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Is Social Work Evidence-based? Does Saying So Make It So?Ongoing Challenges in Integrating Research, Practice and PolicyEileen Gambrill

ABSTRACTThe integration of research and practice is of concern in all helping profes-sions. Has social work become an evidence-based profession as someclaim? Characteristics of current-day social work are presented that disputethis view, related continuing concerns are suggested, and promising devel-opments (mostly outside social work) are described that should contributeto the provision of evidence-informed services to clients.

ARTICLE HISTORYAccepted: December 2015

Social workers confront perhaps the most difficult tasks of any helping professional. They workat the nexus of individual distress often created by preventable life inequities fostered byeconomic, political, and social policies. The funding for their work is shaped by these influencesand affects how they frame problems and the services they offer, in addition to what is taughtand how it is taught in schools of social work. The multiple functions of social welfare and socialwork (helping clients, social control, and social reform) guarantees that goal displacement andconflicts will occur.

As in other helping professions, social work has had a long-term interest in conducting anddrawing on research that contributes to helping clients (e.g., Hudson, 1982; Kirk & Reid, 2002;Orcutt, 1990; Reid, 1994, 2001; Rothman & Thomas, 1994). According to Reid (2001), there aretwo uses of science in the helping professions: “One has been to follow a scientific model inconducting professional activities: science as method;” the second has been “science as knowl-edge” to be drawn on to inform practice” (p. 274). The publications of early social work writersreflect an interest in the scientific method and in research. Charitable organizations in theUnited States in the late 19th and early 20th centuries emphasized scientific charity “describedas the ‘intelligent’ discriminating procurement of facts in the investigation of needs” (Orcutt,1990, p. 124). Social research was of great interest to the women who created Hull House, a sitethat included a Working People’s Social Science Club (e.g., Oakley, 2014). Social work scholarsdrew on different disciplines and from a variety of theorists. Karpf (1931) described knowledgedrawn by social workers from psychology and discussed limitations of such knowledge. JesseTaft drew on the work of George Herbert Mead and Otto Rank (Deegan, 1986). Lilian Ripple(1957) conducted a study of factors associated with continuance in social work, and MaryRichmond (1917) drew on the scientific method as a guide to gathering information. VirginiaRobinson (1921) noted that:

like any other profession which is founded on the scientific method, social casework must move through threestages: (1) observation and assembling of its facts, (2) hypothetical interpretation of these facts, and (3) controlof the facts for new ends. (p. 101)

In the call for articles, the editors of the Journal of Social Work Education state that the purpose ofthis special issue “is to present the state of social work today as grounded in empirical evidence” andthat “in the past 25 years we have seen a shift within social work academia and practice across all

CONTACT Eileen Gambrill School of Social Welfare, University of California Berkeley, Berkeley, CA94720, USA.


© 2016 Council on Social Work Education

methods that emphasizes research and evidence-based practice.” In a publication from the AmericanAcademy of Social Work and Social Welfare (2013) it was claimed that “social work has matured . . .to an evidence-based profession, relying on systematic data” (p. 1).

Has there been a shift? Is social work grounded in empirical evidence?

There certainly has been an increase in use of the words evidence based. An Internet search of theterms social work and evidence-based practice (EBP) produces many results. More social workresearchers are turning out more research, and the number of journals containing social workresearch has increased; for example, there is now a publication titled Journal of Evidence-BasedSocial Work. The common elements approach has also received attention (Barth et al., 2012), andwebsites and clearinghouses claim to list interventions in relation to their evidentiary status. Butwhat is the quality of research conducted and reported? How many practices offered to clients areevidence informed (those most likely to result in hoped-for outcomes)? A close examination of thesequestions suggests that social work is not grounded in empirical evidence. I suggest that we haveseen a shift mainly in language, not in substance. For the same reasons that science is oftenmisrepresented, and critical thinking values, skills, and knowledge have not been infused into socialwork, so has the vision of EBP described in original sources (e.g., Straus, Richardson, Glasziou, &Haynes, 2011; Sackett, Richardson, Rosenberg, & Haynes, 1997) been forgone (e.g., to makeinformed decisions attending to ignorance as well as knowledge). All three are far too radical tobe embraced in the highly politicized and economically contested areas of social work and socialwelfare. We have often been the unwitting victims or cosupporters of others’ agendas (e.g., biome-dical psychiatry) that compromise opportunities to help clients and that are encouraged by our lackof understanding of the technological society in which we live. Consider the following.

First, most social work interventions, including assessment methods, have not been criticallytested in terms of their effects. We have no idea whether they do more harm than good.

Second, information about what is offered to clients in social work agencies is usually too vague to beinformative about the quality of services provided and outcomes attained. Results found in searchingwebsites of some field agencies used at my school reveal only vague information or reliance on surrogatessuch as process measures to reflect quality of services (e.g., number of clients seen). Increased attention isbeing given to data mining, especially administrative data (Putnam-Hornstein et al., 2013). However, to bevaluable, the data mined must be available, reliable, and valid, and it may not be (e.g., Gillingham, 2015).

Third, studies of practices and policies offered and their outcomes often reveal that practicespromoted and used are often not those that are best. In Science and Pseudoscience in Social Work,Thyer and Pignotti (2015) describe an alarming variety of questionable practices used by socialworkers (see also Pignotti & Thyer, 2009). Their illustrations indicate that life-affecting decisionsmade regarding interventions are often neither theoretically nor empirically well grounded; somehave been found to harm clients. Programs claimed to be evidence based have been shown to be nomore effective than other methods (Gorman & Huber, 2009; Littell, 2008).

