Jessie Taft was the most articulate early advocate of therapeutic adoption. The outlines of that approach appear in this excerpt. Temporary and permanents placements, Taft believed, should reflect careful investigation and individualized diagnosis of children’s emotional problems and needs. In Rebecca’s story, Taft’s sensitivity to Freudian themes, such as childhood sexuality and unconscious fears, was evident. So too was her commitment to a vision of social work deeply influenced by psychiatry. Foster placements mattered not only because they were opportunities to interpret and shape individual lives, but because they symbolized an even more ambitious goal: to direct the social future on the basis of a systematic, even “scientific,” understanding of human development and behavior.

There is very little opportunity in this world for radical experimentation with human beings. The necessity for taking children of all ages who are thrown out of their homes by some unfortunate circumstance and attempting to place them suitably in foster homes, not only permits, but forces such experimentation. It remains to make this process conscious, scientific and a matter of accurate record. It is obvious that theoretically, every child who is thus torn loose from his natural setting and robbed temporarily or possibly permanently of his fundamental sense of security, to be placed in a substitute family environment with the prospect of yet another change always an ever present possibility, constitutes a psychiatric problem. . . .

Already the best child placing agencies have recognized the implications of their work in their attempt to make the diagnostic study of each child accepted for care as thorough as possible.

Like psychiatry, social work has found adequate diagnosis more easy of accomplishment than treatment. Theoretically, it may be possible to describe the kind of home a given child should have. Practically it is very difficult to be sure just what will be the result of the interaction between the child and the home actually chosen. The subtleties of unconscious attitudes and inter-relationships among the members of a foster family are difficult of detection and interpretation. . . . Much of the combining of homes and children at present must be done more or less intuitively but a few of the best child placing agencies are struggling through careful study of the foster home, a detailed record of the child’s experience there and the assistance of psychologist or psychiatrist, to analyze and interpret the effect of a given environment upon the behavior and personality of the child and to exercise some degree of conscious control over the process.

The case history which is here presented illustrates the attempt of a Jewish child placing agency to cooperate with a psychologist over a period of four and a half years in the attempt to restore to a reasonable degree of social adjustment a very difficult girl of fourteen. It would have been better, of course, had she been reached in early childhood before her behavior patterns had become so well established, but even so she has repaid the time and effort spent upon her through a steady growth in poise, insight and ability to adjust to reality.

Rebecca H. aged fourteen years, the daughter of foreign born Roumanian Jewish parents, the third child in a family of five, was brought to the Juvenile Court by her mother in August 1919 because she would not go to school, would not get up in the morning, would not help at home, was given to outbursts of temper and was sullen, unhappy and disobedient. She was very much retarded in school having repeated the fifth grade three times and her attempts to work for money had been brief and futile. Her family were convinced that there must be something wrong with her mind and asked the court to assist them. The children’s agencies had at that time a small laboratory school under the direction of a psychologist and to this school Rebecca was sent for observation.

The picture she presented was far from lovely, nor was it of a kind to call out a friendly sympathetic response. She was a large girl at the awkward selfconscious age. All of the muscles of her body drooped. . . .

The physical examination revealed undernourishment, eye and ear conditions which were corrected and an enlarged thyroid. The psychiatric examination attached the label, psychoneurotic.

The girl was in the laboratory school a full month before a psychometric test was given. . . . Her intelligence quotient placed her in the lower limit of the normal group according to Terman’s classification. . . . The girl was given over to a child placing agency in April.

The observation period brought out the fact of Rebecca’s belief or fear that she might be feebleminded. . . . These first months also brought out two other important factors in her behavior, first conflicting attitudes of hatred and loyalty with regard to her family and second extreme shame and fear and avowed ignorance regarding everything even remotely connected with sex. The efforts of the psychologist to reach the roots of these two factors have extended over the entire period the girl has been in care, and the attempt has been made to free her sufficiently to enable her to express her real feelings. . . .

