergency nature of the 
case and on the availability of a therapist, treatment is usually begun. 
The prospective therapist usually writes to the family inviting them to 
begin the therapeutic interviews. During the course of treatment staff 
conferences are held to evaluate the progress of treatment, to redefine 
goals of treatment, or to close the case. SECTION C 
PSYCHIATRIC WARD FOR CHILDREN 
The children’s Psychiatric Ward was established to furnish resi- 
dential therapy, offer means for research and special study, and provide 
opportunities for the training of nurses. The Ward is located on the 
sixth floor of the psychiatric wing of the Illinois Neuropsychiatric 
Institute building. It was opened in December 19^1. 
The bed capacity is held to twelve. Entrance into the Ward is 
through locked, shatter-proofed, glass-paned doors into a central corri- 
dor, in the center of which is a slightly projecting nurses’ charting 
room. This has a safety glass door and windows permitting observation 
of all activities in all directions of the hall. The ward rooms and of- 
fices, as well as bathrooms, toilet rooms, closets, and dining room open 
into this corridor. At the far end is a door opening into a wire-enclosed 
out-door porch, 
Furniture in each of the rooms is sparce. There are hospital- 
type beds and bedside cabinets, but no decorations, curtains, or draperies. 
However, in the lounge there are many comfortable chairs, a piano, draper- 
ies, pictures, and other furnishings to make the room as home-like as 
possible. The dining-room adjoins the lounge. There is a playroom as 
well as a closet in which the clothes of all the children are kept. 
Administration of the Ward 
The State Department of Public Welfare provides the physical main- 
tenance of the Ward including supplies and equipment. Maintenance is ob- 
tained through the regular channels established for the entire Illinois 
Neuropsychiatric Institute. The Superintendent of the Institute for 
Juvenile Research directs the Ward activities through the Chief of the 
Children’s Psychiatric Service, who is a member of the psychiatric staff 
of the Institute for Juvenile Research, Staff members from the various 
departments of the Institute function as psychotherapists, psychologists, 
educational and recreational therapists, and social workers. Because of 
the Ward’s physical location in the Illinois Neuropsychiatric Institute 
building, general administrative policies are established by the Director 
of INI, The nursing staff is provided by the School of Psychiatric Nursing 
of INI and is supervised by that organization. The nursing staff consists 
of full-time graduate nurses. In addition there are affiliates, post- 
graduate students, as well as under-graduate nurses. Attendants are also 
provided. One nurse is designed as head nurse of the Ward, These persons 
all wear street clothes while on duty. Domestic care is provided by the 
dietitian and housekeeper. In addition, the resident of the Pediatric 
Service of the University of Illinois Hospital is also available. The 
resident of psychiatry during his three months’ service at the Institute 
for Juvenile Research provides residential care for the Ward, 
Chart I offers a diagrammatic representation of the organization. Section C 
Admissions to Ward 
Applicants for admission to the Ward are first examined at the 
Institute for Juvenile Research or in one of its regional clinics, and 
are then referred to the Chief of the Children’s Psychiatric Service from 
the Intake Committee. Cases for admission are selected by him. The sel- 
ection of cases is subject to the limitations of the physical plant as 
well as that of facilities and staff. The upper age limit is twelve 
years and the lower, approximately five. There are no restrictions as 
to sex or color. Children whose behavior is such that they might cause 
serious damage to the building or to other patients are usually unaccept- 
able, Only those children whose symptoms are amenable to treatment are 
accepted unless they offer special research or training value. Cases 
referred from the regional clinics are interviewed by personnel from the 
Ward Services, and subsequently discussed for admission. Patient and 
parent, therefore, are asked to come to Chicago for interview and then 
return home at their own expense. It is advisable to avoid making any 
promises concerning acceptance or date of admission to the Ward until 
the child has been definitely accepted. 
Treatment of Ward Children 
Treatment of Ward children is carried by members of the staff of 
the Institute for Juvenile Research, A patient is assigned to a staff 
member in the same manner as in all Institute therapy cases. The fre- 
quency with which a patient is seen rests upon the judgement of his 
therapist, but the patient is usually seen about twice a week, preferably 
in a playroom at the Institute for Juvenile Research, There are, however, 
no fixed limitations. The therapist may call for the patient at the Ward 
or make arrangements to have him brought over to the Institute, This de- 
cision too is left to the therapist. Collaborative therapy is also given 
to the parents of Ward children as in other cases of the Institute, 
The Ward personnel provide the proper environment for the patient 
during his residence. This environmental therapeutic milieu is super- 
vised by trained personnel. Problems are brought up and discussed at 
the Ward staff meetings held bi-weekly in the Institute for Juvenile 
Research building, at which all Ward personnel are present and which 
therapists should attend fairly frequently in order to exchange ideas, 
to learn what has been occurring on the Ward, and to offer therapeutic 
material to the Ward personnel. Thus, collaboration can be accomplished 
as well as a thorough understanding of the dynamics, movement, and 
progress of each case. SECTION D 
DUTIES AND RESPONSIBILITIES OF THE PSYCHIATRIST 
AT THE INSTITUTE FOR JUVENILE RESEARCH AND IN THE REGIONS OF THE STATE 
The main function of the psychiatrist in a child guidance clinic is 
the integration of all available data concerning the problems of a given 
child for the sole purpose of initiating corrective procedures. The social 
service and psychology departments contribute part of these data; the psy- 
chiatrist the rest. The psychiatrist is responsible for the examination 
of the child and parents assigned to him on his Diagnostic Applications 
Service (DAS) day. To help him in his evaluation it is best that he first 
secure adequate knowledge of the presenting problem by reading the DAS 
application and the social history. Usually an evaluation of the child's 
general intelligence and behavior in the test situation is provided by the 
psychologist. It is often helpful for the psychiatrist to acquaint him- 
self also with these results before he attempts to study the child psy- 
chiatrically. 
He then sees the child. If the child is very young or immature, 
the play interview technic is used. It is the responsibility of the psy- 
chiatrist to set the proper limits on the child's behavior so that no 
wanton destruction takes place, and when he leaves the playroom he should 
see to it that it is in a satisfactory condition,* With older and more 
mature children the face to face interview can be used for which inter- 
viewing rooms are available. 
It is the responsibility of the psychiatrist to perform a phy- 
sical examination including a complete neurological examination on all 
children that are seen by him. Only when the child has been under medical 
care and a report of his physical condition is available, is a physical 
examination unnecessary. In the case of pre-adolescent or adolescent 
girls, if the psychiatrist is a male, it is necessary to have either a 
mother or a psychologist present while the examination is performed. If 
the psychiatrist is not satisfied with his own examination and feels that 
a more specialized examination is needed, it is his duty to refer the 
child either to the parents' private physician or to the proper depart- 
ment at the University of Illinois Hospital, In such a case he will 
contact the social service department of that hospital and make an 
appointment for the child. It is the duty of a Fellow to complete all 
assigned physicals on mental defectives for whom psychology has recom- 
mended commitment. Such an examination is usually not an exhaustive 
one, but provides a general evaluation of the child's physical condition. 
The results of the physical examination are recorded in detail on the 
three-page white form, and a summary of the important findings on the 
single-page blue form, both of which may be found in the examination 
room. 