Fourth, critical appraisal of published research (research on research) reveals a very bleak picture.Peer review is deeply flawed. Ioannidis (2005, 2008) argues that most published research findings arefalse or grossly exaggerated. Bias and selective reporting are rife. Most research in psychology eitherhas not or cannot be replicated (Francis, 2012; Makel, Plucker, & Hegarty, 2012). Campbell andCochrane Group’s ( systematic reviews typically reveal mostresearch reports to be flawed. Transforming the knowledge we do have into use is a slow process.Much of the published literature shares the goals and strategies of advertisements for authors andinstitutions rather than pursuit of knowledge (Gambrill, 2012). The website Retraction Watch( is growing thanks to a $400,000 grant from the MacArthurFoundation to catalog the thousands of retractions in articles in peer-reviewed journals. Thus,science is not necessarily self-correcting (Ioannidis, 2012). In 2005 the editors of leading medicaljournals announced that reports of trials would not be published unless they had been registered to


prevent authors from hiding negative reports (DeAngelis et al., 2005; see also The Era of ClinicalTrial Registeries, 2005). Scientism (use of the methods or language of science in contexts in whichthey are not appropriate) abounds, including inappropriate use of statistics (e.g., Ziliak &McCloskey, 2008). The term evidence-based has become a slogan used to sell products—articlesand books with hyped claims about what works. Avoidable distortions of views are common(Gambrill, 2010). Bogus claims about alleged discoveries in neuroscience are common (see theblog Neuroskeptic published by Discover magazine). Poor-quality research misinforms rather thaninforms the selection of practices and policies. Because they are bamboozled by distorted views ofdisliked perspectives and by inflated claims in the peer-reviewed literature about what we know andwhat is achieved, practitioners as well as administrators are in the uncomfortable position of feelingout of step, not current. Janko (1997) argues that false claims contribute to indifference.

Political, social, and economic concerns in the helping professions and related venues, includingresearch centers and governmental organizations, often discourage telling the truth. Entrenchedideas hamper acknowledgment of new ideas (e.g., Barber, 1961; Campanario, 2009). Bauer (2004)contends that science is dominated by research cartels and knowledge monopolies. Social workacademics and researchers are influenced by their environments (Bartley, 1990; Greenberg, 2007;Veblen, 1918/1993). Social and economic pressures on researchers encourage claim inflation, datafudging, and other practices that misinform. A key requirement is publication of original research(e.g., Fanelli, 2010). Newly appointed professors must obtain grants to help support universities(Thyer, 2011), and granting agencies favor those who work within popular frameworks. TheNational Institute of Mental Health states that “Fundamental to our mission is the propositionthat mental illnesses are brain disorders expressed as complex behavioral and cognitive syndromes”(as cited in Abramowitz, 2015). As Abramowitz notes, this implies that cognitive and behavioralprocesses are mere by-products (p. 35). And, what about the role of environmental circumstances?

Fifth, social work has chosen to embrace the EBPs approach rather than the process of EBP, which isdesigned to help individual practitioners deal in an ethical, informed manner with the uncertaintiesand challenges of everyday practice (Straus et al., 2011), drawing on tools such as the Campbell andCochrane databases of systematic reviews are designed to decrease costs associated with drawing onresearch findings. The EBPs approach is quite different from the process of EBP and is more populartoday. Lists of interventions said to be evidence-based (EBPs) are created and are used to guidepractitioners and to mandate what must be used. Problems with such lists include inflated claims ofeffectiveness in the peer-reviewed literature (see previous paragraph) and the need to considerindividual differences in client characteristics and circumstances that may render an evidence-basedintervention inappropriate. Promoters of EBPs will do more harm than good if they are not wellinformed about political, social, and economic influences that shape the pool of literature available,including peer-reviewed publications, and so are appropriately skeptical about what they read.Otherwise, they themselves become advertisers for dubious claims, including those about problemframing.

Sixth, social workers and social work educators have been slow to draw on empirical literatureregarding the helping process, especially common factors and the value of gaining ongoing feedbackregarding the degree of progress, both of which are associated with positive outcomes (Lambert &Shimokawa, 2011). Research suggests that common factors such as empathy, warmth, and forming astrong alliance contribute far more to positive outcomes than do specific interventions (Wampold &Imel, 2015). How many social work programs ensure that all students acquire related minimal-levelcompetencies and use these in their interactions with clients?

Seventh, social work has continued its infatuation with biomedical and institutional psychiatry andcertain areas of clinical psychology (e.g., Illouz, 2008; Lubove, 1965). Social workers are the mainproviders of mental health services in the United States. Misbehaviors and troubled or troubling feelingsand thoughts are given labels such as bipolar disorder, attention-deficit/hyperactivity disorder, socialanxiety disorder, and hundreds of others, including gambling disorder and female sexual interest/arousaldisorder, according to the Diagnostic and Statistical Manual of Mental Disorders, now in its fifth edition


