Social Workers Improving Practice With Purpose

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

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

ARTICLE HISTORY Accepted: December 2015

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

As in other helping professions, social work has had a long-term interest in conducting and drawing 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 are two uses of science in the helping professions: “One has been to follow a scientific model in conducting 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 writers reflect an interest in the scientific method and in research. Charitable organizations in the United States in the late 19th and early 20th centuries emphasized scientific charity “described as 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 site that included a Working People’s Social Science Club (e.g., Oakley, 2014). Social work scholars drew on different disciplines and from a variety of theorists. Karpf (1931) described knowledge drawn by social workers from psychology and discussed limitations of such knowledge. Jesse Taft 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 Mary Richmond (1917) drew on the scientific method as a guide to gathering information. Virginia Robinson (1921) noted that:

like any other profession which is founded on the scientific method, social casework must move through three stages: (1) observation and assembling of its facts, (2) hypothetical interpretation of these facts, and (3) control of 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 of this special issue “is to present the state of social work today as grounded in empirical evidence” and that “in the past 25 years we have seen a shift within social work academia and practice across all

CONTACT Eileen Gambrill [email protected] School of Social Welfare, University of California Berkeley, Berkeley, CA 94720, USA.

JOURNAL OF SOCIAL WORK EDUCATION 2016, VOL. 52, NO. S1, S110–S125 http://dx.doi.org/10.1080/10437797.2016.1174642

© 2016 Council on Social Work Education

methods that emphasizes research and evidence-based practice.” In a publication from the American Academy 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 the terms social work and evidence-based practice (EBP) produces many results. More social work researchers are turning out more research, and the number of journals containing social work research has increased; for example, there is now a publication titled Journal of Evidence-Based Social Work. The common elements approach has also received attention (Barth et al., 2012), and websites and clearinghouses claim to list interventions in relation to their evidentiary status. But what is the quality of research conducted and reported? How many practices offered to clients are evidence informed (those most likely to result in hoped-for outcomes)? A close examination of these questions suggests that social work is not grounded in empirical evidence. I suggest that we have seen a shift mainly in language, not in substance. For the same reasons that science is often misrepresented, and critical thinking values, skills, and knowledge have not been infused into social work, 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 make informed decisions attending to ignorance as well as knowledge). All three are far too radical to be embraced in the highly politicized and economically contested areas of social work and social welfare. 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 lack of understanding of the technological society in which we live. Consider the following.

First, most social work interventions, including assessment methods, have not been critically tested 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 be informative about the quality of services provided and outcomes attained. Results found in searching websites of some field agencies used at my school reveal only vague information or reliance on surrogates such as process measures to reflect quality of services (e.g., number of clients seen). Increased attention is being given to data mining, especially administrative data (Putnam-Hornstein et al., 2013). However, to be valuable, 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 practices promoted 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 social workers (see also Pignotti & Thyer, 2009). Their illustrations indicate that life-affecting decisions made regarding interventions are often neither theoretically nor empirically well grounded; some have been found to harm clients. Programs claimed to be evidence based have been shown to be no more 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 are false or grossly exaggerated. Bias and selective reporting are rife. Most research in psychology either has not or cannot be replicated (Francis, 2012; Makel, Plucker, & Hegarty, 2012). Campbell and Cochrane Group’s (http://methods.cochrane.org/equity/) systematic reviews typically reveal most research 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 and institutions rather than pursuit of knowledge (Gambrill, 2012). The website Retraction Watch (http://retractionwatch.com) is growing thanks to a $400,000 grant from the MacArthur Foundation 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 medical journals announced that reports of trials would not be published unless they had been registered to

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prevent authors from hiding negative reports (DeAngelis et al., 2005; see also The Era of Clinical Trial Registeries, 2005). Scientism (use of the methods or language of science in contexts in which they 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—articles and 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 the blog Neuroskeptic published by Discover magazine). Poor-quality research misinforms rather than informs the selection of practices and policies. Because they are bamboozled by distorted views of disliked perspectives and by inflated claims in the peer-reviewed literature about what we know and what is achieved, practitioners as well as administrators are in the uncomfortable position of feeling out 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, including research centers and governmental organizations, often discourage telling the truth. Entrenched ideas 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 work academics and researchers are influenced by their environments (Bartley, 1990; Greenberg, 2007; Veblen, 1918/1993). Social and economic pressures on researchers encourage claim inflation, data fudging, 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. The National Institute of Mental Health states that “Fundamental to our mission is the proposition that 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 behavioral processes 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 is designed to help individual practitioners deal in an ethical, informed manner with the uncertainties and challenges of everyday practice (Straus et al., 2011), drawing on tools such as the Campbell and Cochrane databases of systematic reviews are designed to decrease costs associated with drawing on research findings. The EBPs approach is quite different from the process of EBP and is more popular today. Lists of interventions said to be evidence-based (EBPs) are created and are used to guide practitioners and to mandate what must be used. Problems with such lists include inflated claims of effectiveness in the peer-reviewed literature (see previous paragraph) and the need to consider individual differences in client characteristics and circumstances that may render an evidence-based intervention inappropriate. Promoters of EBPs will do more harm than good if they are not well informed 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 problem framing.

Sixth, social workers and social work educators have been slow to draw on empirical literature regarding the helping process, especially common factors and the value of gaining ongoing feedback regarding 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 a strong 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-level competencies and use these in their interactions with clients?

