Multiproblem families: A social-psychological perspective

Summary It is generally conceded that our allied mental health professions have fallen short in our attempts to provide adequate services to those people whose need is most desperate, those individuals and families ambiguously and condescendingly designated multiproblem. It could be said that we, the caregivers, have been unwilling or unable to be good enough mothers to these, our motherless children. In fact, the early, formative experience of the people with whom we are concerned has invariably been marked by gross discontinuities in mothering; the consequent defects in controlling, regulatory psychic structure (ego defects) are most prominently manifested in the chaotic life-style which characterizes these individuals and families. Our task as caregivers, when viewed from this perspective, is clear: we must somehow bring order out of disorder. But, with tragic regularity, disorder prevails; the provider of service succumbs to the same painful feelings of disorganization, bewilderment, frustration, and helplessness with which his client struggles, and, eventually, both give up in despair. What is more, this sense of fragmentation and futility pervades the institutions responsible for provision of services. Client, caregiver, and institution, all are trapped in the same tortuous maze. How, then, are we to extricate ourselves? Certainly not by drafting yet another master plan which promises everything and delivers nothing. Both realistic and humanistic considerations dictate more modest goals: We might not be able to rescue everyone who needs assistance, but we can help a few. And, whatever approach we may adopt, the service we offer can only be effective if it is based upon a sustained and sustaining (in essence, maternal) relationship.Sometimes I Feel Like a Motherless Child