On Science, Antiscience, and the Client's Right to Effective Treatment

Abstract

In the May 1997 issue of Social Work, we published an article entitled Should Social Work Clients Have the Right to Effective Treatment? (Myers & Thyer, 1997). In it, we argued that as certain specific psychosocial interventions become well established as effective treatments for particular forms of psychosocial problems, clients consulting social workers should have the right to be provided with such interventions as a first-choice treatment. We reviewed some of the evidentiary standards that have led to certain interventions being labeled supported and proposed some ethical standards to promote social workers' training in and applying of these treatments, where appropriate. In the January 1998 issue of this journal, Professor Stanley Witkin (1998a) responded to our earlier article, arguing that our position was untenable for a number of reasons. Among them was our purported use of such tactics as misuse of analogy, oversimplification, false consensus, to authority, and the use of testimonials and misrepresentation (p. 75). We would like to respond to these charges. To some extent Witkin's issues are legitimate. We did not present a balanced argument, listing the pros and cons of our position, the differing philosophies of science, the real and imagined flaws of empirically oriented science, a review of postmodernism's influence on social work practice, and so forth. We have no doubt that the reader will recognize the acute journal space constraints, which preclude addressing all possible issues dealing with a topic as controversial as ours (some philosophical issues are dealt with in chapter-length form by Thyer & Wodarski, 1998). Witkin's review of some of these issues is a useful service. However, his call for us to provide data to back up an argument based on values and ethical principles strikes us as mixing apples and oranges. Data are called for in evaluating claims to effectiveness of particular interventions, not in advancing positions based on rationality, values, and professional standards. It is perfectly appropriate for empirically oriented social workers to make use of the language of rights, ethics, and obligations, because we are as concerned (if not more so) with such issues as are our nonempiricist colleagues. The use of such language would be a problem if empiricists maintained that scientific considerations should be the only relevant criteria in making practice decisions, but of course, as Witkin well knows, to advocate that empirical considerations be given a greater voice in practice is not to assert that they should be the only voice heard. What Appeals to Authority? Of course we made careful and extensive references to earlier work supportive of our position, drawing on the literatures of social work, psychology, psychiatry, and behavior analysis. What Witkin calls appeals to we prefer to reframe as being consistent with the conventional standards called scholarship. We would be remiss in not citing such earlier work. We cannot help but note that Witkin engaged in precisely the same practice in crafting his response, bolstering his views by citing the work of Gergen, Heinemann, Gewirth, Witkin himself, Denzin, and other postmodernist authorities. At no point did we contend that because someone else says something, it must be true, and we should therefore follow their recommendations. That argument truly would be a straightforward appeal to authority, and as such would carry little weight in terms of scientific evidence. There are compelling differences between to authority and placing one's current work in scholarly context, and we are confident that the reader can discriminate between the two practices. What Misrepresentation of Social Work? Our article did focus primarily on clinical problems and interventions related to mental health practice, because these are the two areas in which the greatest numbers of evidence-based treatments have been developed and psychosocial problems addressed. …