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

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(DSM-5; American Psychiatric Association, 1976). The client is viewed as having an illness (mental) in need 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 of four people is alleged to have a diagnosable mental disorder. To most people, to question this view is considered heretical and deluded, a reaction that shows the spectacular success of equating (mis)behavior and illness. Biomedical remedies for (mis)behaviors and distress are promoted on the website of the National 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 CHADD.org, an organization funded primarily by pharmaceutical companies. Critiques of the disease-centered model of psychotropic drug action are ignored (e.g., Moncrieff, 2008b, 2013a, 2013b), as are penetrating critiques of the concept of mental illness (e.g., Kirk, Gomory, & Cohen, 2013; Szasz, 1987) and lack of reliability 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 personal ones the state has power over (see Foucault, 1973; Illich, 1976; Mills, 1959). There are great stakes in how problems are framed, and people with vested interests devote considerable time, money, and effort to influence what others believe (Loeske, 1999). Psychological and biomedical views ignore contextual 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 profession concerned 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 client concerns (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 theory describing 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. A constructional approach focuses on identifying client strengths and developing alternative behavioral repertoires in pursuit of hoped-for outcomes (Layng, 2009; Staats, 2012). This science of behavior offers emperically informed constructive ways to rearrange environments including helping clients to create alternative repertoires that compete with disliked behaviors.

Ninth, as illustrated in earlier sections, critical thinking, values, skills, and knowledge are not in abundant evidence in much of the discourse in social work. This can be seen in avoidable distortions of 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 and scientific 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 critically about claims is not valued by many groups and individuals; on the contrary, they may try to hide the effects of practices and policies and appeal to pseudoscience. Interest in status and money looms larger 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 as the source of problems continues in much of social work including social work education, deflecting attention 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. Lack of awareness regarding the influence of the public relations industry, the media, and the biomedical

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industrial complex in promoting misleading claims is a barrier to recognizing social, political, and economic 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 psychiatric view 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 in creating 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 its dehumanizing effects. “Technique refers to any standardized means for attaining a predetermined result. Thus, it converts spontaneous and unreflective behavior into behavior that is deliberate and rationalized. ” (Ellul, 1965, p. vi). Ellul (1965) argues that we live in a technological society dominated 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 and surveillance systems are technologies. Self-help books and psychotherapies are techniques. We spend our time looking at, listening to, and talking to machines. Many social work scholars note the increase in required administrative tasks (the tick-box mentality) and its negative effects including decreased 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 individual differences. It squeezes out the qualitative. Ellul (1964) suggests that technology has become the new sacred.

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, guided by standardized codes and labels. Health and happiness are equated with adjustment. Cognitive therapy reduces us to our thoughts. Biological views reduce us to brain chemistry. Both ignore cultural contexts and individual subjectivities, and complex interactions among them. Stivers (2008) argues that “the medicalization of deviance denies both the freedom and the responsibility of 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. It creates negative psychological and social consequences including loneliness and anxiety and fragmentation 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 power is located in abstract systems such as bureaucracies, it is difficult or impossible to pinpoint and change. Propaganda is the means used to prevent increasing mechanization and technological organization from being felt as too oppressive. It is “called upon to solve problems created by technology, 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 of all psychological influence” (p. 107) such as adapting to dehumanizing working conditions (see, for example, the discussion of the mental hygiene movement in Lubove, 1965). Stivers (2001) argues that much of the advice in therapy and self-help books is “conformist” (p. 60). The products of social science are drawn on to maximize the effectiveness of propaganda. Edward Bernays, the founder of the field of public relations, drew on psychoanalytic theory: “The individual can no

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

Ellul (1965) states that “intellectuals are most easily reached by propaganda” (p. 113) because they read so much material in secondary sources. As illustrated in prior sections, propaganda is not confined to fringe healers; it has a robust presence in the peer-reviewed literature including inflated claims of knowledge and effectiveness. Propaganda methods include oversimplifications, creation of fear, begging the question (simply asserting what should be argued), appeal to self-interest, and censorship of alternative views and contradictory evidence (Gambrill, 2012). A review of advertising on 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 what is true and what is false. Relying on scientific criteria offers a way to do so. The essence of science is bold guessing and rigorous testing. This view of science as we know it today is one in which the theory-laden nature of observation is assumed (i.e., our assumptions influence what we observe), and rational 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 of science 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 route to knowledge. “Science is the belief in the ignorance of experts” (Feynman, 1969). Far from reinforcing myths about reality, science is likely to question them. All sorts of questions people may 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 that homes are found for applicants within 10 days, data could be gathered to see whether this claim is true. Scientists are often wrong and find out they are wrong by testing their predictions. Although the purpose of science is to seek true answers to problems (statements that correspond to facts), this does 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 to science, distinguishing it from pseudoscience. Scientists are skeptics. They question what others view as 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 resist their allure (e.g., Gambrill, 2012; Lilienfeld, Lynn, & Lohr, 2015; Thyer & Pignotti, 2015). The term pseudoscience 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 confuse logical positivism with science as we know it today (Shadish, 1995). The former approach was discarded decades ago because of the induction problem, the theory-laden nature of observation, and the utility of unobservable constructs (e.g., Phillips, 1990; Popper, 1963, 1994). Science is often misrepresented as a collection of facts or as referring only to controlled experimental studies. Many people 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 that knowledge and morality are inherently bounded by or rooted in culture. Gelner (1992) argues that this 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-informed practice and scientific exploration. Costs include forgoing the comfortable feeling of certainty and

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the time and effort required to accurately understand alternative views and to seek and critically appraise 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 in Victorian times. To those who uncritically embrace the view that they are helping others, asking that verbal statements of compassion and caring be accompanied by evidence of helping may seem disloyal or absurd. According to Ellul (1965), “If we practice a profession, we cannot limit ourselves to its financial rewards, we must also invest it with idealistic or moral justification. It becomes our calling, and we will not tolerate its being questioned” (p. 157).

