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Professor Gordon Hamilton, of the New York School of Social Work, has written an excellent monograph on the practice of psychoanalytically oriented psychotherapy by social workers in a child guidance clinic. The book is a report of the three-year study of a project which the Jewish Board of Guardians of New York has carried on for over ten years.
To do psychotherapy, the social worker must have a diagnosis of the case. The classification employed is simplified under three headings: 'the child who acts out his impulses', 'the anxious child', and 'the severely disturbed child'. The first refers to the primary behavior (conduct and habit) disorders; the second, not too clear, probably includes anxiety and conversion hysteria; the last group, most inclusive, collects psychosomatic illnesses, stuttering, epilepsy, psychotic reactions, obsessive and compulsive neuroses, 'psychopathic personalities' (a regrettable, archaic inclusion) and neurotic characters. Workers are warned to be alert for signs of physical and mental illness.
This classification is an oversimplification which misses its purpose. If social workers can be taught psychotherapy, should they not be expected to use more adequate clinical diagnoses? Can a social worker alone do all that is asked? Is it not the best and safest solution, as is stated later in the text, to have each case reviewed periodically by a psychiatrist?
The primary behavior disorder syndrome is well described, but that these children enjoy their badness (p. 48), have deficient superegos (p. 45) and little feelings of guilt (p. 49) seems contrary to fact. These children show evidences of quantitatively well-developed but qualitatively distorted, oversevere superegos. They have extreme and oversensitive reactions of guilt which they, to be sure, do not verbalize but act out. This acting out does not represent pleasure but inner conflict, like any other neuroses; it is a temporary, symptomatic relief from a primitively cruel supereg