(DSM-5; American Psychiatric Association, 1976). The client is viewed as having an illness (mental) inneed of a diagnosis and treatment. Ivan Illich (1976) used the term “the medicalization of life” (p. 39).The boundaries on categories of alleged disorders such as social anxiety continue to expand. One out offour people is alleged to have a diagnosable mental disorder. To most people, to question this view isconsidered heretical and deluded, a reaction that shows the spectacular success of equating (mis)behaviorand illness. Biomedical remedies for (mis)behaviors and distress are promoted on the website of theNational Association of Social Workers). For example, on one of its Web pages, Shryer (2012) states that“stimulants are still the gold standard.” For further information, he recommends, anorganization funded primarily by pharmaceutical companies. Critiques of the disease-centered modelof psychotropic drug action are ignored (e.g., Moncrieff, 2008b, 2013a, 2013b), as are penetratingcritiques of the concept of mental illness (e.g., Kirk, Gomory, & Cohen, 2013; Szasz, 1987) and lack ofreliability and validity of the DSM-5 (American Psychiatric Association, 2015) (e.g., Kirk et al., 2013).

Sociologists emphasize the social construction of personal and social problems, for example,framing political concerns such as equality of rights or freedom from unwanted control as personalones the state has power over (see Foucault, 1973; Illich, 1976; Mills, 1959). There are great stakes inhow problems are framed, and people with vested interests devote considerable time, money, andeffort to influence what others believe (Loeske, 1999). Psychological and biomedical views ignorecontextual factors and related research showing the influence of environmental factors on health,psychological distress, and behavior (e.g., Adler & Stewart, 2010). This is remarkable in a professionconcerned with oppression and discrimination and the need for social reform. Ignoring social,political, and economic factors that affect clients’ lives results in incomplete analyses of clientconcerns (oversimplifications) and lost opportunities to help clients.

Eighth, empirical research and the related theory regarding the science of behavior (e.g, Madden,2013; Staats, 2012) is typically ignored in social work education and in many areas of practice.Discussions of strengths-based social work typically ignore behavioral research and related theorydescribing a constructional approach to helping. Related theory is often distorted (Thyer, 2005).Problems differ in their prospects for resolution, which are influenced by the accuracy of under-standing; client concerns may be framed in a way that facilitates or hinders the discovery of options.A biomedical approach focuses on identifying disorders of clients, or what is wrong with them. Aconstructional approach focuses on identifying client strengths and developing alternative behavioralrepertoires in pursuit of hoped-for outcomes (Layng, 2009; Staats, 2012). This science of behavioroffers emperically informed constructive ways to rearrange environments including helping clientsto create alternative repertoires that compete with disliked behaviors.

Ninth, as illustrated in earlier sections, critical thinking, values, skills, and knowledge are not inabundant evidence in much of the discourse in social work. This can be seen in avoidable distortionsof ideas, false claims about the evidentiary status of policies and programs, use of vague language,and ignoring compelling critiques of views promoted (see prior discussion). The terms science andscientific are often used to merely increase credibility of claims. Such use is a form of propaganda(encouraging beliefs and actions with the least thought possible; Ellul, 1965). Thinking criticallyabout claims is not valued by many groups and individuals; on the contrary, they may try to hide theeffects of practices and policies and appeal to pseudoscience. Interest in status and money loomslarger than helping clients and telling the truth.

Related continuing concerns

A variety of failures of integration continue. Focusing on the thoughts and brains of individuals asthe source of problems continues in much of social work including social work education, deflectingattention from the dehumanizing effects of the technological society in which we live (Ellul, 1964,1965; Stivers, 2004, 2008). Social work has drawn heavily on psychiatry and cognitive psychology,ignoring vital contributions of sociology, evolutionary psychology, and behavioral psychology. Lackof awareness regarding the influence of the public relations industry, the media, and the biomedical


industrial complex in promoting misleading claims is a barrier to recognizing social, political, andeconomic causes of personal and social problems including poor health, homelessness, and poverty.Social work is for the most part a woman’s profession, yet academics have forwarded a psychiatricview that pathologizes women (e.g., Ussher, 2013).

Naïveté regarding the technological society in which we live

Those who work in the area of critical social work highlight the effects of structural factors increating and maintaining discrimination and social exclusion but overlook Ellul’s (1964, 1965)penetrating analysis of the mass society in which we live that is dominated by technique and itsdehumanizing effects. “Technique refers to any standardized means for attaining a predeterminedresult. Thus, it converts spontaneous and unreflective behavior into behavior that is deliberate andrationalized. ” (Ellul, 1965, p. vi). Ellul (1965) argues that we live in a technological societydominated by the mass media, which creates alienation and fragmentation resulting in loneliness,anxiety, and a desperate search for meaning. Technology includes material (manufactured products)and nonmaterial creations such as bureaucracies and administrative systems. The mass media,advertising, public relations, propaganda, and bureaucracies are all techniques. Case records andsurveillance systems are technologies. Self-help books and psychotherapies are techniques. We spendour time looking at, listening to, and talking to machines. Many social work scholars note theincrease in required administrative tasks (the tick-box mentality) and its negative effects includingdecreased time between clients and social workers (e.g., Munro, 2011; Rogowski, 2011, 2013).Technologies become increasingly interrelated so that a change in one (a data management system)may be countered or amplified in another. Technology presses for ever greater efficiency, standar-dization, systematization, and the elimination of variability, which requires inattention to individualdifferences. It squeezes out the qualitative. Ellul (1964) suggests that technology has become the newsacred.

