Should Social Work Clients Have the Right to Effective Treatment

A patient sees a medical doctor about an ailment for which there is a treatment that has been demonstrated to be effective through well-controlled and replicated outcome studies. Does that patient have the right to receive this validated treatment, or should the physician have the choice of providing another treatment based on his or her own interests, training, or beliefs? A client sees a clinical social worker about a psychosocial disorder for which there is a treatment that has been demonstrated effective through repeated, well-designed outcome studies. Does the client have the right to receive this validated treatment, or does the social worker have the latitude to provide another, unsupported treatment? In regard to psychiatry, Klerman (1990) clearly stated, "The psychiatrist has a responsibility to use effective treatment. The patient has a right to the proper treatment. Proper treatment involves those treatments for which there is substantial evidence" (p. 417). Chambless et al. (1996) made the following assertion regarding the client's right to effective psychological treatment: Psychology is a science. Seeking to help those in need, clinical psychology draws its strength and uniqueness from the ethic of scientific validation. Whatever interventions that mysticism, authority, commercialism, politics, custom, convenience, or carelessness might dictate, clinical psychologists focus on what works. They bear a fundamental ethical responsibility to use where possible interventions that work and to subject any intervention they use to scientific scrutiny. (p. 10) The Association for Behavior Analysis's Task Force on the Right to Effective Treatment (cited in Van Houten et al., 1988) has formulated a statement of clients' rights, asserting that "The individual has a right to the most effective treatment procedures available" (p. 113). The Code of Ethics of the Florida Association for Behavior Analysis (1987) reads, "Clients have a right to effective treatment" (p. 1, italics added). A social worker, Leslie Tutty (1990), has suggested to community mental health professionals that "it is important to provide the most effective treatment available. This entails professionals keeping current on the research on treatment effectiveness for their particular client populations" (p. 13). Despite these and many similar assertions found in different disciplines, it seems that social workers and other human services professionals have been slow to adopt methods of intervention that have been demonstrated to be effective in the practice research literature. The NASW Code of Ethics (1996) has placed little emphasis on the client's right to receive effective, empirically validated treatment. In the section regarding the social worker's ethical responsibility to the social work profession, the code states, "Social workers should contribute to the knowledge base of social work and share with colleagues their knowledge related to practice, research, and ethics. Social workers should seek to contribute to the profession's literature and to share their knowledge at professional meetings and conferences" (p. 24). The code goes on to say that "social workers should critically examine and keep current with emerging knowledge relevant to social work" (p. 25). In regard to the social worker's ethical responsibility to the client, the code states, "Social workers should use clear and understandable language to inform clients of the purpose of the services, risks related to the services, limits to services, . . . relevant costs, reasonable alternatives, clients' right to refuse or withdraw consent" (pp. 7-8). These standards offer at least vague support for the provision of effective treatment but still place no direct requirements on the social worker. Reference to effective or empirically validated treatment is completely absent in the ethical codes developed by the National Association of Black Social Workers (see Loewenberg & Dolgoff, 1996), the National Federation of Societies for Clinical Social Work (1988), the Feminist Therapy Institute (1987), and the Canadian Association of Social Workers (1994). …