It takes courage to challenge accepted beliefs, especially when held by authorities who do not value a culture of thoughtfulness in which well-argued alternative views are welcome and arguments critically evaluated. To the autocratic and powerful, raising questions threatens their power to simply pronounce what is and is not without taking responsibility for presenting well-reasoned arguments and involving others in decisions. Socrates was sentenced to death because 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 be viewed as a threat rather than as a source of knowledge that may help clients attain goals they value.

Promising developments

In the reality that the future holds a promise of new paths, we could say that we are always at a critical juncture. I suggest that we are at a critical juncture but, as argued earlier, not because social work is “grounded in empirical evidence” and “emphasizes research and evidence-based practice” as stated by the editors of this journal in their call for articles. Quite the opposite; in most cases we have the words but not the substance. I suggest the following developments, most of 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-informed services 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 in this 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 answer questions pursued. This waste has reached such enormous proportions that efforts are now under way to decrease it, including the creation of a new center at Stanford, The Meta-research Innovation 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 creation of the International Congress on Peer Review and Biomedical Research held every 4 years since 1986. The Journal of Negative Results in Biomedicine publishes negative and unexplained or controversial research, often rejected by mainstream journals. Some journals have introduced negative results sections (e.g., Dirnagl & Lauritzen, 2010), and open peer review is becoming more common (e.g., Shanahan & Olsen, 2014). What will we find when we carefully examine the quality 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 “A strong case can be made that a critical mass of tested intervention knowledge has been established” (p. 278). Is this true, even 15 years later? Critical appraisal of research suggests that 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.

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Increasing user-friendly tools for acquiring critical appraisal skills

Increasingly user-friendly websites are available for honing critical appraisal skills, such as http:// www.testingtreatments.org. Content is available in multiple languages. This site includes discussion of important topics such as the vital difference between relative and absolute risk and correlation and causation. Campbell and Cochrane databases provide systematic reviews. User-friendly websites such as www.fallacyfiles.com 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) Its growth 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, ever more standardized, interconnected, and decontextualized. Conflicts of interests abound, which is described later. The past few years have seen increasing critiques of the medicalization of problems in living (e.g., Kirk et al., 2013), including in the field of psychiatry itself (e.g., Frances, 2010). Social work scholars have been at the forefront of documenting reliability and validity problems with the ever lengthening list of problems in living viewed as “mental illnesses” in the DSM (American Psychiatric Association, 2015; Kirk, Gomory, & Cohen, 2013). Moncrieff (2008a) argues that biological psychiatry forwards neoliberal political agendas. Claims that changes in serotonin are responsible 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). The definition of social anxiety and depression as brain diseases requiring medication benefits the pharmaceutical industry. Cohn & Wolfe, a public relations company hired by GlaxoSmithKline to lay the groundwork for the introduction of Paxil, created the term social anxiety disorder and popularized this diagnosis (Moynihan & Cassels, 2005). The promotion of the belief that deviant behaviors are caused by an illness (a brain disease) has spawned scores of industries and thousands of 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 in her probing critique of the grand narrative of clinical psychology, which focuses on the thoughts and emotions of individuals, ignoring their ever changing nature and related contextual factors. She notes 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 therapy changed 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 view of behavior (e.g., Abramovitz, 2015).

Increased client involvement

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

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Services Is Busy Hounding Free Range Parents,” www.freerangekids.com). AbleChild.org works against what parents view as harmful psychiatric labeling of their children and use of medication. MindFreedom International (http://www.mindfreedom.org) was created in 1990 to work against psychiatric practices of restraints, involuntary commitment, electroshock, and forced medication. Intervoice.org (the International Hearing Voices Network) offers an alternative to stigmatization for those who hear voices. Increasing attention is being given to involvement of clients in research and as informed participants in the helping process (e.g., Coulter & Ellins, 2006; Edwards & Elwyn, 2009; Kaltoft, Nielsen, Salkeld, & Dowie, 2014). For example, the Cochrane Collaboration (http://www. cochrane.org) 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 of resources for altering circumstances, failure to help clients and perhaps even harm will occur. And bad outcomes do not necessarily reflect poor decisions. But much harm is preventable such as the excessive 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 take a 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). Errors and mistakes are inevitable and provide valuable learning opportunities. This is recognized in many areas, 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 book by Reason, 2001). Feedback is an essential part of learning; only by recognizing our mistakes and errors can we make better guesses about how to avoid them in the future. Unavoidable errors occur despite researchers’ taking advantage of available knowledge and critical thinking skills and in spite of making and acting on well-informed judgments. Avoidable errors are those that could have been avoided, for example, by being better informed regarding practice-related research findings, by thinking more critically about assumptions and by carefully tracking progress. A recognition of and active search for errors keeps the inevitable uncertainty involved in trying to help clients clearly in 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’s characteristics and to neglect environmental circumstances), are a source of error in decision making. Here too we are out of step with developments in some other helping professions, especially medicine, in which considerable attention is being given to cognitive biases (e.g., Croskerry, 2003; for an exception, see Gambrill & Gibbs, 2009, 2012). Confirmation biases influence judgment in all phases of work with clients: defining problems, deciding on causes, and selecting service plans. We tend to seek and overweight evidence that supports our beliefs and ignore and underweight contrary evidence (Nickerson, 1998). Assignment of a label to a client may result in a selective search for data that confirm the label, while contradictory data may be ignored. Anchoring effects may result in inaccurate assessment and selection of ineffective or harmful plans. We use different standards to criticize opposing evidence than to evaluate supporting evidence. We tend to recall our successes and overlook our failures. This is one reason intuition may lead us astray.