The medicalization of deviance is an example of the universality of technology (Stivers, 2008).Disliked behaviors are viewed as illnesses fixed by technologies of medication or therapy, guidedby standardized codes and labels. Health and happiness are equated with adjustment. Cognitivetherapy reduces us to our thoughts. Biological views reduce us to brain chemistry. Both ignorecultural contexts and individual subjectivities, and complex interactions among them. Stivers(2008) argues that “the medicalization of deviance denies both the freedom and the responsibilityof the actor” (p. 46). Szasz (1961, 1987) has argued this for more than half a century.

This technological society is foreign to human needs for community and social relations. Itcreates negative psychological and social consequences including loneliness and anxiety andfragmentation and splits such as that between belief and action. There is an illusion of freedom(Stivers, 2008). Moral problems are converted into social problems (Stivers, 2001). Because poweris located in abstract systems such as bureaucracies, it is difficult or impossible to pinpoint andchange. Propaganda is the means used to prevent increasing mechanization and technologicalorganization from being felt as too oppressive. It is “called upon to solve problems created bytechnology, to play on maladjustments, and to integrate the individual into a technological world”(Ellul, 1965, p. xvii). It is interested “in shaping action and behavior with little thought” (Ellul,1965, p. 278). A major function is to squelch criticism and censor dissenting points of view.Related examples illustrate the deep ethical and epistemic concerns with propaganda(Cunningham, 2002). Ellul (1965) argues that, “adjustment has become one of the keywords ofall psychological influence” (p. 107) such as adapting to dehumanizing working conditions (see, forexample, the discussion of the mental hygiene movement in Lubove, 1965). Stivers (2001) arguesthat much of the advice in therapy and self-help books is “conformist” (p. 60). The products ofsocial science are drawn on to maximize the effectiveness of propaganda. Edward Bernays, thefounder of the field of public relations, drew on psychoanalytic theory: “The individual can no


longer judge for himself because he inescapably relates his thoughts to the entire complex of valuesand prejudices established by propaganda” (Ellul, 1965, p. 170).

Ellul (1965) states that “intellectuals are most easily reached by propaganda” (p. 113) because theyread so much material in secondary sources. As illustrated in prior sections, propaganda is notconfined to fringe healers; it has a robust presence in the peer-reviewed literature including inflatedclaims of knowledge and effectiveness. Propaganda methods include oversimplifications, creation offear, begging the question (simply asserting what should be argued), appeal to self-interest, andcensorship of alternative views and contradictory evidence (Gambrill, 2012). A review of advertisingon marketing brochures distributed by drug companies to physicians in Germany revealed that 94%of the content in these had no basis in scientific evidence (Tuffs, 2004).

Continuing misrepresentations and misunderstandings of science

A concern for helping and not harming clients obliges us to critically evaluate assumptions about whatis true and what is false. Relying on scientific criteria offers a way to do so. The essence of science isbold guessing and rigorous testing. This view of science as we know it today is one in which thetheory-laden nature of observation is assumed (i.e., our assumptions influence what we observe), andrational criticism is viewed as the essence of science (Miller, 1994; Phillips, 1992; Popper, 1963).Concepts are assumed to have meaning and value even though they are unobservable. This view ofscience emphasizes the elimination of errors by means of criticism (Popper, 1994, p. 159).

Science rejects a reliance on authority (e.g., pronouncements by officials or professors) as a routeto knowledge. “Science is the belief in the ignorance of experts” (Feynman, 1969). Far fromreinforcing myths about reality, science is likely to question them. All sorts of questions peoplemay not want raised may be raised, such as, Does this residential center really help residents?Scientific statements can be tested (they can be refuted). If an agency for the homeless claims thathomes are found for applicants within 10 days, data could be gathered to see whether this claim istrue. Scientists are often wrong and find out they are wrong by testing their predictions. Althoughthe purpose of science is to seek true answers to problems (statements that correspond to facts), thisdoes not mean that we can have certain knowledge. A critical attitude, which Karl Popper (1963)defines as a willingness and commitment to open up favored views to severe scrutiny, is basic toscience, distinguishing it from pseudoscience. Scientists are skeptics. They question what others viewas fact or common sense. They ask for arguments and evidence.

Surveys show that most people do not understand science (National Science Foundation, 2006).We are surrounded by pseudoscience and propaganda, making it a continuous challenge to resisttheir allure (e.g., Gambrill, 2012; Lilienfeld, Lynn, & Lohr, 2015; Thyer & Pignotti, 2015). The termpseudoscience refers to material that makes sciencelike claims but provides no evidence for them(Bunge, 1984). Science is often misrepresented in the social work literature. Some academics confuselogical positivism with science as we know it today (Shadish, 1995). The former approach wasdiscarded decades ago because of the induction problem, the theory-laden nature of observation, andthe utility of unobservable constructs (e.g., Phillips, 1990; Popper, 1963, 1994). Science is oftenmisrepresented as a collection of facts or as referring only to controlled experimental studies. Manypeople confuse science with pseudoscience and scientism (false claims of being scientific (Phillips,1987). Relativists argue that all methods are equally valid in testing claims. It is assumed thatknowledge and morality are inherently bounded by or rooted in culture. Gelner (1992) argues thatthis view undervalues coercive and economic constraints in society and overvalues conceptual ones(see also Munz, 1992).