Her first longtime placement was in the country in a non-Jewish home with two elderly sisters, women of some education, refinement and understanding. It was not until July 1920, after three months in this setting, that Rebecca, whose social poise, voice and manners had taken on the general coloring of her environment and who was revelling in the absence of dirt, noise and confusion, held her first comparatively free and spontaneous interview with the psychologist. She spoke of her belief that her mother was not really her own mother but a stepmother because this would account for the fact that she was treated differently from the rest of the family. She had always, she felt, been disliked and discriminated against. Yet, she argued, surely no stepmother would take you around to clinics as my mother did, to try to get you well. She knew, intellectually, that there was no basis in fact for this belief, yet it had emotional weight. . . .

It was not until December 1920, a year after the first contact with her that Rebecca revealed one of her greatest sources of shame. When she was seven, her oldest sister, then about fourteen had begun to give the mother trouble, and would not work or go to school but ran the streets with boys and finally had an illegitimate child whose father she later married. The mother had taken this girl to court as she afterward took Rebecca, and always Rebecca had had her sister’s example held up before her as a warning and her likeness to her sister pointed out with dire prophesies as to her future. No threat or reproach was so overwhelming as this.

Rebecca remained with the maiden ladies, who were genuinely fond of her in spite of her trying ways over a year with much profit and was finally removed because of sickness in the home.

All through this period the psychologist had endeavored to give her a more open wholesome attitude toward sex. . . . In September 1921, when in a temporary city home she. . .confessed to the habit of masturbation, this, after two years of intimate friendly contact, apparent confidence and many opportunities for talking over any disturbing experience.

Her emotional reaction to this revelation was quite overwhelming and seemed to reduce her to her original state of depression and inferiority, but after several intervals she was able to talk about it with some calmness and objectivity. In the fall of 1921 she was again placed in a non-Jewish home in the country, where the woman, a practical nurse, made a business of boarding difficult children. . . .

The contribution of this placement to Rebecca’s reeducation is unquestioned. It put through a habit training program whose success had a distinct effect upon the girl’s self-respect and belief in her own normality, it restored self-confidence through school success, the completion of the seventh grade, it introduced a new emotional stimulus to achievement through the attachment to the foster mother and brought about the first successful adjustment to other children. . . .

In August 1922, an attempt was made to prepare her for the working world, by giving her training for child’s nurse in a babies hospital. She responded well in interest and effort but proved to be too slow for sick babies and a day nursery was recommended. In November 1922 she began to work in a day nursery under most favorable conditions, as far as work was concerned but with poor adjustment to her home placements which had to be changed frequently. . . .

That Rebecca is now a well adjusted person, cannot be maintained nor can one be sure that her present adjustment will continue to be equal to the strain of living, but one can surely say that she has at the present time, a good fighting chance and that she has improved steadily in self-confidence, control and insight. What were the causes of her maladjustment from the psychoanalytic viewpoint it is impossible to say as the intimate history of her earliest childhood and the family interrelationships has never been obtained either from her or her foreign speaking parents. . . .

The factors in treatment have been first, the relationship to the psychologist which has supplied for four years a steady background of belief in her ability and worth. . . . Second, the removal from the nagging, critical, hateful family atmosphere to homes which satisfied some of her longings for a better standard of living and gave her actual contact with happy, satisfying, human relationships. . . .

This give a bare outline of what has happened in the life of one girl over a period of four years but conveys no idea of the painstaking work of supervision, of the patience and skill which the workers in the child placing agency have supplied in their effort to reestablish an individual whose self-confidence had been thoroughly undermined.

Our knowledge of the homes through which we worked is inadequate, our records are but feeble attempts to put on paper the vital processes of which we have been a part, our knowledge of what has taken place and our ability to interpret and direct it consciously are all too limited, but the history of Rebecca will serve its purpose if it conveys in some measure the complexity and subtlety of the material in which the child placing agency works, the contribution it may make to our knowledge of human behavior and its need for all of the understanding which psychiatry can bring to bear.