*See page 5 of this section for further details about playrooms. Section D 
Occasionally an electroencephalogram is indicated. In such an 
event it is the duty of the psychiatrist to complete the forms for this 
examination, securing the necessary data from the social service history 
or through direct questioning of the parents. It is his responsibility 
also to make an appointment with Dr. Darrow and to see to it that the 
parents are properly notified. He may obtain from Room 210 the forms 
which give the parents the necessary directions for preparing the child 
for this examination. 
After the examination of the child is completed the parents are 
seen. If both parents are available each one is seen separately. If no 
parents are present and the child has been referred through some agency, 
the accompanying worker is then seen. The psychiatrist in his interview 
tries to secure the dynamics of the problem and to evaluate the treat- 
ability of the parents. If he believes that placement is indicated he 
should find out how the parents feel about this. If he thinks the case 
should be closed he should tentatively close it, leaving an opening in the 
event the staff reverses his decision. Usually it is better to close 
cases in a completion interview with the significant parent. It is of .. . 
the utmost importance that a signed permission blank be secured from 
the parents which will enable us to give information to the proper sources 
when such an action is necessary. If permission is obtained at the time 
of the interview, the energy and time involved in sending a letter to the 
parents asking for such permission can be saved. 
At the DAS staff the psychiatrist presents the problem and any 
pertinent information in this area. After the staff jointly makes dis- 
position of the case it is the duty of the psychiatrist to carry out, 
with his particular case, any procedures recommended by the staff. The 
psychiatrist will write all reporting letters to agencies, physicians, 
and occasionally to other sources, if he is the only person assigned to 
the case. The reporting letter is written for the Superintendent of the 
Institute and signed with his or her name. For this reason care should 
be exercised in making any commitments. Agencies should be given a 
summary of our examination and our staff recommendations, but only such 
material should be included as the agency can accept. The following 
are sections which are included in a letter: 
The letter begins, "We wish to report to you the results of 
our examination of the above-named child who was seen here on such-and- 
such a date.” The next paragraph reads, ,fA physical examination dis- 
closed, It was recommended that An ,’lectrco- 
cardiographic examination was also made and the following was reported 
,f Or, "No physical examination was made because a report 
from your physician (or agency) was available and there were no indica- 
tions for repeating the procedure.1' 
The next paragraph gives the psychological findings. In re- 
porting the psychological findings no IQ ratings should be given to any Section D 
agencies except those connected with the court, the Illinois Children*s 
Home and Aid Society, the Jewish Children*s Bureau, etc* Agencies have 
a tendency to misinterpret our scores and reports to them should read as 
follows: "On the Stanford-Binet (or other tests) John earned a rating 
which indicated he was of average general intelligence." In a letter to 
the court, one may say, "On the Stanford-Binet (or other tests) John, 
with a chronological age of ..... earned a mental age of giving him 
an IQ of • •••• which classifies him as of ••••••• general intelligence. 
In all cases the statement should then be made as to whether the psy- 
chologist considered the rating reliable. 
The next paragraph contains the psychiatric evaluation of the 
child and a summary of the interview with the parent or parents. Both 
these statements should be very brief and in terms which are not con- 
fusing and which the average worker may understand. 
A paragraph is now included in which the staff opinion and any 
recommendations which have been made are given. This information is 
usually presented as follows: "It is the opinion of the staff that John 
Doe is a disturbed child due to such-and-such. It was felt that such- 
and-such might be of value," or, "It was suggested that John Doe might 
benefit if It might be well for the psychiatrist to remember 
that the paragraph containing the recommendations is usually the part 
of the letter most important to the agency* 
The letter is closed by saying, "If in any way we can be of 
further help to you, please feel free to call upon us," 
It is advisable to use the child’s first name whenever possible, 
for this helps to add a more personal touch to the letter. 
It is the duty of the psychiatrist to be present at any con- 
ferences that are scheduled with an agency* He is to see all parents 
in completion and is responsible for restaffing the case in DAS if nec- 
essary. If the staff recommends short service interviews, it may be his 
function to give these interviews and to restaff the case on completion, 
or earlier, if such is the recommendation of the staff. 
The psychiatrist is also responsible for completing all forms 
which are to be used later for research purposes. 
After the DAS presentation the psychiatrist is responsible for 
the dictation of his examination and for placing these reports in the 
proper records. So far as possible, it is his duty, after the DAS staff 
is completed, to follow the case through to its completion. If a 
Rorschach, a Thematic Apperception Test (TAT), or other psychological 
test is necessary, the psychiatrist should consult with the psychol- 
ogist to set hours such that the parents will not be required to come 
back more often than necessary. Steps in this procedure are indicated 
on the DAS sheet and these should be consulted until some final dispo- 
sition of the case is made. However, it is helpful to make notes of Section D 
DAS recommendations as not infrequently they are omitted from the DAS 
sheet or, if recorded, may not be clear. 
In addition to the duties and responsibilities set forth in 
the preceding pages, the psychiatrist is reqiired at times to speak to 
Parent-Teacher Associations and other interested groups. Occasionally 
small groups are assigned to him for teaching purposes. 
The procedures just presented hold also for the several Regions 
of the State, The difference is that the facilities which are available 
at the Institute for Juvenile Research are usually not present in the 
Regions and consequently some changes are necessary. The beginning staff 
member usually accompanies some experienced staff member to the Regional 
clinic until such a time as he is able to carry on alone. It is the re- 
sponsibility of the psychiatrist when traveling to a Regional clinic to 
order his train ticket at the information desk in the lobby of the 
Institute for Juvenile Research and to make arrai geraents for hotel ac- 
commodations. Usually a team consisting of a psychiatrist, a psychologist, 
and a social worker travels to a certain Region, In some Regions a per- 
manent staff is present consisting either of a social worker or a psy- 
chologist, or a social vorker and a psychologist. In these Regions the 
procedures may differ in certain respects® The psychiatrist, as at the 
Institute for Juvenile xResearch, studies the problem, secures all avail- 
able information from social service and psychology, examines the child 
psychiatrically, and interviews the parents. In the Regions, because of 
limited facilities and lack of time, all physical examinations are 
usually completed by the local physicians. If any further examinations 
are indicated the psychiatrist suggests to the agency or to the parents 
that these be made. 
The psychiatrist is the moderator in the DAS staff of a Regional 
clinic. He presents his findings and together with the other members of 
his team makes suitable recommendations. The responsibilities of the 
psychiatrist are quite flexible. Where a permanent staff is available, 
as in East St, Louis, the psychiatrist dictates his findings and recom- 
mendations after the DAS staff and the permanent staff write the re- 
porting letters and carry out recommendations. In such a clinic student 
social workers carry the treatment and the psychiatrist usually super- 
vises treatment and holds treatment staffs. Where no permanent staff 
are available, no treatment is feasible, as a rule. In all the Regions 
the available community resources are made use of as much as possible. 