Forgoing the essence of critical thinking: Criticism

Thinking critically has costs and benefits that are shared by the process of evidence-informedpractice and scientific exploration. Costs include forgoing the comfortable feeling of certainty and


the time and effort required to accurately understand alternative views and to seek and criticallyappraise research findings. It may result in loss of shared social bonds (Munz, 1985). Phillips (1992)argues that raising questions about truth has the taboo quality today that talking about sex had inVictorian times. To those who uncritically embrace the view that they are helping others, asking thatverbal statements of compassion and caring be accompanied by evidence of helping may seemdisloyal or absurd. According to Ellul (1965), “If we practice a profession, we cannot limit ourselvesto its financial rewards, we must also invest it with idealistic or moral justification. It becomes ourcalling, and we will not tolerate its being questioned” (p. 157).

It takes courage to challenge accepted beliefs, especially when held by authorities who do notvalue a culture of thoughtfulness in which well-argued alternative views are welcome andarguments critically evaluated. To the autocratic and powerful, raising questions threatenstheir power to simply pronounce what is and is not without taking responsibility for presentingwell-reasoned arguments and involving others in decisions. Socrates was sentenced to deathbecause he questioned other people’s beliefs (see Plato’s Apology, trans. Tredennick & Tarrant,1954/1993; Janko, 1997). Evolutionary history highlights the powerful role of status (Gilbert,1989). The student who questions a professor, supervisor, administrator, or physician may beviewed as a threat rather than as a source of knowledge that may help clients attain goals theyvalue.

Promising developments

In the reality that the future holds a promise of new paths, we could say that we are always at acritical juncture. I suggest that we are at a critical juncture but, as argued earlier, not becausesocial work is “grounded in empirical evidence” and “emphasizes research and evidence-basedpractice” as stated by the editors of this journal in their call for articles. Quite the opposite; inmost cases we have the words but not the substance. I suggest the following developments, mostof which are outside social work, that should contribute to more accurate accounts of current-day social work practice, policy, and research as well as the provision of evidence-informedservices to clients.

Increased exposure of false claims and flaws in research and calls to decrease related waste

Exposure of bogus claims in the peer-reviewed literature has increased, as discussed earlier inthis article. This started in the medical and biomedical area (Ioannidis, 2005, 2014). Ioannidis(2014) estimates that billions of dollars have been wasted on research that cannot answerquestions pursued. This waste has reached such enormous proportions that efforts are nowunder way to decrease it, including the creation of a new center at Stanford, The Meta-researchInnovation Center (METRICS) (see also Chalmers et al., 2014; Ioannidis et al., 2014).Recognition that all was not well in the peer-reviewed literature was the impetus for creationof the International Congress on Peer Review and Biomedical Research held every 4 years since1986. The Journal of Negative Results in Biomedicine publishes negative and unexplained orcontroversial research, often rejected by mainstream journals. Some journals have introducednegative results sections (e.g., Dirnagl & Lauritzen, 2010), and open peer review is becomingmore common (e.g., Shanahan & Olsen, 2014). What will we find when we carefully examine thequality of social work research? Exposures of bogus claims also appear in our daily newspapers(e.g., Teicholz, 2015) and on websites such as Retraction Watch. Reid (2001) suggested that “Astrong case can be made that a critical mass of tested intervention knowledge has beenestablished” (p. 278). Is this true, even 15 years later? Critical appraisal of research suggeststhat it is not. Conducting research that cannot answer questions raised is a great waste of money,time, and effort. Related false claims mislead practitioners and clients alike.


Increasing user-friendly tools for acquiring critical appraisal skills

Increasingly user-friendly websites are available for honing critical appraisal skills, such as Content is available in multiple languages. This site includes discussionof important topics such as the vital difference between relative and absolute risk and correlation andcausation. Campbell and Cochrane databases provide systematic reviews. User-friendly websites suchas can be drawn on to enhance critical thinking skills.

Increasing criticism of the biomedical industrial complex

Biomedical industrial complex refers to the increasingly globalized interconnections among phar-maceutical, biotechnological, medical, public relations, research contracting, and educational indus-tries with funding agencies, private and governmental, and various lobbying groups (Gomory,Wong, Cohen, & LaCasse, 2011; Clarke, Mamo, Fosket, Fishman, & Shim, 2010; Orr, 2010) Itsgrowth and ever more intertwined relationships and use of technologies (e.g., for diagnosis, billing,selection of interventions, surveillance) illustrate the technological society in which we live, evermore standardized, interconnected, and decontextualized. Conflicts of interests abound, which isdescribed later. The past few years have seen increasing critiques of the medicalization of problemsin living (e.g., Kirk et al., 2013), including in the field of psychiatry itself (e.g., Frances, 2010). Socialwork scholars have been at the forefront of documenting reliability and validity problems with theever lengthening list of problems in living viewed as “mental illnesses” in the DSM (AmericanPsychiatric Association, 2015; Kirk, Gomory, & Cohen, 2013). Moncrieff (2008a) argues thatbiological psychiatry forwards neoliberal political agendas. Claims that changes in serotonin areresponsible for depression have been debunked by social work scholars (LaCasse & Leo, 2005).