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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 be treated as diseases, and absolute risk may be hidden. A variety of propaganda ploys, such as the omission of relevant information is employed in fraudulent acts. Fraud is common in the conduct of research, as discussed earlier (e.g., Gupta, 2013; Resnik & Master, 2013; Tavare, 2012). Increased attention 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 pharmaceutical companies (Cosgrove, Bursztajn, Krimsky, Anaya, & Walker, 2009). Conflicts of interest between academic researchers and pharmaceutical companies are common (Angell, 2011; Gøtzsche, 2013; Mackey & Liang, 2012). Until recently, most continuing education in medicine was funded by the pharmaceutical 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 nursing homes but also for people who live alone or in assisted-living facilities (Pear, 2015). Social workers should 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 all relevant information available, and it is difficult to integrate different kinds of data. Even when a great deal is known, this knowledge is usually in the form of general principles that do not allow specific predictions about individuals (Dawes, 1994). Every source of information has a margin of error that may be small or large. Uncertainty may concern (a) the nature of the problem, (b) the outcomes 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 be missing, and accurate estimates of the probability that different alternatives will result in desired outcomes may be unknown. Uncertainty is often related to ignorance: what is not understood or known about problems clients confront and their possible solutions. Appraisal of claims often reveals that little is known. Proctor and Schiebinger (2008) argue that the study of ignorance is just as important as the study of knowledge. Ignorance may be deliberately created. Distortions and misrepresentations of the origins and philosophy of EBP provide an example of the creation of avoidable ignorance (Gambrill, 2010).

Professionals, including social workers, are often uninformed about uncertainty and how to handle 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 as the systematic review) to help social workers do this. The Uncertainties Page in the British Medical Journal brings these to the attention of physicians (see also Database of Uncertainties about the Effects of Treatments at www.library.nhs.uk/duets). Shouldn’t we have similar pages in Social 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 as clients vastly overestimate the predictive accuracy of tests (e.g., Gigerenzer, 2014). Overlooking ignorance 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 that help is at hand when it is not. This also will result in misinforming clients. Keeping uncertainty in clear view requires knowledge about how to critically appraise research related to life-affecting questions, such as asking, Is this assessment measure valid?

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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). Collecting systematic data concerning service outcomes that provide a guide for decisions and allow us to discover whether 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 inquiry is valued and mistakes are viewed as learning opportunities (Gambrill & Gibbs, 2009). Authoritarian administrators may squelch critical discussions of claims made about services (e.g., Do they do more good than harm?). Pressure to conform may result in poor decisions. In “Why I Do Not Attend Case Conferences,” Meehl (1973) describes a tendency to reward anything anybody says, “gold and garbage alike” (p. 255). Agencies differ in the provision of tools that facilitate informed decisions, such as access to up-to-date databases that can be searched to seek answers needed to make informed decisions. In addition, 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 that intervention is too often focused on the alleged dysfunctions of individuals ignoring environmental causes, and that uncertainty abounds, has costs. My students routinely report concerning agency practices, about which nothing is being done and which are not being discussed. Examples include a counselor who receives kickbacks from referring clients to a friend’s agency and a social worker who knows that an agency is using ineffective services (when effective ones are available). Even among beginning master’s students, there was a troubling acceptance of practices and policies based on the assumption 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 together to change this.” Being a witness to grave needs that cannot be met is not pleasant. Some way out must be found. A gap between what is needed and what can be offered encourages ritualism that may 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. The path most likely to close gaps between what is needed and what is offered is to acknowledge and clearly describe these gaps and work together with others to expose the need and garner more resources. Courage, a caring heart, and critical appraisal skills are needed for this.

Conclusion

We must look beyond what is claimed, that social work today is grounded in empirical evidence, to what is taking place. Disadvantages of exaggerated claims of integration of practice, policy, and research include selecting ineffective or harmful services, misinforming clients and practitioners, and obscuring questions in need of investigation. I have argued that not only is social work not grounded on empirical evidence but that many current practices and policies are based on views directly counter to social work’s long-term interest in decreasing oppression, discrimination, and inequality in society such as misattributing the results of harsh environmental circumstances to individual differences in brains and psychological variables (e.g., thoughts). Rather than providing each child in school with a high-quality education, wellness centers are set up in schools. Do such centers make up for lack of a high-quality education that includes recreational opportunities, sports, drama, and music 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 clients and ignore environmental variables. Not understanding our own environment, we cannot help

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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 the Council 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, accurate descriptions of what has been achieved. Careers are advanced by alleged new discoveries. Without well-honed skills in critically appraising claims of knowledge and the values, courage, and training to use 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 and distress. Without an understanding of modern-day science, social workers are likely to fall for scientism and pseudoscience, and harm rather than help their clients.

Thinking critically about what is defined as a problem and proposed remedies commits us to the effort 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 related belief 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 be hidden or distorted (e.g., unequal arrest records of Blacks and Whites for drug offences). Multicausal views that assign equal weight to many factors may be used to avoid dissent (Tesh, 1988). Only through critical appraisal can we discover our errors and perhaps learn how to do better in the future. 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.