The social worker arranges conferences with the court, social agencies, 
schools, etc., and the psychiatrist acts as the moderator. It is his 
duty, too, in such Regions to talk to various groups in line with com- 
munity education and do such teaching as is required* 
On returning to the Institute for Juvenile Research it is the 
duty of the psychiatrist to write reporting letters to the proper 
sources giving a complete report of the examinations and the recommenda- 
tions which have been made. This is only necessary when no permanent Section D 
staff is present in the Region. It is his responsibility upon his return 
to the Institute to fill out a complete expense account which must be 
turned in to the finance department as soon as possible. It is of the 
utmost importance that if any changes in the traveling schedule are nec- 
essary the psychiatrist notify the three interested departments: first 
the downstate Region, second, the clinic manager, and third, the staff 
psychiatrist who arranges the DAS schedule. 
It might be well in closing to summarize the functions of the 
psychiatric staff at different levels; 
Residents in affiliation; 
Beginning Fellows: Diagnostic procedures 
Advanced Fellows; Diagnostic procedures 
Treatment 
Accompanying more experienced staff 
members to Regional clinics 
Giving talks 
Junior Staff Members: Diagnostic procedures 
Treatment 
Regional clinics 
Moderator at DAS 
Giving talks 
Senior Staff Members; Treatment 
Supervision of psychiatrists at 
above level 
Moderator at DAS 
Teaching 
Giving talks 
Administrative procedures such as 
scheduling DAS cases, etc. 
Research projects may be carried out by any member of the staff. 
Work on such projects is usually done in addition to the other required 
duties. 
Playrooms 
There are three playrooms, two on the second-floor and one on 
the fourth-floor, all available for diagnostic or therapeutic interviews» 
The playrooms on second-floor are kept locked and the keys are in the re- 
ceptionist’s desk. The fourth-floor playroom, which is just off the 
lecture hall, is unlocked* Material for use in the playrooms are on 
shelves in these rooms. Additional material is stored in the closet on Section D 
the second-floor opposite the elevator. The key to this closet is like- 
vase in the receptionist’s desk. Equipment and material in this closet 
are essentially for therapy and should be replaced at the conclusion of 
the therapeutic hour. All toys and material are purchased from a limited 
budget by members of the Playroom Committee, composed of one member each 
from psychiatry, psychology, and social service. The therapist is re- 
sponsible for the maintenance of the playroom used. There is no pro- 
vision for help to arrange the toys and equipment. The only service pro- 
vided is janitorial (sweeping and mopping of floors), which is done in 
the evening. Thus co-operation is sought from personnel using rooms in 
cleaning paint brushes, capping paint jars, sweeping up sand from the 
floor, etc. 
To assure privacy, as well as availability of a playroom, a 
schedule is maintained. This schedule is posted on the inside of the 
therapeutic supply closet door. Each therapist signs up for the hour 
desired. Provision is made to start the therapeutic hour on the hour 
or half hour. In order to keep the schedule up-to-date, and to pro- 
vide maximun availability of playrooms, each therapist is requested to 
reserve a playroom each month. On the last week of the month therapists 
are reminded by a notice on bulletin boards to renew the reservation of 
the hour they have used.. Failure to renew indicates that the therapist 
no longer has any need for the playroom. On and after the first of the 
month anyone can reserve unused hours, A therapist reserves a playroom 
by signing his name on the posted schedule in the appropriate hour. He 
may drop his reservation of the hour at any time by erasing his name 
from the undesired hour. Certain times are reserved for diagnostic and 
ward use, which get priority. SECTION E 
DIAGNOSTIC INTERVIEW WITH THE CHILD 
It is difficult to generalize concerning the psychiatric examin- 
ation of a child since there are many variable factors involved* These 
vail be discussed in more detail later* The interview is likely to lead 
into many digressions dependent on the child’s interests and the material 
that comes out* 
In most instances, the child has already made one visit to the 
clinic and therefore does not Mve the initial fear or hesitancy or 
questions about the clinic procedure. In cases where no previous psy- 
chological examination was done here, this must be kept in mind so that 
the initial contact with the child can be a reassuring one. The method 
of approach which will usually produce the best results is to treat the 
child essentially as one would any normal child under an ordinary situa- 
tion. 
When the psychiatrist goes into the waiting room to take the 
child for the examination, it is the usual procedure for him to intro- 
duce himself by name. In some instances, however, where there is a 
history of fear of doctors or the child may seem a little hesitant, 
it may be well not to emphasize the fact that the examiner is a 
doctor because of many children's association of doctors with painful 
procedures. The mother will sometimes begin to come with the child 
for the interview and is to be told very gently that the doctor will 
see the child alone and will talk with her later* If the child refuses 
to come without the mother, as happens with some insecure children, 
the mother can be taken into the playroom with a suggestion that she 
leave when the child has become interested in something in the playroom. 
The actual form of the interview depends on the age, intelligence, 
and responsiveness of the child. It is our feeling that up into the 
latency period or the age of about ten or eleven, the playroom situation 
is usually the best one* With children beyond this age it is usually 
possible to have a regular interviewing situation. 
In the playroom there should be no questions and little conver- 
sation until the child has had an opportunity to look around and become 
somewhat relaxed. If there is spontaneous conversation, the examiner 
will, of course, respond to it. If the child is hesitant about handling 
the toys, he can be told that while in the playroom he is allowed to play 
with anything he wants to. 
When the child is relaxed and is over his first reaction, it is 
well to start with some innocuous conversation on general subjects which 
are applicable to any child, that is, questions about his recreational Section E 
activities, school, movies, etc. Sometimes, if there is a severe school 
problem, the school questions should not be touched upon too early® 
After some general conversation, the interview should be led to more 
pertinent subjects. It is important with children to use their own 
language, that is, to speak in terms that they can understand, such as, 
for example, using the word "ditching11 and "skipping" school instead of 
"truancy." 
It is important to try to get information on possible con- 
flic tual things by indirection, that is, in leading up to conversation 
dDout the parents, ask about the child's sisters and brothers, if any, 
then, if there are none, whether he would like any and whether he thinks 
his parents would. If there are siblings, one can bring up the matter 
of possible fighting or arguing with them and thus introduce the parents 
by saying, "What does your mother do about this?" or, "What does your 
father do?" These questions can lead to others about activities which 
may be shared with the parents, punishments which the parents may give, 
and questions about other adults in the patient's life* 
The asking of a direct question, such as, "Do you like your 
father or mother best?** Can lead to a great deal of anxiety on the part 
of the child, as might be expected when one stops to think about the con- 
flicts which these children have concerning their parents and that these 
conflicts are frequently the chief reason for their referral to us* Some 
such question as "Of all the people you know in the world who do you like 
the best?" would be much less threatening* A common answer to this is 
"God," and the child should then be asked, "Well, of all the people on 
earth?" One should also remember that a child's answers to direct and 
pointed significant questions are always open to doubt since children 
learn very early the expected and proper answers to questions that adults 
ask and tend to give these as a routine without very much thought* 
It is well also to get across to the child the fact that nega- 
tives are acceptable, that is, accept the fact and possibly verbalize it 
that most children fight with their brothers and sisters; that lots of 
children do not like school; and that these things do not set him apart 
from others. 
There are certain standard questions which are a part of the 
stock of most child psychiatrists, particularly in their early experi- 
ence in diagnostic interviews with children. These questions are asked 
not for factual information, but to give some leads as to the child's 
fantasy life, his identifications with adults or other children, and his 
possible conflicts. These questions include those of having him make 
three wishes for what he Would like to have if he were allowed to wish 
for anything he wanted; questions about sleep, leading up to information 
about sleeping arraigements as well as dreams and nightmares; questions Section E 
about daydreams, if the child is old enough to understand the meaning; 
his likes and dislikes in school subjects, types of movies and playmates. 