Drug companies benefit from the creation of new diseases, such as panic disorder and pre-menstrual dysphoric disorder, by increasing markets for their medications (Conrad, 2007). Thedefinition of social anxiety and depression as brain diseases requiring medication benefits thepharmaceutical industry. Cohn & Wolfe, a public relations company hired by GlaxoSmithKline tolay the groundwork for the introduction of Paxil, created the term social anxiety disorder andpopularized this diagnosis (Moynihan & Cassels, 2005). The promotion of the belief that deviantbehaviors are caused by an illness (a brain disease) has spawned scores of industries and thousandsof agencies, hundreds of research centers, and thousands of advocacy groups that advance this view.Residential psychiatric facilities for youths and nursing homes are multimillion-dollar businesses(see the section titled “Increased Attention to Fraud and Corruption”).

Increasing critique of clinical psychology

Illouz (2008) also emphasizes splits created by our technological society and its alienating effects inher probing critique of the grand narrative of clinical psychology, which focuses on the thoughts andemotions of individuals, ignoring their ever changing nature and related contextual factors. Shenotes that this attention to thoughts and emotions was of great interest to corporations to “manage”the workforce. The “therapeutic culture” and related discourses offers endless possibilities for“coherently narrativising the life story through its ‘diseases’” (p. 196). Much of behavior therapychanged over the years from a focus on the influence of learning experiences to a focus on thoughts;for example, the Association for Behavioral and Cognitive Therapy promotes the mental illness viewof behavior (e.g., Abramovitz, 2015).

Increased client involvement

An Internet search of “social workers and complaints” reveals many websites containing relatedmaterial, especially concerning child welfare services (see “What Happens When Child Protective


Services Is Busy Hounding Free Range Parents,” works againstwhat parents view as harmful psychiatric labeling of their children and use of medication.MindFreedom International ( was created in 1990 to work againstpsychiatric practices of restraints, involuntary commitment, electroshock, and forced (the International Hearing Voices Network) offers an alternative to stigmatization forthose who hear voices. Increasing attention is being given to involvement of clients in research and asinformed participants in the helping process (e.g., Coulter & Ellins, 2006; Edwards & Elwyn, 2009;Kaltoft, Nielsen, Salkeld, & Dowie, 2014). For example, the Cochrane Collaboration ( maintains a consumer network.

Increased attention to harming in the name of helping

Even in the best of circumstances, given the uncertainty surrounding problems and the lack ofresources for altering circumstances, failure to help clients and perhaps even harm will occur. Andbad outcomes do not necessarily reflect poor decisions. But much harm is preventable such as theexcessive use of psychotropic medication for children (U.S. Government Accountability Office, 2012)and the elderly (Tija et al., 2014; see also Gambrill, 2012; Lilienfeld, 2015) Social workers should takea far more active role in exposing harming in the name of helping (see the discussion in the section“Increased Attention to Fraud and Corruption.”)

Increased attention to errors

Avoidable medical errors are the third leading cause of death in the United States (James, 2013).Little attention has been devoted to errors in social work (for an exception see Munro, 1996). Errorsand mistakes are inevitable and provide valuable learning opportunities. This is recognized in manyareas, including medicine, aviation, and nuclear power where mistakes are actively searched for.Errors are usually due to systemic factors, including poor training (as described in the classic bookby Reason, 2001). Feedback is an essential part of learning; only by recognizing our mistakes anderrors can we make better guesses about how to avoid them in the future. Unavoidable errors occurdespite researchers’ taking advantage of available knowledge and critical thinking skills and in spiteof making and acting on well-informed judgments. Avoidable errors are those that could have beenavoided, for example, by being better informed regarding practice-related research findings, bythinking more critically about assumptions and by carefully tracking progress. A recognition ofand active search for errors keeps the inevitable uncertainty involved in trying to help clients clearlyin view.

Increased attention to the role of cognitive biases in decision making

Cognitive biases, such as the fundamental attribution error (the tendency to focus on a person’scharacteristics and to neglect environmental circumstances), are a source of error in decisionmaking. Here too we are out of step with developments in some other helping professions, especiallymedicine, in which considerable attention is being given to cognitive biases (e.g., Croskerry, 2003; foran exception, see Gambrill & Gibbs, 2009, 2012). Confirmation biases influence judgment in allphases of work with clients: defining problems, deciding on causes, and selecting service plans. Wetend to seek and overweight evidence that supports our beliefs and ignore and underweight contraryevidence (Nickerson, 1998). Assignment of a label to a client may result in a selective search for datathat confirm the label, while contradictory data may be ignored. Anchoring effects may result ininaccurate assessment and selection of ineffective or harmful plans. We use different standards tocriticize opposing evidence than to evaluate supporting evidence. We tend to recall our successes andoverlook our failures. This is one reason intuition may lead us astray.


Increased attention to fraud and corruption

Fraud is the intentional false representation of a matter of fact to obtain an unfair gain (e.g., status,money). For example, effects of prescribed medication may be misrepresented, risk factors may betreated as diseases, and absolute risk may be hidden. A variety of propaganda ploys, such as theomission of relevant information is employed in fraudulent acts. Fraud is common in the conduct ofresearch, as discussed earlier (e.g., Gupta, 2013; Resnik & Master, 2013; Tavare, 2012). Increasedattention has been given to fraud and corruption in biomedical psychiatry as well as in health care(for example, undeclared conflicts of interest; Angell, 2011; Gøtzsche, 2013; Mackey & Liang, 2012).For example, most members of many DSM Task Forces have financial ties to pharmaceuticalcompanies (Cosgrove, Bursztajn, Krimsky, Anaya, & Walker, 2009). Conflicts of interest betweenacademic researchers and pharmaceutical companies are common (Angell, 2011; Gøtzsche, 2013;Mackey & Liang, 2012). Until recently, most continuing education in medicine was funded by thepharmaceutical industry (Brody, 2007). Journalists often expose fraud and corruption (e.g., Barry &Finkelstein, 2000). Widespread overuse of antipsychotics is paid for by Medicare, not only in nursinghomes but also for people who live alone or in assisted-living facilities (Pear, 2015). Social workersshould become more active in exposing fraud and corruption that diminishes quality of life.

