





































Private practice social work might be argued to be a cure for a 
wealthy man’s worries, or more simply, a cure for the worried 

well. This type of social work can have a higher earning potential and is 
generally available to those who have insurance or can afford to pay for the 
services. Social workers’ participation in private practice has the potential to 
draw criticism and debate regarding social work’s mission and ethics. Has 
social work in fact deviated from its historical definition and abandoned its 
mission to serve the underprivileged, or does private practice represent a 
logical and worthwhile modern progression, one reflecting the current social 
and political climate? This paper will examine some of the stereotypes and 
perceptions about public and private social work practice. It will explore how 
this dichotomy may be the newest incarnation of an old social work schism 
between whether the profession should focus on change at the community 
level or focus on change at the individual level. In addition, this paper will 
highlight how the two approaches to social work, historically and today, are 
not irreconcilable. On the contrary, healthy debate is critical to the ongoing 
development of the profession. 

 Journal of Student Social Work, Volume IV    ��  

Since the 1980s, social workers have increasingly left the service of the 
public sector and entered into private practice. A substantial number of 
today’s social workers practice for-profit client-based therapy rather than 
agency-based public service. These recent changes are causing critics to 
question whether social work’s new focus on for-profit services has deviated 
from social work’s original purpose to forge allegiances with the poor, the 
disadvantaged, and the oppressed. Is this change in focus an abandonment 
of social work’s historical principles?  Or is it simply a modern and logical 
evolution?  This paper examines the debate between private and public social 
work practice. It describes how social work historically emerged and evolved 
on two interconnected fronts, one with a focus on change at the community 
level, and one with a focus on change at the individual level. This paper 
posits that the two approaches are not irreconcilable and that healthy debate 
has led, and continues to lead, the profession forward.  

Jenna Benn

The Privatization of Social Work: A 
Deviation or a Logical Progression?



Social Work’s Professional Development and Debates 

In the 19th century, social work emerged and evolved with two purposes 
in mind — to combat and change societal injustices, and to help individuals 
who directly suffer from the oppression of these systems. Jane Addams, 
founder of the settlement house movement, approached social work from a 
paradigm that emphasized grassroots social change within the community 
and larger society. She primarily focused on societal injustice rather than 
on individual maladjustment (McLaughlin, 2002). Her contemporary, Mary 
Richmond, founder of the Charity Organizational Society, used a social 
work case model that focused on the improvement of the family and the 
individual. Richmond primarily focused on the study, diagnosis, and 
treatment of casework on an individual and familial level, as distinguished 
from the betterment of the masses (McLaughlin). Together, these different 
schools of thought created the foundation for today’s practice of social 
work. It is important to note that although Jane Addams shaped early social 
work efforts and inspired some of the modern social work methods, such 
as groupwork (Goldstein, 1973), the settlement house movement for which 
she is most famous ultimately dissolved. In contrast, Mary Richmond’s 
model of casework continued to largely set the stage for modern social 
work practice. The tradition of community work and social justice seems 
to have often taken a secondary role in social work, perhaps in part because 
of social work’s strivings to be recognized as a full profession and compete 
with related disciplines for resources and clients. 

Since the profession’s emergence, heated debates have ensued regarding 
social work’s definition and purpose. In 1915, Abraham Flexner, assistant 
secretary of the General Education Board, pronounced that social work 
was not a full and legitimate profession (Austin, 1983). He asserted that 
although social work was a useful social activity, particularly as it helped 
link individuals with problems to resources, it did not fulfill the criteria to 
be a formally recognized profession (Austin). Flexner’s argument came at 
a critical point in the early development of social work and social work 
education. His earlier criticism of medical education triggered important 
changes in that field. However, Flexner’s criticism of social work as a 
full profession ultimately seemed to, in response, cause social workers to 
question their own legitimacy and rethink the purpose and mission of social 
work. His standards for becoming a full profession included becoming more 
specific in purpose and developing a distinct body of presumably scientific 

the privatization of social work

��    Journal of Student Social Work, Volume IV



knowledge; Mary Richmond’s more individual-centered and medical-
oriented model seems to have been more likely to forward this cause, and the 
reverberations can still be felt today. Schools, such as Columbia University’s 
School of Social Work, seem to be largely dominated by students who focus 
on clinical, rather than community or policy practice.   