His ambition is a clue to his fantasy life or his identifications. Ask- 
ing him what age he would like to be and why, sometimes gives a clue to 
his attitudes toward growing up. 
The matter of sex discussion can sometimes be omitted entirely 
if it is not especially pertinent to the problem or is likely to disturb 
the child. If it is to be discussed, it should be approached indirectly 
such as with questions about babies. It is well to remember that in many 
cases parents do not welcome a discussion of this matter with their chil- 
dren. 
If there seems to be some resistance or confusion on the part of 
the child, it is well to get his idea as to why he came* If he does not 
know, or has a wrong idea, it can be explained in very simple terms that 
the children who come here do so because they are having some kind of 
trouble and the examiner wonders what his particular trouble might be, 
and if there is anything we can do to help9 It will probably be nec- 
essary to let him know that you realize he has difficulties and have been 
given information so that we can help him* 
At some time during the interview it is well to reassure the 
child about the confidential nature of the interview and also to inform 
him that the examiner is going to talk to the mother but does not need to 
tell her things the child would rather not have repeated* 
The interview with the older child in the interview situation 
is patterned pretty much along these same lines. As will be seen, no 
specific form can be given for this interview as it leads into various 
subjects which may be important in one child’s problem and have no signi- 
ficance in another. Also remember that some children, especially those 
from the juvenile court, are very fearful that they may be coming here in 
order to be sent to ’’reform school” or ”to find out if they are crazy,” 
If it seems as though treatment might be indicated, this matter 
can be brought up with the child in the form of asking him whether he 
might like to come back for further help with his problems* 
If a physical examination is indicated, it can be done either 
before or after the psychiatric interview, depending upon convenience and 
also on the attitude of the child* Sometimes the physical examination 
can be used as a means of establishing good rapport* At other times it 
will have to be left until rapport has been established and anxiety re- 
duced through the interview* 
Each individual psychiatrist will, as time goes on and he be- 
comes experienced, develop his own technics for examination* These will 
depend on his own attitudes, interests, and inclinations® The important Section E 
thing is to get pertinent information for the case® Remember also that 
negatives are as important as positives, that is, that if a child blocks 
on a question this is significant and can be interpreted as well as if he 
had given a direct answer. The child*s reaction with the parent in the 
waiting-room should also be noted as it often contributes significant 
information concerning the relationships. 
The matter of taking notes during the interview frequently comes 
up. Most psychiatrists feel that it does not impair the relationships or 
cause any blocking. If there is a question about it the child can be re- 
assured that the examiner does not want to forget arything and is going to 
discuss his problems with the other people who have seen him and who might 
be able to help him. 
Remember at all times that most of these children come to us 
primarily because of poor relationships with adults and therefore cannot 
be expected to form good relationships immediately. 
The diagnostic interview should also be regarded, insomuch as 
possible, as a therapeutic interview since frequently this is the psy- 
chiatrist's only contact with the child. This can be used therefore to 
give reassurance and to decrease anxiety. In follow-ups we have found 
in a surprising number of instances that actually a diagnostic interview 
had also been therapeutic. 
In any case where you have a question about the examination do 
not hesitate to discuss it with the psychiatrist who is moderator for the 
day, or with any of the senior psychiatrsts if the moderator is not 
available at the moment you need him. SECTION F 
INTERVIEW WITH THE PARENT 
The parent usually interviewed is the mother because, in most 
cases, fathers cannot leave work and also many parents tend to feel 
that problems such as are considered in our clinic are the function of 
the mother to handle. 
In some instances a history has already been taken in our clinic 
or has been received from the juvenile court or some other outside agency. 
In these cases the psychiatrist will have the only contact with the mother* 
In other cases, where it does not seem necessary to obtain a detailed 
history and the social service department may not have taken a history, 
it is then the function of the psychiatrist, as a part of his interview 
with the mother, to obtain such material concerning her own or the 
father’s background, or the child’s development as may be pertinent to 
the particular situation or problem. 
In instances where a history has already been taken it is well 
to avoid a repitition of the history material and to tell the mother 
that the information has already been received from the historian or 
from the application,. It is often best to open the conversation by ask- 
ing what disturbs the parent most. This will usually lead to a statement 
of the problem which can then be discussed in terms of our findings. The 
mother should be given information about the finings on the physical ex- 
amination, their significance, and our recommendations. She should be 
given also information about the psychological examination and this 
should be done carefully, not in numerical IQ’s but in general as to what 
the child can be expected to accomplish. For instance, with superior 
children, there may be a tendency for parents to put on pressure and this 
should be avoided by pointing out that there are physical and emotional 
factors to be considered as well as intellectual ones. With the dull 
child, the parent should be reassured as to the child’s adequacy for 
making a living. 
Some parents also need reassurance that their child is not con- 
sidered mentally ’’abnormal.” 
The interview from this point on is subject to many variations 
depending on the attitudes and the anxieties of the mother and the amount 
of interpretation that she is able to take at this first interview. It 
is important to avoid an attitude of hostility or of placing blame for the 
child’s problems. If the mother verbalizes the opinion that she is 
probably responsible for the child’s problems, that is an opening for 
discussing, her own problems which have made her react toward the child 
in the way that she does. 
The interview should be kept therapeutic. There should be some 
discussion of the mother’s feelings and this can lead to a discussion of 
the relationship betweeq the parents without giving the impression that Section F 
we are trying to pry into her personal affairs. It is usually a simple 
matter also to lead the mother into a discussion of her own and the 
father's background in terras of the child’s problems rather than as a 
matter of information which should already be known to the examiner. 
In this interview too there are certain questions which mapy examiners 
ask rqther routinely in order to get some idea of the mother's attitudes 
or to give ati opening for discussion. For example, she is asked if the 
child reminds her particularly of any one or resembles any one in the 
family in order to see if there is any identification, especially of a 
hostile nature. Another question is whether she feels the child is happy 
or unhappy. One of the questions also which may or may not have been 
covered in the history regards sleeping arrangements. This can be led 
up to in a non-threatening manner by asking about the child's sleeping 
habits, such as restlessness, nightmares, etc., and then determining what 
the sleeping arrangements are in the fanily. 
During the interview the examiner should be evaluating in his 
own mind the possibilities for psychotherapeutic treatment. If the 
mother seems a good therapeutic risk, the possibility can be discussed 
with her in terms of treatment of herself or of both herself and the child. 
This can be interpreted as an attempt to help her with her attitudes so 
that she can handle the child better. Mother should be told that our 
decision about this matter will be reached after all the examiners have 
had a chance to discuss it. Some of the interview should include a dis- 
cussion of her own ideas for handling the problem and ideas about place- 
ment, institution, foster home, change of school, etc. 
In your report on the interview it is also important to give in- 
formation as to how treatment was presented and the mother’s reaction to 
it. Since we have a long waiting list for treatment, it is frequently 
decided by the psychiatrist at the time of the first interview or by 
the diagnostic staff that a further evaluation of the mother should be 
made before treatment is undertaken to determine what help she received 
from the first interview and evaluate again treatment possibilities. If 
the case is recommended for treatment either in the first diagnostic 
staff or in later follow-ups, it is considered by the Treatment Commit- 
tee. If the Committee decides that the case should not be accepted for 
treatment a report of their decision with the reasons is put into the 
record and the examining psychiatrist is then asked to see the mother 
and take this matter up with her. 
