Roy M. Kahn, Director of Psy chological Research for the Children's Unit at Metropolitan State Hospital and also for the state Department of Mental Health, has supervised Phillips Brooks House case-aide programs for three years. Groups of Harvard and Radclifle students in this program go out to various hospitals, including Met State, once a week to see individual patients. The group discusses their visits with a professional consultant.

In a recent interview, Dr. Kahn spoke--as a PBH consultant--about the motivations and learning processes of students who participate in the program.

I DON'T know the motivations for people getting into case-aide work. I imagine that these students are not exactly a representative sample of Harvard, because in almost every instance there has been some kind of family problem, either between the case-aide worker and his parents, who are possibly highly placed and overly busy, or who have had separations, divorces, deaths in the family, and other things. In a way it is possible that, in seeking to work with people with problems, they are also seeking to find some way to come to grips with their own problems.

A lot of case-aide workers are probably not altruistic, but selfish, in the sense that they are very eager to prove something about themselves. But this effort to prove themselves is also an effort to grow and should not be seen in any other light than that. It isn't really selfishness. I guess, to want to grow, but it isn't altruism. They're not going in masochistically.

A number of case-aides, on their own elect to go into individual therapy. Not a lot of them, and not because they think they're going to go insane but because they get confronted with things that they think they need help with. They probably could resolve these things on their own, in some other fashion, over the next five or ten years. But it might be much more difficult.

Testing Reality

I think that the concerns of case-aides about their emotional security are no more and no less than the concerns of any other people of the same age. The way they approach their problems may be a little different. They may seek to test reality by going to see what very disturbed people are like. They may seek opportunities to apply their knowledge or experience or theories -- they're tired of being students.

They may have family members who have been ill and be attempting to atone for unconscious guilt or something. But these are not the basic motivations. I don't know what the basic motivations are. They relate to efforts to establish their own value, their own work, their own capacity, their own ability, and to somehow grow from wherever they are to some other place they want to get to.

The role that they fill for the patients may help them do that, and the judgments that they have to make may help them do that. And I think that their outrage at the realities of life in mental hospitals may help them do that. The knowledge that intentions are not enough, that action is also required--and in this generation you see that knowledge more and more especially politically--is also important.

Different students join the program for different reasons, mostly because they come equipped rather differently for the work that they're going to do. A fairly consistent thing develops in case-aide work, and that is, through the year, a kind of group feeling or group coherence which grows up among the case workers in any given group. It comes from the discussions. Each group has a day leader--he's a student--and a [professional] supervisor. The frequency with which they meet with the professional person--advisor (I guess everyone's a professional person)-- varies very much from group to group. The kind of group that forms also varies with the frequency.

Classic Pattern

What you get, then, eventually, in a good working case-aide group, is a kind of group process--normal group process, not group therapy. This is definitely not group therapy. You get a normal group process, provided that the membership doesn't flit in and out and provided that they do bring a certain amount of dedication to their work.

We have an almost classic pattern in these groups. The sooner the population of the group coheres, the sooner the effects of the group set in. Students won't express themselves in the group until they feel comfortable, so you have to have a stable population. The first two or three weeks, it's frightening, it's exciting, it's exploratory.

It is then crucial that the supervision not become group therapy. But personality changes in the case-aides do occur. Students who are aware of their own problems actually do change in their relationships with their families. The girls start out talking about "Daddy," but by the end of the year they're talking about "my father." This is just a little bit different. The boys, some of them, become aware of their relationships with their brother, and so forth, but none of this is discussed in the group. This is something they do internally. This is not Soc Rel 120.

What it is is that in the course of exploring how other people feel, how meaningful they themselves can be to other people, and how little things mean something to them and to others when there is an interaction between the patient and the case-aide worker, they begin to discover that actually, they have a lot of feelings that they didn't know about. The group may point it out to them or the patient may point it out to them by refusing to see them one week after they've missed a session, and they hadn't thought they were that important.