References

Aarons, G. A., Hurlburt, M., & Horwitz, S. M. (2011). Advancing a conceptual model of evidence-based practice implementa- tion in public service sectors. Administration and Policy in Mental Health, 38, 4–23. doi:10.1007/s10488-010-0327-7

Abramowitz, J. S. (2015). ABCT responds to the NIMH strategic plan draft. The Behavior Therapist, 38, 35–36. Adler, N. E., & Stewart, J. (2010). The biology of disadvantage: Socioeconomic status and health. Annals of the New

York Academy of Sciences, 1186, 1–4. doi:10.1111/j.1749-6632.2009.05385.x American Academy of Social Work and Social Welfare. (2013). Introduction and context for grand challenges for social

work (Grand Challenges for Social Work Initiative, Working Paper No. 1). Baltimore, MD: Author. American Psychiatric Association. (2015). Diagnostic and statistical manual of mental disorders (5th ed.). Washington,

DC: American Psychiatric Association. Angell, M. (2011, July 14). Illusions of psychiatry. New York Review of Books [Online]. Retrieved from www.nybooks.

com/articles/archives/2011 Barber, B. (1961). Resistance by scientists to scientific discovery. Science, 134, 596–602. doi:10.1126/science.134.3479.596 Barry, D., & Finkelstein, K. E. (2000, February 7). Stolen Medicaid millions stoked a boom in adult day care, Officials say. The

New York Times, A21. Barth, R. P., Lee, B. R., Lindsey, M. A., Collins, K. S., Strieder, F., Chorpita, B. F., . . . Sparks, J. A. (2012). Evidence-

based practice at a crossroads: The timely emergence of common elements and common factors. Research on Social Work Practice, 22, 108–119. doi:10.1177/1049731511408440

Bartley, W. W., III. (1990). Unfathomed knowledge, unmeasured wealth: On universities and the wealth of nations. LaSalle, IL: Open Court.

Bauer, H. (2004). Science in the 21st century: Knowledge monopolies and research cartels. Journal of Scientific Exploration, 18, 643–660.

Brody, H. (2007). Hooked: Ethics, and the medical profession and pharmaceutical industry. New York, NY: Rowman & Littlefield.

Bunge, M. (1984). What is pseudoscience? The Skeptical Inquirer, 9(1), 36–47. Campanario, J. M. (2009). Rejecting and resisting Nobel class discoveries: Accounts by Nobel Laureates.

Scientometrics, 81, 549–565. doi:10.1007/s11192-008-21415

JOURNAL OF SOCIAL WORK EDUCATION S121

Chalmers, I., Bracken, M. B., Djulbegovic, B., Garattini, S., Grant, J., Gűlmezoglu, A. M., . . . Oliver, S. (2014). How to increase value and reduce waste when research priorities are set. The Lancet, 383, 156–165. doi:10.1016/S0140-6736(13)62229-1

Clarke, A. E., Mamo, L., Fosket, J. R., Fishman, J. R., & Shim, J. K. (Eds.). (2010). Biomedicalization: Technoscience, health, and illness in the U.S. Durham, NC: Duke University Press.

Conrad, P. (2007). The medicalization of society: On the transformation of human conditions into treatable disorders. Baltimore, MD: Johns Hopkins University Press.

Cosgrove, L., Bursztajn, H. J., Krimsky, S., Anaya, M., & Walker, J. (2009). Conflicts of interest and disclosure in the American Psychiatric Association’s clinical practice guidelines. Psychotherapy and Psychosomatics, 78, 228–232. doi:10.1159/000214444

Coulter, A., & Ellins, J. (2006). Patient-focused interventions: A review of the evidence. London, UK: Picker Institute Europe, The Health Foundation.

Croskerry, P. (2003). The importance of cognitive errors in diagnosis and strategies to minimize them. Academic Medicine, 78, 775–780. doi:10.1097/00001888-200308000-00003

Cunningham, S. B. (2002). The idea of propaganda: A reconstruction. Westport, CT: Praeger. Dawes, R. M. (1994). House of cards: psychology and psychotherapy built on myth. New York, NY: The Free Press. DeAngelis, C. D., Drazen, J. M., Frizelle, F. A., Haug, C., Hoey, J., Horton, R., . . . Van Der Weyden, M. B. (2005).

Clinical trial registration: A statement from the international committee of medical journal editors. JAMA, 292, 1363–1364. doi:10.1001/jama.292.11.1363

Deegan, M. J. (1986). The clinical sociology of Jesse Taft. Clinical Sociology Review, 4, 30–45. Dirnagl, U., & Lauritzen, M., (Eds.). (2010). Fighting publication bias: Introducing the Negative Results section.

Journal of Cerebral Blood Flow & Metabolism, 30, 1263–1264. doi:10.1038/jcbfm.2010.51 Edwards, A., & Elwyn, G. (2009). Shared decision-making: Achieving evidence-based patient choice. New York, NY:

Oxford. Ellul, J. (1964). The technological society. New York, NY: Vintage Books. Ellul, J. (1965). Propaganda: The formation of men’s attitudes. New York, NY: Vintage Books. Fanelli, D. (2010). Do pressures to publish increase scientists’ bias? An empirical support from US states data. PLoS

ONE, 5(4), e10271. doi:10.1371/journal.pone.0010271 Feynman, R. (1969). What is science? The Physics Teacher, 7, 313–320. doi:10.1119/1.2351388 Fixen, D. L., Naoom, S. F., Blase, K. A., Friedman, R. M., & Wallace, F. (2005). Implementation research: A synthesis of

the literature. Tampa: University of South Florida, National Implementation Research Network. Foucault, M. (1973). The birth of the clinic: An archeology of medical perception. New York, NY: Pantheon. Frances, A. (2010, July 6). Normality as an endangered species: Psychiatric fads and overdiagnosis. Psychiatric Times