In some cases it may be necessary to give the mother specific 
advice about handling certain problems. If it seems that she will be 
unable to carry out this specific advice because of her own emotional 
conflicts, it may be well to emphasize at this point that sometimes par- 
ents cannot do the things that are advised because of their own feel- 
ings. This is important because frequently when specific advice is 
given, the parents become extremely anxious because they are unable Section F 
to carry out the recommendations and therefore feel very guilty* One 
sees this frequently, for instance, when specific advice is given as to 
how to handle feeding problems* A mother may be told very clearly not 
to pay any attention to the child if he does not eat but her own anxiety 
is so great that she is unable to follow these instructions and then 
become more anxious, more guilty, and also hostile toward the person 
who gave her these instructions. It is better to discuss either at the 
diagnostic interview or in subsequent interviews the reason why she has 
this difficulty and approach it in that way. 
If, during the course of the interview, it seems a good idea 
to have an interview with the father, this should be discussed with the 
mother in terms of getting a complete picture, but the examiner should 
not be insistent if he encounters some resistance. She should be told 
that we will send an appointment directly to the father. 
The interview with the father would follow essentially the same 
pattern as that with the mother. If both parents come in for the examina- 
tion, it is well to watch them together to get an idea of the interplay 
of relationships and this should be done after individual interviews with 
them. If interpretation is necessary, it is well to give this to both 
parents at the same time so that they cannot misquote. 
At the end of the interview, the mother should be asked whether 
she wishes any report sent, or she should be told that certain people, 
who may be specified, such as the school, the doctor, or a certain agency, 
wish a report and she should be asked if she is willing to give signed 
permission, emphasizing that we do not give out any information without 
permission from the parents. SECTION G 
POSSIBLE DISPOSITION OF CASES 
Introduction 
The suggestions and remarks in this section will be of value 
in your handling of that part of the interview with the parent which 
deals with the help that the Institute cai give in the case. Although 
in your first cases you will most frequently end the interview with the 
parent by stating that the final decision regarding disposition will be 
made at the staff conference, later you will be able to anticipate the 
staff’s recommendation and handle the parent more individually. 
It is probably tempting, in view of certain successes of psy- 
chotherapy, to advise every parent that the child and/or parent will be 
seen in therapeutic interviews. However, there are strong, practical 
and clinical considerations which should limit the number of cases rec- 
ommended for therapy. First, there is a long waiting list for treatment 
and there is a shortage of therapists. The clinical considerations will 
be given in more detail later on but can be briefly summarized thus: 
Some cases cannot benefit by, some are not reacfy- for, 
and some do not need extended therapeutic interviews. 
Many cases can be disposed of on the diagnostic level. The in- 
dications for such disposition are covered in the section entitled 
’’Closed.” In other cases there may be some doubt as to disposition, 
and further observations may be necessary before deciding to close or to 
treat. This matter is discussed in the section ’’Temporizing Measures.” 
Finally, some cases meet the criteria for therapeutic interviews, indi- 
cations for which are given in the section entitled ’’Treatment.” 
I Closed 
Closing the case on the diagnostic level signifies that the 
given the maximum amount of help at the stated time. 
This does not necessarily mean that we are no longer interested in the 
case. The principal reasons for closing a case are these: 
A. Lack of anxiety 
1, In the parent 
Since the successful handling and treatment of a child’s problem' 
depend on the constructive concern that the parent has about the 
problem, lack of parental anxiety is probably the chief reason 
for closing the case. Juvenile court cases are a striking ex- 
ample of this lack of anxiety which also shows up in cases in 
which schools or agencies have been mainly interested in re- 
ferring the child, the parents all the while being apathetic 
about the problem. Section G 
While complete lack of anxiety is rather easy to detect, 
one must be careful not to over-evaluate the seeming anxiety 
shown by a parent who has been pressed by the court, school, 
or agency. These parents are anxious about adverse public 
opinion and come in to placate the pressuring forces. They 
do not make good treatment cases. 
Another clue to lack of anxiety is a series of broken ap- 
pointments for the diagnostic interview. 
2, In the child 
Most children do not show anxiety about their problems; they 
are more complained against than complaining. It is only in 
adolescents that some anxiety on their part is necessary for 
treatment to be successful. 
B. Resistiveness to treatment 
1, In the parent 
Many parents are concerned about or irritated by the child 
but resist strongly the idea of therapy for themselves as 
part of the collaborative treatment plan. The anxiety is 
there but treatment is a threat to them. They tend to pro- 
ject the blame for the child1 s problem on physical causes, 
neighborhood, school, the other parent, etc. With special 
and delicate handling, they may sometimes be made secure 
enough to be accepting of treatment. More often, however, 
the case has to be closed because of the marked resistiveness. 
2, In the child 
Usually children are not resistive to the idea of therapeutic 
interviews. In some cases, however, and more especially in 
adolescents, this factor may be strongly present and is 
usually due to the manner in which the parent or agency has 
presented the Institute to the child* A punitive presenta- 
tion will make a child quite resistive. If this factor is 
rather predominant in adolescents, treatment would be diffi- 
cult and therefore the case should be closed. 
C, Personality problem too severe 
1, In the parent 
Untreatable situations occur when the significant parent is 
very narcissistic, schizoid, completely rejecting, alcoholic, 
narcotic, feeble-minded, etc. Less severe parental disturb- 
ances are treatable if anxiety and willingness are present. Section G 
However, the goal of treatment with said parent would then 
be a limited one. For example, a possessive, compulsive 
mother who would need analytic therapy three or four times 
a week to alleviate her neurosis, might, by once-a-week 
therapy at the Institute, be able to get help with her se- 
ductiveness toward her son. 
2, In the child 
Children presenting emotional problems who are too retarded 
or psychotic, or who have organic handicaps such as blindness, 
deafness, mutism, encephalitis, etc., are generally not taken 
on for treatment unless a member of the staff especially desires 
to do so. Psychotic children or children with severe hostile 
or impulsive behavior usually cannot be treated on an out-patient 
basis. Unfortunately, in-patient facilities are rare and ex- 
pensive - our Ward takes only two or three a year. Thus, for 
want of facilities such cases frequently must be closed. We 
usually consider personality problems too severe and fixed in 
cases where children have shown a long and chronic history of 
delinquent behavior which points toward the diagnosis of psy- 
chopathic personality. This feature is occasionally seen in 
the juvenile court cases referred to us. 
D. Minimal personality disturbances in the child 
Frequently the child’s problem is too minor in that it falls 
within the limits of normalfbehavorial deviation and:innsuch cases tt*is 
the parents' anxiety with which we have to deal, A common example of 
this occurs when parents have a healthily aggressive boy, but when they 
read in the newspapers about cases such as that of the Heirens or Lang 
boy they begin to become anxious for fear their boy might turn out the 
same way. This anxiety can of course be easily handled by reassurance 
if the child's problem is indeed very minor. 