Increased attention to ignorance and uncertainty

Social workers as well as other professionals work under uncertainty, yet they must act. Rarely is allrelevant information available, and it is difficult to integrate different kinds of data. Even when agreat deal is known, this knowledge is usually in the form of general principles that do not allowspecific predictions about individuals (Dawes, 1994). Every source of information has a margin oferror that may be small or large. Uncertainty may concern (a) the nature of the problem, (b) theoutcomes desired, (c) what is needed to attain valued outcomes, (d) likelihood of attaining outcomes,and (e) measures that will best reflect the degree of success. Information about options may bemissing, and accurate estimates of the probability that different alternatives will result in desiredoutcomes may be unknown. Uncertainty is often related to ignorance: what is not understood orknown about problems clients confront and their possible solutions. Appraisal of claims often revealsthat little is known. Proctor and Schiebinger (2008) argue that the study of ignorance is just asimportant as the study of knowledge. Ignorance may be deliberately created. Distortions andmisrepresentations of the origins and philosophy of EBP provide an example of the creation ofavoidable ignorance (Gambrill, 2010).

Professionals, including social workers, are often uninformed about uncertainty and how tohandle it ethically and effectively. Accurately estimating current knowledge and, if it is lacking,filling in the gaps, is a hallmark of the process of EBP, and tools have been developed (such asthe systematic review) to help social workers do this. The Uncertainties Page in the BritishMedical Journal brings these to the attention of physicians (see also Database of Uncertaintiesabout the Effects of Treatments at Shouldn’t we have similar pages inSocial Work and the Journal of Social Work Education? Many authors describe our innumeracy,referring to our difficulties in reasoning correctly about uncertainty. Professionals as well asclients vastly overestimate the predictive accuracy of tests (e.g., Gigerenzer, 2014). Overlookingignorance and uncertainty encourages attitudes (e.g., overconfidence) and problem-solving styles(e.g., jumping to conclusions) that may get in the way of helping clients or delude clients thathelp is at hand when it is not. This also will result in misinforming clients. Keeping uncertaintyin clear view requires knowledge about how to critically appraise research related to life-affectingquestions, such as asking, Is this assessment measure valid?


Increased attention to implementation obstacles

Considerable attention is being paid to implementation obstacles and how to overcome them (e.g.,Aarons, Hurlburt, & Horwitz, 2011; Fixen, Naoom, Blase, Friedman, & Wallace, 2005; Grol & Wensing,2004). Knowledge of local resources and circumstances is needed (indigenous knowledge). Collectingsystematic data concerning service outcomes that provide a guide for decisions and allow us to discoverwhether we are helping, harming, or having no effect (e.g., Lambert & Shimokawa, 2011) may be resisted.Agencies differ in the extent to which they encourage a culture of thoughtfulness in which critical inquiryis valued and mistakes are viewed as learning opportunities (Gambrill & Gibbs, 2009). Authoritarianadministrators may squelch critical discussions of claims made about services (e.g., Do they do moregood than harm?). Pressure to conform may result in poor decisions. In “Why I Do Not Attend CaseConferences,” Meehl (1973) describes a tendency to reward anything anybody says, “gold and garbagealike” (p. 255). Agencies differ in the provision of tools that facilitate informed decisions, such as access toup-to-date databases that can be searched to seek answers needed to make informed decisions. Inaddition, the staff may be overworked.

The burden of thinking critically about knowledge and ignorance

Recognizing that all is not as it should be regarding services provided, for example, realizing thatintervention is too often focused on the alleged dysfunctions of individuals ignoring environmentalcauses, and that uncertainty abounds, has costs. My students routinely report concerning agencypractices, about which nothing is being done and which are not being discussed. Examples include acounselor who receives kickbacks from referring clients to a friend’s agency and a social worker whoknows that an agency is using ineffective services (when effective ones are available). Even amongbeginning master’s students, there was a troubling acceptance of practices and policies based on theassumption that nothing could be done. Rarely was the description of a harmful practice accom-panied by statements such as, “I am going to do something about this” and “We must work togetherto change this.” Being a witness to grave needs that cannot be met is not pleasant. Some way outmust be found. A gap between what is needed and what can be offered encourages ritualism thatmay soothe the caring but do little for clients. Ritualism is illustrated in many ways in social work,including reliance on psychiatric labels that have no connection to the realities of clients’ lives. Thepath most likely to close gaps between what is needed and what is offered is to acknowledge andclearly describe these gaps and work together with others to expose the need and garner moreresources. Courage, a caring heart, and critical appraisal skills are needed for this.


We must look beyond what is claimed, that social work today is grounded in empirical evidence, towhat is taking place. Disadvantages of exaggerated claims of integration of practice, policy, andresearch include selecting ineffective or harmful services, misinforming clients and practitioners, andobscuring questions in need of investigation. I have argued that not only is social work not groundedon empirical evidence but that many current practices and policies are based on views directlycounter to social work’s long-term interest in decreasing oppression, discrimination, and inequalityin society such as misattributing the results of harsh environmental circumstances to individualdifferences in brains and psychological variables (e.g., thoughts). Rather than providing each child inschool with a high-quality education, wellness centers are set up in schools. Do such centers make upfor lack of a high-quality education that includes recreational opportunities, sports, drama, andmusic and art classes?