[Online]. Retrieved from www.psychiatrictimes.com Francis, G. (2012). Publication bias and the failure of replication in experimental psychology. Psychonomic Bulletin &

Review, 19, 975–991. doi:10.3758/s13423-012-0322-y Gambrill, E. (2010). Evidence based practice and the ethics of discretion. Journal of Social Work, 11, 26–48. Gambrill, E. (2012). Propaganda in the helping professions. New York, NY: Oxford University press. Gambrill, E., & Gibbs, L. (2009). Critical thinking for helping professionals: A skills-based work book (3rd ed.). New

York, NY: Oxford University Press. Gelner, E. (1992). Postmodernism, reason and religion. New York, NY: Routledge. Gigerenzer, G. (2014). Risk savvy: How to make good decisions. New York, NY: Penguin. Gilbert, P. (1989). Human nature and suffering. New York, NY: Guilford Press. Gillingham, P. (2015). Predictive risk modelling to prevent child maltreatment and other adverse outcomes for service

users: Inside the “black box” of machine learning. British Journal of Social Work. Retrieved from http://bjsw. oxfordjournals.org/content/early/2015/04/08/bjsw.bcv031

Gomory, T., Wong, S. E., Cohen, D., & LaCasse, J. R. (2011). Clinical social work and the biomedical industrial complex. Journal of Sociology & Social Welfare, 38, 135–165.

Gorman, D. M., & Huber, J. C. (2009). The social construction of “evidence-based” drug prevention programs: A reanalysis of data from the Drug Abuse Resistance Education (DARE) program. Evaluation Review, 33, 396–414. doi:10.1177/0193841X09334711

Gøtzsche, P. (2013). Deadly medicines and organized crime: How big pharma has corrupted health care. London, UK: Radcliffe.

Greenberg, D. S. (2007). Science for sale: The perils, delusions and rewards of campus capitalism. Chicago, IL: University of Chicago Press.

Grol, R., & Wensing, M. (2004). What drives change? Barriers to and incentives for achieving evidence-based practice. Medical Journal of Australia, 180(Suppl., 6), S57.

Gupta, A. (2013). Fraud and misconduct in clinical research. Perspectives on Clinical Research, 4, 144–147. doi:10.4103/2229-3485.111800

Gusfield, J. R. (2003). Constructing the ownership of social problems: Fun and profit in the welfare state. In J. D. Orcutt, & D. R. Rudy (Eds.), Drugs, alcohol, and social problems (pp. 7–18). New York, NY: Rowman & Littlefield.

Hudson, W. W. (1982). Scientific imperatives in social work research and practice. Social Service Review, 50, 241–258.

S122 E. GAMBRILL

Illich, I. (1976). Medical nemesis: The expropriation of health. New York, NY: Pantheon Books. Illouz, E. (2008). Saving the modern soul: Therapy, emotions, and the culture of self-help. Berkeley: University of

California Press. Ioannidis, J. P. A. (2005). Why most published research findings are false. PLoS Medicine, 2(8), e124.

doi:10.1371/journal.pmed.0020124 Ioannidis, J. P. A. (2008). Why most discovered true associations are inflated. Epidemiology, 19, 640–648.

doi:10.1097/EDE.0b013e31818131e7 Ioannidis, J. P. A. (2012). Why science is not necessarily self-correcting. Perspectives on Psychological Science, 7,

645–654. doi:10.1177/1745691612464056 Ioannidis, J. P. A. (2014). How to make more published research true. PLOS Medicine, 11(10), e1001747.

doi:10.1371/journal.pmed.1001747 Ioannidis, J. P. A., Greenland, S., Hlatky, M. A., Khoury, M. J., Macleod, M. R., Moher, D., . . . Tibshirani, R. (2014).

Increasing value and reducing waste in research design, conduct, and analysis. The Lancet, 383, 166–175. doi:10.1016/S0140-6736(13)62227-8

James, J. T. (2013). A new evidence-based estimate of patient harms associated with hospital care. Journal of Patient Safety, 9, 122–128. doi:10.1097/PTS.0b013e3182948a69

Janko, R. (1997). Literature, criticism and authority: The experience of antiquity. Retrieved from https://www.royalhollo way.ac.uk/classics/cucd/janko.html

Kaltoft, M. K., Nielsen, J. B., Salkeld, G., & Dowie, J. (2014). Increasing user involvement in health care and health research simultaneously: A proto-protocol for “person-as researcher” and online decision support tools. JMIR Research Protocols, 3(4), e61. doi:10.2196/resprot.3690

Karpf, M. J. (1931). The scientific basis of social work: A study of family casework. New York, NY: Columbia University Press.

Kirk, S. A., Gomory, T., & Cohen, D. (2013). Mad science: Psychiatric coercion, diagnosis, and drugs. New Brunswick, NJ: Transaction.

Kirk, S. A., & Reid, W. J. (2002). Science and social work: A critical appraisal. New York, NY: Columbia University Press.

LaCasse, J. R., & Leo, J. (2005). Serotonin and depression: A disconnect between the advertisements and the scientific disclosure. PLoS Med, 2(12), e392. DOI:10.1371/journal.pmed.0020392

Lambert, M. J., & Shimokawa, K. (2011). Collecting client feedback. In J. C. Norcross (Ed.), Psychotherapy relationships that work: Evidence-based responsiveness (2nd ed.). New York, NY: Oxford University Press.

Layng, T. V. J. (2009). The search for effective clinical behavior analysis: The nonlinear thinking of Israel Goldiamond. Behavior Analysis, 32, 163–184.