Often the parents are anxious at the time of application but by 
the time of the diagnostic stucty’ their anxiety has been relieved. This 
phenomenon occurs quite often and seems to be the result of the ability 
of the parents to crystalize their feelings into taking action. 
In this same connection, cases frequently come to us in which 
there has been a gradual resolution of the problem in that the child is 
slowly improving. We feel that we should not intervene with treatment 
in such cases but rather should allow the natural strengths and assets 
of the family unit to manifest themselves* Parents in cases such as 
these need only reassurance that there is nothing to worry about in the 
child, that the parents are doing as much as they can, and that the 
mother can come back at some later time if improvement stops. Often 
the diagnostic examination will result in lessening of the parent’s 
anxiety* Since some therapy (suggestive, cathartic, explanatory) is 
going on in the diagnostic procedure, we should not be surprised that 
parental anxiety will drop after such an examination. Section G 
E. Child's problem not in an emotional area 
Here are function is principally diagnostic rather than thera- 
peutic, These cases include: 
1, Feeble-minded children whose parents desire commitment* 
2. Infants examined with the prospect of adoption. (Psyc- 
chologists are usually the only members of the staff who 
see cases of types 1, and 2.) 
3* Social agencies who plan to place children sometimes ask 
for an evaluation to determine whether the child is dis- 
turbed or retarded. Frequently the child has no emotional 
disturbance per se, but there is a sociological disturbance 
in that the child has no family.. Social agencies are then 
advised as to whether or not the child is disturbed and they 
can, on the basis of our findings, seek proper placement. 
If the child is disturbed we sometimes consider him for 
treatment if the disturbance continues after placement out- 
side the home has been obtained. 
F. Realistic or administrative difficulties 
Occasionally the family lives in an outlying region which is too 
far for the parent and/or child to come in for therapy. Again, the parent 
may work all day or cannot leave infant children, or is pregnant, etc. 
These cases obviously have to be closed until the family can make con** 
venient arrai gements• 
On the administrative side it has not been our policy to work 
collaboratively with other agencies or psychiatrists. For example, if 
a mother is in treatment with a private psychiatrist, we would not take 
the child on for therapy at the Institute for Juvenile Research, 
* * * * * * % # 
Closing a case on the diagnostic level still leaves us with the 
responsibility for giving some help with the problem. Even if the case, 
for any of the reasons just given, is not suitable for extended treatment, 
we can make certain recommendations which are therapeutic in nature. 
1, Environmental manipulation 
The most heroic manipulation is placement of the child away from 
home, either in a foster home or boarding school. This recommendation 
should not be made too lightly for the reasons that good placements are not 
plentiful and that there is a certain emotional trauma associated with 
separation from the family. In cases in which, however, there is a more or 
less chronic disturbance in the child and little hope of changing the 
pathologic family situation, placement appears to be the only solution. Section G 
Lesser manipulations include such recommendations as 
a. The fanily move away from the deteriorated, delinquent 
neighborhood; 
b* the friction-producing in-laws or grandparents move out 
of the home; 
c* change in school curriculum or change of schools be made 
(This recommendation should be made only after consulta- 
tion with our psychology department); 
d. the child be sent to camp for the summer; 
e, a preschool child be sent to nursery school, 
Z Advice to parents about handling their child 
It is still not quite settled as to how effective advice to the 
parents is in helping the child's problem. With flexible, mature parents 
it might be of value, otherwise probably not. In some cases advice is 
given to let the child have a regular allowance, to spend more time playing 
with the child, to be firm with the child, to be more permissive with the 
child, etc. Usually these suggestions are easy for the .psychiatrist to make 
but frequently difficult for the parents to follow, due to their own per- 
sonality difficulties. 
3. Referral to other therapeutic facilities 
a® Children with organic pathology can be referred to 
the appropriate? clinic® 
b. Occasional use may be made of such group programs 
as those of the Boy Scouts, church groups, community pro- 
jects, etc®, in cases in which more adequate socializa- 
tion is desirable. 
c. To parents who are financially able and desire rather 
immediate treatment of the child we suggest that they 
seek help from a private child-psychiatrist* 
d. Frequently the parent is the disturbed person rather 
than the child* In cases in which the parental dis- 
turbance is rather chronic and the child's disturbance 
mild or purely reactive, we usually refer the parent 
to an adult clinic or make a recommendation that he 
or she seek private psychiatric help® 
It may be seen in our closing of the case that we strive f<*r a 
course of action satisfying both to the referring source and ourselves. 
It is also our policy to leave the door open for parents or agencies to 
return to us in case they want further help® Section G 
II. Temporizing Measures 
In many instances it is not immediately clear as to how the 
case may be best handled. In such cases we have recourse to the following 
procedures which give us time and information for further evaluation. 
A. Completion 
Completion essentially means the securing of certain additional 
information which is necessary for evaluation. For example, if we want 
to learn about the father from himself rather than from the mother's re- 
port of him, we can tell mother that our recommendation will be post- 
poned until after we see father. In the case of a child we would occa- 
sionally like to have an EEG, or a Rorschach, or a school report before 
we commit ourselves. 
B. Conference 
Occasionally when a social agency has referred the child we would 
like a more or less informal talk with the agency worker, either to get 
more information from her or to make more detailed recommendations as to 
handling. In such a conference a better opportunity is provided to ob- 
serve the anxieties and limitations of the worker and to handle them in a 
therapeutic manner. 
C• Service interview 
Sometimes we feel that two or three interviews with the parent 
in addition to the original diagnostic interview would be sufficient 
therapeutically to help the child. Such interviews would be more clearly 
indicated when the child is either mildly disturbed or is acutely and 
strongly reacting to some temporary unwholesome stress in the family situa- 
tion, When the child is chronically and markedly disturbed, such inter- 
views would be mainly used therapeutically to help the parent accept place- 
ment of the child away from home if that was our goal. 
Service interviews, however, may also be used for the purpose 
of prognosis. Frequently we are not quite sure that the parent will re- 
spond well to treatment. Our doubt makes us reluctant, on the one hand, 
to refuse therapy, and, on the other hand, to commit ourselves to a lengthy 
and probably unsuccessful treatment program. In such instances, if the 
parent is seen two or three times more, we can observe how he or she re- 
sponds to the therapeutic situation. Decision as to treatment will then 
be easier. Section G 
D, Follow-up 
Follow-up significes that we see the parent and/or child again, 
usually from one to six months after the diagnostic interview. This 
procedure is mainly used when the child is quite disturbed and when 
there is some obstacle to treatment or placement. When the obstacle 
to therapy is realistic (e,ga out of town cases; mother working) 
follow-up is done on our initiative, (We send the appointment letter.) 
When the obstacle to therapy is due to parental resistiveness or lack 
of anxiety, we usually leave the initiative for follow-up to the 
parent (parent writes in asking for the promised appointment). In 
this way the procedure can be used to test the amount of anxiety 
present in the parent. Section G 
III. Treatment 
Although we strive to be therapeutic in all of our early con- 
tacts with the child and parents, we reserve the term "treatment" for a 
series of regular weekly interviews which usually last from three to 
eighteen months. The goal of treatment varies in each case but is cen- 
tered around amelioration of the child's problem. Thus, for example, 
in treating the parent it may not be necessary to bring about some per- 
sonality change in her or him if short term supportive therapy will en- 
able the parent to take a step which is advantageous to the child. 
