Who Is to Define Effective Treatment for Social Work Clients

Cupido dominandi cunctis affectibus flangrantior est. - Tacitus Myers and Thyer (1997) argue that social work clients should have the right to "effective" treatment and assert that the NASW Code of Ethics (NASW, 1996) should be amended to safeguard the "clients' right to receive effective treatment and social workers' obligation to be educated about and to provide such treatment" (p. 288). In fact, few would argue that clients should not have the right to effective treatment. It would almost be like arguing against Morn and apple pie. A closer examination of the arguments made by Myers and Thyer reveals an altogether erroneous and ill-advised set of recommendations. In fact, prescribing empirically validated treatments (EVTs) as ethical imperatives by officially adopting them as parts of the codes of ethics of professional organizations would seriously impede the right of clients to effective treatment and might well compromise client self-determination in the choice of treatment methods and objectives. I argue further that their proposals would do a major disservice to practicing social workers and to the profession and would attempt to solve the very controversial problem of the relationship between clinical research and clinical practice by administrative and political edict. Let us briefly examine the arguments of Myers and Thyer. They quote Gerald Klerman and Dianne Chambless to the effect that, in the fields of psychiatry and psychology, clients have the right to effective treatment that is evidence based and note that social work organizations in the United States and Canada have not adopted specific provisions in their codes of ethics requiring or even mentioning EVTs. They then examine the work of the Task Force on Promotion and Dissemination of Psychological Procedures of Division 12 of the American Psychological Association (APA) (Task Force, 1995), which has identified a number of psychological treatments that are regarded as efficacious on the basis of published clinical trials and manuals that describe the psychosocial treatments in detail. Citing Persons (1995), they present six possible reasons why professionals have been slow to adopt EVTs in clinical practice. They conclude that the slow adoption of EVTs is "related to educational issues, including classroom training, internship training, and continuing education" (p. 292). They recommend a number of possible changes in the structure of education that would serve to disseminate EVTs in the professional community. They further recommend that avenues within the legal system be explored to work to guarantee clients' right to effective treatment; they also propose a change in the NASW Code of Ethics (1996) enhancing the clients' right to effective treatment. Myers and Thyer's argument is erroneous on several counts: 1. It ignores the problems involved in translating research findings into clinical practice while asserting that there is only one sort of research that is the proper province of social work and psychotherapy. 2. It asserts that there is only one goal for social work and for psychotherapy, one which I would broadly characterize as the goal of "symptom removal." 3. It ignores or downplays the major controversies that have arisen over the proposed official adoption of EVTs in other fields, such as clinical psychology. 4. Its focus on education, which is in some ways useful, ignores the implications and dangers of establishing a sort of hegemony of the researcher and educator over the practicing social worker. To What Extent Are EVTs Applicable to Actual Clinical Practice? The current literature is replete with examples of clinicians and researchers who question the applicability of findings from EVT-related research studies to actual practice with clients in clinical practice settings (for example, Fensterheim & Raw, 1996a, 1996b; Garfield, 1996; Goldfried & Wolfe, 1996; Howard, Orlinsky, & Lueger, 1994; Raw, 1993; Shapiro, 1996; Silverman, 1996; Strupp & Anderson, 1997; Wolfe, 1994). …