Lilienfeld, S. O. (2015). Psychological treatments that cause harm. Perspectives on Psychological Science, 2, 53–70. doi:10.1111/j.1745-6916.2007.00029.x

Lilienfeld, S. O., Lynn, S. J., & Lohr, J. M. (2015). Science and pseudoscience in clinical psychology (2nd ed.). New York, NY: Guilford Press.

Littell, J. H. (2008). Evidence-based or bias? The quality of published reviews. Children and Youth Services Review, 30, 1299–1317. doi:10.1016/j.childyouth.2008.04.001

Loeske, D. R. (1999). Thinking about social problems: An introduction to constructionist perspectives. New York, NY: Aldine de Gruyter.

Lubove, R. (1965). The professional altruist: The emergence of social work as a career. Cambridge, MA: Harvard University Press.

Mackey, T. K., & Liang, B. A. (2012). Combating healthcare corruption and fraud with improved global health governance. BMC International Health and Human Rights, 12(1), 23.

Madden, G. J. (2013). APA handbook of behavior analysis. Washington, DC: American Psychological Association. Makel, M. C., Plucker, J. A., & Hegarty, B. (2012). Replications in psychology research: How often do they really

occur?. Perspectives on Psychological Science, 7, 537–542. DOI:10.1177/1745691612460688 Meehl, P. E. (1973). Why I do not attend case conferences. In P. E. Meehl (Ed.), Psychodiagnosis: Selected papers

(pp. 255–304). Minneapolis: University of Minnesota Press. Miller, D. (1994). Critical rationalism: A restatement and defense. Chicago, IL: Open Court. Mills, C. W. (1959). The sociological imagination. New York, NY: Oxford University Press. Moncrieff, J. (2008a). The myth of the chemical cure: A critique of psychiatric drug treatment. New York, NY: Palgrave. Moncrieff, J. (2008b). Neoliberalism and biopsychiatry: A marriage of convenience. In C. I. Cohen, & S. Timimi (Eds.),

Liberatory psychiatry: Philosophy, politics and mental health (Vol. 9, pp. 235–256). New York, NY: Cambridge University Press.

Moncrieff, J. (2013a). Models of drug action. Retrieved from http://joannamoncrieff.com Moncrieff, J. (2013b). The bitterest pills: The troubling story of antipsychotic drugs. New York, NY: Palgrave Macmillan. Moynihan, R., & Cassels, A. (2005). Selling sickness: How the world’s biggest pharmaceutical companies are turning us

all into patients. New York, NY: Nation Books.

JOURNAL OF SOCIAL WORK EDUCATION S123

Munro, E. (1996). Avoidable and unavoidable mistakes in child protection work. British Journal of Social Work, 26, 793–808. doi:10.1093/oxfordjournals.bjsw.a011160

Munro, E. (2011). The Munro review of child protection: Final report. London, UK: Department of Education. Munz, P. (1985). Our knowledge of the growth of knowledge: Popper or Wittgenstein. London, UK: Routledge &

Kegan Paul. Munz, P. (1992). What’s postmodern, anyway? Philosophy and Literature, 16, 333–353. doi:10.1353/phl.1992.0047 Murkin, G. (2014). Drug decriminalization in Portugal: Setting the record straight. Retrieved from http://www.tdpf.org.

uk/blog/drug-decriminalisation-portugal-setting-record-straight. National Science Foundation. (2006). Surveys of public understanding of science and technology: 1979-2006. Retrieved

August 22, 2011 from www.ropercenter.uconn.edu Nickerson, R. S. (1998). Confirmation bias: A ubiquitous phenomenon in many guises. Review of General Psychology,

2, 175–220. doi:10.1037/1089-2680.2.2.175 Oakley, A. (2014). Father and daughter: Patriarchy, gender and social science. Chicago, IL: Policy Press. Orcutt, B. A. (1990). Science and inquiry in social work practice. New York, NY: Columbia University Press. Orr, J. (2010). Biopsychiatry and the informatics of diagnosis: Governing mentalities. In A. E. Clarke, L. Mamo, J.

R. Fosket, J. R. Fishman, & J. K. Shim (Eds.), Biomedicalization: Technoscience, health, and illness in the U.S. (pp. 353–379). Durham, NC: Duke University Press.

Pear, R. (2015, March 2). Psychiatric drug overuse is cited by federal study. New York Times, A13. Phillips, D. C. (1987). Philosophy, science and social inquiry: Contemporary methodological controversies in social

science and related applied fields of research. New York, NY: Pergamon Press. Phillips, D. C. (1990). Postpositivistic science: Myths and realities. In E. G. Duba (Ed.), The paradigm dialog (pp. 31–45).

Thousand Oaks, CA: SAGE. Phillips, D. C. (1992). The social scientist’s bestiary: A guide to fabled threats to, and defenses of, naturalistic social

studies. New York, NY: Pergamon. Pignotti, M., & Thyer, B. A. (2009). Use of novel unsupported and empirically supported therapies by licensed clinical

social workers: An exploratory study. Social Work Research, 33, 5–17. doi:10.1093/swr/33.1.5 Popper, K. R. (1963). Conjectures and refutations: The growth of scientific knowledge (4th ed.). London, UK: Routledge

& Kegan Paul. Popper, K. R. (1994). The myth of the framework: In defense of science and rationality. New York, NY: Routledge. Proctor, R. N., & Schiebinger, I. (Eds.). (2008). Agrostology: The making and unmaking of ignorance. Palo Alto, CA:

