Premature withdrawal from treatment in a child guidance clinic : an exploratory study of the factors which underlie clients' decisions to withdraw from social work treatment at the Provincial Child Guidance Clinic, North Burnaby, B.C.

Abstract

This is an exploratory study of the problem of clients' discontinuation in a child guidance clinic. The problem is considered first in terms of its therapeutic and administrative implications for clients and social workers. Reference is made to the professional literature which suggests the multi-causative factors which operate in a client's decision to withdraw from social work services. The problem is also related to social work prinicples and concepts. This is done to demonstrate that, by their continued efforts to understand the meaning of behaviour, to study the client in as much of his total life situation as possible, and to refine and enrich methods of family diagnosis, social workers can sharpen their diagnostic skills and their ability to select effective treatment goals. A brief discussion of the history of child guidance together with a more detailed account of the Provincial Child Guidance Clinic in North Burnaby gives a broad perspective to the problem of discontinuation. The problem is illustrated in five selected cases in which clients withdrew themselves and their children from Clinic services. The case records are examined, highlighting both dynamic patterns within the individual families and also their attitudes towards the child's problems and their Clinic experiences. These areas are thought to be significant factors relating to the parents' decisions to withdraw. Five follow-up interviews are conducted and recorded which indicate the clients' verbal reactions to the Clinic, including their conscious reasons for withdrawal. An assessment is made of the degree of Clinic help which the five families were able to employ. Common patterns are elucidated in the five cases and are designated as "withdrawal indicators". These indicators may, in the future, have prognostic value in determining which cases are likely to withdraw. The indicators are applied to six additional cases (tabulated in Appendix D). The results show that two-thirds of the indicators are present in each of the six cases. A further study is recommended in which the indicators would be applied to a larger number of discontinued cases, thus determining their reliability as predictive tools. The clients' reasons for withdrawal are discussed together with the recommendation that an additional study be done both to validate these reasons and to demonstrate new ones. In light of the findings various recommendations are made which the Clinic social work staff might implement in an attempt to decrease the rate of discontinuation. The withdrawal indicators should be recognized as forms of resistance and should be handled by the workers in early interviews. Increased skills in the areas of family diagnosis and a more discriminating system of recording will help to expedite the workers' recognition of the indicators. Also, greater skill by the workers in recognizing brief service cases, in handling reassignment, in their interpretation of the Clinic and its functions, and in their choice of words, will help to strengthen the clients' motivation to a continued Clinic contact. Recommendations are also made whereby the waiting-period, which emerges as the strongest reason for discontinuation, might be utilized as a therapeutic tool in treatment. Withdrawal must, in nearly all cases, reflect the clients' dissatisfactions with the services of the Clinic. To attain their goals for their clients, the agency, and themselves, the Clinic social workers must strive to understand and decrease the rate of discontinuation.Arts, Faculty ofSocial Work, School ofGraduat