In the section entitled "Closed” were mentioned the contraindica- 
tions to treatment. As for indications, we might describe the ideal case: 
A parent, anxious about a real problem in the child, seems to have a good 
personality make-up, is interested, realizes more or less his or her in- 
volvement in the child's disturbance, and appears to have made an effort 
to. solve the problem prior to coming to the Institute, Such ideal cases 
are unfortunately the exception rather than the rule. Thus we frequently 
have to embark on the treatment of a problem when the case is somewhat 
less than ideal. 
Therapy is carried on by members of the departments of psy- 
chiatry, social service, and psychology. If both the child and parent are 
to be treated, two therapists are necessary. This is known as collabora- 
tive treatment. Frequently, however, this is not necessary and either 
child or parent may be treated alone. ("Parent" refers to real, step, or 
fosteP parent.) The indications for such recommendations are; 
A, Treatment of child and parent 
In most cases in which the child displays a neurotic pattern 
(i,e., negative or sterotyped, non-adaptive behavior which springs from 
inner conflicts) he should receive individual treatment. The significant 
parent should be seen in therapeutic interviews at the same time for one 
or both of the following reasons: 
1, To decrease any unhealthy attitudes which contribute to 
the perpetuation of the child's disturbance 
2• To prepare the parent for the eventual more healthy 
changes in the child's behavior, e.g., an inhibited 
child becoming normally aggressive. (For a fuller ex- 
planation of the neurotic pattern as opposed to the 
non-neurotic reactive pattern, see Witmer's Psychiatric 
Interviews with Children. New York; The Commonwealth 
Fund, 19U7.) Section G 
B. Treatment of parent alone 
1, Frequently we see children whose disturbance is more superficial 
and who seem to be reactive to the anxiety, inconsistency, ambivalence, 
etc,, of the parents. In these cases it is common, for example, to have 
the school report state that the child presents no problem, whereas the 
mother complains bitterly or anxiously of the way the child behaves at 
home. Another clue to the fact that the child has not a fixed non- 
adaptive disturbance is that the permissive and accepting atmosphere 
of the psychiatric examination we find the child to be rather responsive, 
spontaneous, and free of significant psychopathology. In such cases we 
would treat parent alone. 
2, When a child is in the preschool period and there seems to be 
very good evidence for considering the mother directly causative of the 
problem, and when the child’s neurotic pattern does not yet seem to be 
"fixed,” then treatment of the mother alone is generally indicated. This 
is a difficult period in which to determine whether or not the child re- 
quires treatment in addition to the mother’s treatment. Generally speaking, 
the Institute’s policy has been to treat only mothers of preschool children, 
feeling that when the attitudes of mothers are modified in this group of 
children the seemingly neurotic pattern of the child clears up. It must 
be emphasized that most normal children go through a so-called neurotic 
stage so that when they are seen at the Institute the picture may be con- 
fusing and may appear to be one of a neurotic pattern. 
3, Parents who cannot accept their child’s retardation may need help. 
Here the parent would be seen alone. The psychology department has had 
more experience with parents who cannot accept the fact that their child is 
slow and, although the usual service interviews by the psychologist will 
generally suffice to bring about the desired result, occasionally longer 
treatment is necessary. 
C. Treatment of the child alone 
1, Children in institutions have to be treated alone. Attempts to 
modify the environment at the institution have to be made through occa- 
sional conference or phone calls with the adminstrative head, house par- 
ent, or social workers. 
2, Rather infrequently we treat a child or adolescent alone without 
the parent being in actual treatment. The child's therapist has the re- 
sponsibility for being in occasional contact with the parent (more often 
by phone calls) in order to prepare the parent for certain changes, ex- 
plain certain symptoms, dr make suggestions. 
This procedure is more often used in private practice where the 
expense of double therapists may be too much for the family. The indica- 
tions for such procedure at the Institute have not been definitely formu- Section G 
lated as yet, At present, due to a shortage of therapists, we are experi- 
menting further with this procedure. It would seem that in cases in which 
the child has a neurotic pattern and the parents for some reason or other 
are no longer contributing to its perpetuation, treatment of the child 
alone may be attempted. 
3, Medication cases are carried occasionally by staff members when a 
project of a certain kind is being carried out, A psychiatrist may be 
interested in treating epileptics or choreic children with drugs. Here the 
child can be treated alone with occasional phone call contacts with the 
parents• 
Concluding remarks 
It must be emphasized again that the foregoing suggestions can 
be used only as a guide in your thinking and handling of the disposition 
of a case. There are so many individual variations with every case that 
a rigid adherence to the explanations in this section would be unwise. 
However, by using these suggestions as a guide, you will probably feel 
more comfortable in your interview with the parent and better able, at the 
DAS staffing of the case to contribute to the thinking concerning disposi- 
tion. SECTION H 
DIAGNOSTIC APPLICATIONS SERVICE PRESENTATION 
Introduction 
It is hoped that the suggestions offered here will be helpful 
to the reader in arriving at stimulating and instructive DAS presentations 
and discussions* The remarks which follow pertain more to the form of 
presentation than to its contents* That a presentation should be in- 
spiring is obvious, since usually from four to ten persons have to listen 
to it* A poor staff presentation will lose the interest of the listeners 
and cause them to become restless so that when the time for discussion 
comes their only thought will be to get on to the next case* Sometimes 
even the moderator may betray these symptoms and is thus unable to con- 
tribute his best to the discussion. 
The things which make for a good presentation are the same as 
those which make for a good lecture, speech, or story* Most important 
is preparation* The essential and important facts in the case should be 
known well enough so that one need not refer too closely to the chart 
during his presentation. Questions may arise such as, "How does one know 
what the essential facts are and what the non-essential?1’ ’’Isn't it the 
moderator's teaching function to separate the wheat from the chaff?” If 
we are going to make the presentation intereasing there will have to be 
some preliminary sifting and organizing on our part. In other words, 
thought should be devoted to the case before it is presented* Usually a 
half hour or so of such preparation will suffice, A good presenation is 
characterized by 
1, Proper emphasis 
2. Continuity 
3« Succinctness 
By proper emphasis is meant the high-lighing of important dynamic 
factors; by continuity, the logical, causative progression of events* Suc- 
cinctness needs no definition* 
One must keep in mind the primary purpose of the DAS staff which 
is the securing and exposition of enough information so that the proper 
disposition of the case can be made. The teaching function of DAS is 
secondary to this purpose. Frequently a case can be presented in such a 
way that both disposition and teaching can be accomplished, but if one of 
these, due to pressure of time, has to take precedence, it should be the 
disposition. 
Before presenting a case you should have some idea as to the 
amount of time in DAS at your disposal, and how best use may be made of 
it. You should, in time, be able to anticipate what factors in a case 
will form the problem meriting general discussion. Selectivity must 
operate here since the time which can be given to any one case precludes Section H 
a discussion of all the factors. In a particular case it may be very clear 
that the mother needs treatment, but the problem for discussion is whether 
she can be treated at the Institute, or whether she needs more intensive 
treatment. In another case the disposition may be clear (the mother and 
child are treatable and anxious for treatment) but the problem necessi- 
tating discussion centers around the etiology of the child’s disturbance. 