We ignore Ellul’s (1964, 1965) penetrating critique of the technological society in which we live,leaving us vulnerable to propaganda that encourages us to focus on the brains and thoughts of clientsand ignore environmental variables. Not understanding our own environment, we cannot help


clients to understand theirs. Without a contextual understanding of problems, we miss the relation-ship between the personal and the political (Mills, 1959). Efforts to enhance personal and profes-sional status and to maintain funding strain against use of theory and research to increase economic,political, and social opportunities for clients. The efforts of professional organizations such as theCouncil on Social Work Education and the National Association of Social Workers to protect turf,acquire funds, and enhance the positive image of social workers compete with measured, accuratedescriptions of what has been achieved. Careers are advanced by alleged new discoveries. Withoutwell-honed skills in critically appraising claims of knowledge and the values, courage, and training touse these, social workers become advertisers for flawed products such as misleading research reports.They become promoters of products that are irrelevant or harmful to decreasing inequities anddistress. Without an understanding of modern-day science, social workers are likely to fall forscientism and pseudoscience, and harm rather than help their clients.

Thinking critically about what is defined as a problem and proposed remedies commits us to theeffort and courage required to question popular assumptions and examine underlying points of view.Such views are often implicit rather than explicit; they are part of the basic social fabric and relatedbelief systems in which we live, perhaps unquestioned or even unrecognized. They may be deliber-ately suppressed (e.g., failure of the war on drugs; Murkin, 2014). Related facts and figures may behidden or distorted (e.g., unequal arrest records of Blacks and Whites for drug offences). Multicausalviews that assign equal weight to many factors may be used to avoid dissent (Tesh, 1988). Onlythrough critical appraisal can we discover our errors and perhaps learn how to do better in thefuture. As Ellul (1965) wrote, “Propaganda ceases when dialogue begins” (p. 6).

Notes on contributor

Eileen Gambrill is Professor of the School of Social Welfare, University of California Berkeley.


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  1. Clіck оn the “Place оrder tab at the tоp menu оr “Order Nоw” іcоn at the bоttоm, and a new page wіll appear wіth an оrder fоrm tо be fіlled.
  2. Fіll іn yоur paper’s іnfоrmatіоn and clіck “PRІCE CALCULATІОN” at the bоttоm tо calculate yоur оrder prіce.
  3. Fіll іn yоur paper’s academіc level, deadlіne and the requіred number оf pages frоm the drоp-dоwn menus.
  4. Clіck “FІNAL STEP” tо enter yоur regіstratіоn detaіls and get an accоunt wіth us fоr recоrd keepіng.
  5. Clіck оn “PRОCEED TО CHECKОUT” at the bоttоm оf the page.
  6. Frоm there, the payment sectіоns wіll shоw, fоllоw the guіded payment prоcess, and yоur оrder wіll be avaіlable fоr оur wrіtіng team tо wоrk оn іt.

Nоte, оnce lоgged іntо yоur accоunt; yоu can clіck оn the “Pendіng” buttоn at the left sіdebar tо navіgate, make changes, make payments, add іnstructіоns оr uplоad fіles fоr the оrder created. e.g., оnce lоgged іn, clіck оn “Pendіng” and a “pay” оptіоn wіll appear оn the far rіght оf the оrder yоu created, clіck оn pay then clіck оn the “Checkоut” оptіоn at the next page that appears, and yоu wіll be able tо cоmplete the payment.

Meanwhіle, іn case yоu need tо uplоad an attachment accоmpanyіng yоur оrder, clіck оn the “Pendіng” buttоn at the left sіdebar menu оf yоur page, then clіck оn the “Vіew” buttоn agaіnst yоur Order ID and clіck “Fіles” and then the “add fіle” оptіоn tо uplоad the fіle.

Basіcally, іf lоst when navіgatіng thrоugh the sіte, оnce lоgged іn, just clіck оn the “Pendіng” buttоn then fоllоw the abоve guіdelіnes. оtherwіse, cоntact suppоrt thrоugh оur chat at the bоttоm rіght cоrner


Payment Prоcess

By clіckіng ‘PRОCEED TО CHECKОUT’ yоu wіll be lоgged іn tо yоur accоunt autоmatіcally where yоu can vіew yоur оrder detaіls. At the bоttоm оf yоur оrder detaіls, yоu wіll see the ‘Checkоut” buttоn and a checkоut іmage that hіghlіght pоssіble mоdes оf payment. Clіck the checkоut buttоn, and іt wіll redіrect yоu tо a PayPal page frоm where yоu can chооse yоur payment оptіоn frоm the fоllоwіng;

  1. Pay wіth my PayPal accоunt‘– select thіs оptіоn іf yоu have a PayPal accоunt.
  2. Pay wіth a debіt оr credіt card’ or ‘Guest Checkout’ – select thіs оptіоn tо pay usіng yоur debіt оr credіt card іf yоu dоn’t have a PayPal accоunt.
  3. Dо nоt fоrget tо make payment sо that the оrder can be vіsіble tо оur experts/tutоrs/wrіters.


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