Stanford University Press. Putnam-Hornstein, E., Wood, J. N., Fluke, J., Yoshioka-Maxwell, A., & Berg, R. P. (2013). Preventing severe and fatal

child maltreatment: Making the case for the expanded use and integration of data. Child Welfare, 92, 59–75. Reason, J. (2001). Managing the risk of organizational accidents. Brookfield, VT: Ashgate. Reid, W. J. (1994). The empirical practice movement. Social Service Review, 68, 165–184. doi:10.1086/604045 Reid, W. J. (2001). The role of science in social work: The perennial debate. Journal of Social Work, 1, 273–293.

doi:10.1177/146801730100100303 Resnik, D. B., & Master, Z. (2013). Policies and initiatives aimed at addressing research misconduct in high-income

countries. PLOS Medicine, 10(3), e1001406. doi:10.1371/journal.pmed.1001406 Richmond, M. (1917). Social diagnosis. New York, NY: Russell Sage Foundation. Ripple, L. (1957). Factors associated with continuance in casework services. Social Work, 2, 87–94. Robinson, V. P. (1921). Analyses of processes in the records of family caseworking agencies. The Family, 2, 101–106. Rogowski, S. (2011). Managers, managerialism, and social work with children and families: The deformation of a

profession. Practice: Social Work in Action, 23(3), 157–167. Rogowski, S. (2013). Critical social work with children and families: Theory, context & practice. Bristol, UK: Policy

Press. Rothman, J., & Thomas, E. (Eds.). (1994). Intervention research. New York, NY: Haworth Press. Sackett, D. L., Richardson, W. S., Rosenberg, W.& Haynes, R. B. (1997). Evidence-based medicine: How to practice and

teach EBM. New York, NY: Churchill Livingstone. Shadish, W. R. (1995). Philosophy of science and the quantitative-qualitative debates: Thirteen common errors.

Evaluation and Program Planning, 18, 63–75. doi:10.1016/0149-7189(94)00050-8 Shanahan, D. R., & Olsen, B. R. (2014). Opening peer-review: The democracy of science. Journal of Negative Results in

BioMedicine, 13,(2). doi:10.1186/1477-5751-13-2 Shryer, W. (2012). Attention deficit disorder versus attention deficit hyperactivity disorder: Q&A with William Shryer,

LCSW, BCD. Retrieved from http://www.helpstartshere.org/ Staats, A. W. (2012). The marvelous learning animal: What makes human nature unique. Amherst, NY: Prometheus. Stivers, R. (2001). Technology as magic: The triumph of the irrational. New York, NY: Continuum. Stivers, R. (2004). Shades of loneliness: Pathologies of a technological society. Lanham, MD: Roman & Littlefield. Stivers, R. (2008). The illusion of freedom and equality. Albany, NY: SUNY Press. Straus, S. W., Richardson, W. S., Glasziou, P., & Haynes, R. B. (2011). Evidence-based medicine: How to practice and

teach it (3rd ed.). New York, NY: Churchill Livingstone.

S124 E. GAMBRILL

Szasz, T. S. (1961). The myth of mental illness. New York. NY: Hoeber-Harper. Szasz, T. S. (1987). Insanity: The idea and its consequences. New York, NY: Wiley. Tavare, A. (2012). Scientific misconduct is worryingly prevalent in the UK, shows BMJ survey. BMJ, 344, e377.

doi:10.1136/bmj.e377 Teicholz, N. (2015). The big fat surprise: Why butter, meat and cheese belong in a healthy diet. New York, NY: Simon &

Schuster. Tesh, S. N. (1988). Hidden arguments of political ideology and disease prevention policy. New Brunswick, NJ: Rutgers

University Press. The Campbell Alliance. (2005). The era of clinical trial registries: A White paper. Retrieved from http://www.

campbellalliance.com/articles/final_clinical_trial_registries_3-23-05.pdf Tuffs, A. (2004). Only 6% of drug advertising material is supported by evidence. BMJ, 32, 485. Thyer, A. (2005). The misfortunes of behavioral social work: Misprized, misread, and misconstrued. In S. A. Kirk

(Ed.), Mental health in the social environment: Critical perspectives (pp. 330–343). New York, NY: Columbia University Press.

Thyer, B. A. (2011). Harmful effects of federal research grants. Social Work Research, 35, 3–7. doi:10.1093/swr/35.1.3 Thyer, B. A., & Pignotti, M. G. (2015). Science and pseudoscience in social work practice. New York, NY: Springer. Tija, J., Briesacher, B. A., Peterson, D., Liu, Q., Andrade, S. E., & Mitchell, S. L. (2014). Use of medications of questionable

benefit in advanced dementia. JAMA Internal Medicine, 174, 1763–1771. doi:10.1001/jamainternmed.2014.4103 Tredennick, H., & Tarrant, H. (trans). (1954/1993). The last days of Socrates. New York, NY: Penguin. U.S. Government Accountability Office. (2012). Children’s mental health: Concerns remain about appropriate services

for children in Medicaid and foster care. Washington, DC: Author. Ussher, J. M. (2013). Diagnosing difficult women and pathologising femininity: Gender bias in psychiatric nosology.

Feminism & Psychology, 23(1), 63–69. doi:10.1177/0959353512467968 Veblen, T. (1993). The higher learning in America. New Brunswick, NJ: Transaction. (Original work published 1918) Wampold, B. E., & Imel, Z. E. (2015). The great psychotherapy debate: The evidence for what makes psychotherapy work

(2nd ed.). New York, NY: Routledge. Ziliak, S. T., & McCloskey, D. N. (2008). The cult of statistical significance: How the standard error costs us jobs, justice

and lives. Ann Arbor, MI: University of Michigan Press.

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