In yet another case, for example, a schizophrenic whom we would not treat, 
the discussion may concern the prognosis or the disposition. 
Actual Presentation 
The following suggestions apply to the actual presentation; the 
spirit rather than the exact letter of the suggestions should be kept in 
mind. 
Introduction: 
1, In the introductory paragraph the high-lights of the problem and the 
reasons for referral to us are given: HThis is the case of Johnny Black, 
an eleven-year-old boy, referred to the Institute primarily because 
of his stealing. Other problems also are concerned with socially un- 
acceptable behavior, and include his lying, fighting, and truancy. The 
referral was made through the impetus of the mother, who consulted the 
juvenile court, which, in turn, sent the mother and boy here,” 
2. In this paragraph the family setting and pertinent social and economic 
factors are briefly given: "Johnny is the oldest in a sibship of five 
and has two younger brothers and two younger sisters. He lives with 
his parents and siblings in a run-down neighborhood. Father is em- 
ployed as a truck driver; the mother does part-time work and the 
economic status is marginal," 
3, In this paragraph the problem is gone into more fully and the emo- 
tional reason for referral is given: "Johnny's stealing and other 
problems began around five years ago, about the time the youngest 
brother was born, and has continued in an episodic fashion to the 
present time. The stealing is only from members of the family. 
The father is angry at the boy because of his stealing and the 
mother is concerned. It was the mother's concern, heightened by her 
reading of recent newspaper reports of crimes, of juvenile delinquen- 
cies, that made her seek help at this particular time," 
Social history 
This is usually given by the social worker; she will pick up where you 
have left off. If you have to present the social history, please do 
not read it. You should have familiarized yourself with it prior to 
the staff meeting. When you give the social history, it is better to 
interpolate your own findings with those of the social worker rather 
than to wait until you report your contacts with the mother. Section H 
Since you cannot report all the information gathered in the social 
history, only the high-lights, or psychopathologic features, should 
be emphasized. If the child’s early development was within the 
limits of normal, a simple statement such as ’’Early development was 
unremarkable,” will suffice. To report the features of the parental 
backgrounds in a succinct way is somewhat more difficult and will 
depend upon experience. Most important are the stresses which the 
parent underwent in childhood and the type of child he or she was* 
For example: ’’Mother, being the eldest child, had undue responsibil- 
ity for the care of her siblings. Her mother was rather accepting, 
but always sickly, her father was very strict, especially about 
mother’s dating, but was not otherwise punitive. As a child mother 
accepted these limitations with outward conformity, but admits inward 
resentment.” Since our focus is on the child, we should be particular- 
ly alert to pick out and emphasize those stresses in the parental 
backgound which have contributed to present attitudes toward the child. 
Psychological: 
This presentation is made by a psychologist and includes the reading 
of the school report. 
Psychiatric on the child: 
Before giving the results of the psychiatric examination you should 
state the results of the physical, if made, and if not made, tell why 
it was not done. Then you can proceed to the psychiatric examination. 
For a time at least, give a complete account of what kind of child 
you have seen and what transpired during the interview. Later, with 
more experience, you will be able to report the significant and omit 
the less significant data^ 
Psychiatric on mother: 
Again, do not repeat what the social worker has said. Either say 
you agree with the social worker, or point out where you differ. 
Try to emphasize. 
Ij, How the mother feels and acts toward the child. 
2* What, in the present family setting, makes her act as she does? 
3, What, in the mother’s background, predisposes her to such attitudes? 
U* What kind of personality has mother? 
5. How treatable is she? 
6. Parent’s ideas re solution; attitudes toward treatment, placement, etc. 
7« How was the situation left with mother? Section H 
The following is an example: ’’Mother was essentially as described 
by the social worker. She did not show with me the tearfulness that 
she showed during the history taking. She seems guilty and per- 
missive toward the boy as evidenced by... * .., 
(Give actual observations from the examination). These attitudes 
might be connected with her hostility and guilt toward her own 
younger siblings whom she had to take care of. Also, it might be con- 
nected with her attempt to abort this unwanted child. At present she 
is insecure because of the precarious economic status, and because of 
father's irresponsible attitudes which deprive her of dependent satis- 
factions, Mother seemed to be an anxious type of person, with a capac- 
ity to give, and with some insight into her own involvement in the 
child’s disturbance. She was anxious for help when this was sug- 
gested and"eiqplained. She was told that we would contact her if .treat- 
ment was indeed recommended by our staff, and in the event it was 
not recommended that I would see her again to talk over other plans.” 
Recommendations: 
Even though the recommendations are a function of the entire DAS staff, 
you should venture an opinion as to what seems to you the best waytq 
handle your case. In forming your opinions, the section on ’’Possible 
Disposition of Cases” will be helpful. 
Postponement of staffing: 
Occasionally you do not have enough information to staff a case, even 
though you have seen the child in the morning. This situation will 
arise if the significant parent (mother) failed to come in. For ex- 
ample, you saw a boy, but the mother was sick and had the father bring 
him in. Sometimes even if the mother and the boy have been seen, 
you may want to see the father before fully evaluating the case. In 
such instances all you need to do at the afternoon staffing is to say, 
"In the case of Johnny Jones, I would like to postpone staffing until 
I have seen the father." 
Presentation of case for re-staffing; 
In presenting a case that has been staffed previously, the reason for 
re-staffing should be made clear and used as a point of departure for 
the presentation, A very short summary of the significant features 
should be included. For example; "This is the case of an eleven-year- 
old boy, referred because of enuresis*, Re-staffing had been recom- 
mended because there was a question as to whether this boy was too 
disturbed for therapy, or was possibly psychotic. Therefore a Ror- 
schach was done,” (Then the psychologist reports the Rorschach.) Section H 
Example; ’’This is an eight-year-old girl, referred for excessive 
masturbation. Although mother had led a rather promiscuous life 
in her youth, and it was possible that she was unconsciously en- 
couraging of the girl’s behavior, restaffing was recommended in 
order to see what part the father played in the picture,” (Then 
psychiatrist reports on interview with father,) 
Example: ’’This is the case of a ten-year-old, passive boy with a 
reading difficulty* Two service interviews were had with mother 
to evaluate treatibility. What essentially happened during these 
interviews was ” 
Function of moderator: 
The moderator's function is primarily to aid in the disposition of the 
case, and secondarily, to teach* As was said earlier, both functions 
can often be carried out. Because of the pressure of time and the 
number of cases, the moderator has frequently to act as a "traffic 
manager,” interrupting at times to get the significant material, at 
other times making a seemingly arbitrary decision about the disposi- 
tion. 
Since there are individual differences in the evaluation of the 
dynamics or disposition of a case, we should not be surprised if one 
moderator gives a particular impression of a case and the next 
moderator gives a different impression of an apparently similar case. 
By exposure to varying points of view, you can develop your own 
feeling and philosophy about the cases you will see. 
Closing Remarks 
The foregoing suggestions are aimed at achieving an ideal pre- 
sentation, Often, due to factors beyond our control, a particular case 
will have to be presented less than ideally. Also, it is not expected 
that right from the beginning your presentations will be crystal clear. 
Some time and experience are needed for that. However, if the sugges- 
tions presented here are kept in mind, not only you, but the rest of us, 
will benefit much.