 The latest incarnation of this division between individual focused versus 
society or community focused social work methods may be private versus 
public social work practice. Today 60% of social workers practice private 
clinical social work (Kassan, 1996). With this high level of participation in 
privatized social work, critics might argue that social work has abandoned 
its mission to serve the poor and oppressed, and failed to focus on broader 
contemporary social problems. Therapists in private practice primarily work 
with the individuals and families who are able to afford their services or 
have insurance. Medicaid and Medicare recipients, as well as individuals 
and families with restrictive insurance plans, are only eligible for a limited 
amount of treatment coverage, requiring in some cases that therapists restrict 
therapy when patients cannot pay out of pocket. The goal of treatment may 
only be to stabilize the problem, which may not be therapeutically adequate 
or beneficial for the patient over the long run. In contrast, the affluent are 
better able to pay for more comprehensive treatment. Today’s restrictive 
insurance plans may ultimately stunt the opportunity for successful private 
therapy for a large segment of the population. 

Critics may also take issue with the average earnings of private practice 
therapists. On average, clinical social workers at public agencies earn 
between $42-45,000 a year (Linsley, 2003). In 2000, private practice social 
workers earned a median annual income of $55,512 (Linsley). Therapists 
in private practice can make a significantly higher income that can increase 
with years of experience. Private practice social workers who have more 
than 25 years of experience earn an average income of $79,600, nearly 1/3 
more than social workers in the public sector (NASW, 2001). There is a 
perception among some that social workers who engage in private practice 
reflect a new wave of self-indulgence and radical individualism that has 
shifted social work’s mission to the treatment of the individual at the expense 
of the collective (Herron & Welt, 1992).  

Some social workers may hold up icons like Jane Addams, who believed 
in living with the poor as neighbors, as a means to further our understanding 
of the implication of societal problems and may assert that private practice 
social work departs from these romantic ideals in two significant ways. 

benn

 Journal of Student Social Work, Volume IV    ��  



First, the therapist who commands high prices serves a less impoverished 
population. Second, private practice workers’ pursuit of higher salaries 
greatly reduces the possibility that they will live among, and ultimately 
serve, such a population. There seems to be a perception among some social 
workers that living among clients, and even struggling to survive on meager 
pay, is the best way to experience empathy for the populations they serve.

However, in private practice, just as in any method of social work, the focus 
is on the worth and dignity of the person. Private clinical social workers are 
strongly committed to helping the individual negotiate environmental stress, 
regardless of economic background (Herron & Welt, 1992). Moreover, these 
private practitioners may also serve clients who are stuck in the middle: those 
who do not have enough money or lack the insurance to afford the services 
of more expensive professionals, such as psychiatrists or psychologists, 
yet do not qualify for government benefits, such as Medicaid or Medicare. 
Clinical social workers argue that it is idealistic to try to change the world 
and more realistic to change one person at a time (Van Heugten & Daniels, 
2001), and social work has a long tradition of individual-oriented practice. 

Studies indicate that 15% of the population needs mental health services, 
and only 2% of the population receives them (Herron & Welt, 1992). There 
is a significant gap between those needing services and those receiving 
them. This reinforces the need for more social workers to treat mental 
health. Private practice, while often serving those who may have access to 
relatively more services, plays an important part in meeting this need. People 
of all economic backgrounds have legitimate issues that deserve attention. 
Critics may scoff at serving people with economic means, however they are 
not immune to pressures and hardships. People who are relatively well-off 
can and do suffer from mental health issues that can be just as serious and, 
at times, be associated with worse outcomes (Luthar, 2003). Dismissing or 
marginalizing this population in favor of serving people who have what may 
have judged to be “real” problems, seems to run counter to social works’ 
mandate to serve suffering community members regardless of economic 
status. 

In addition, not all private practitioners exclusively serve the upper 
classes. Often therapists are willing to accept no fee or a low fee so the poor 
may access services (Herron & Welt, 1992). Social workers, more so than 
private psychologists, may be more likely to offer their clients options like 
sliding scale fees exactly because of their commitment to social justice, and 
thus open the door for clients to receive the benefit of a service that might 

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��    Journal of Student Social Work, Volume IV



otherwise be unreachable. Proponents of private practice do not feel that 
therapists are selling out to the bourgeoisie or dominant class in society, 
but rather look at private practice as a career phase. More often than not, 
private clinical social workers return to the public sector at a senior or 
managerial level with skills gained through private clinical experience as a 
means to exert influence on the workplace and professional direction (Van 
Heugten & Daniels, 2001). In addition, social workers in clinical private 
practice may supplement their income by working concurrently at a public 
agency. Social workers returning to the public sector after private practice, 
or simultaneously working in both, are not necessarily neglecting a specific 
population but rather providing services to many varied populations.

In addition to serving wealthy and non-wealthy clients at some point in 
their career, social workers might question whether or not the trend toward 
privatization is a reflection of society’s capitalistic system co-opting the field. 
Some argue that criticism should be levied at the monetarily driven culture 
of the United States rather than pointing fingers at private practice (Van 
Heugten & Daniels, 2001). It is possible that the desire for a higher salary in 
private practice is a reflection of the highly individualized, money-oriented 
nature of a capitalistic society like the United States. Social workers, just like 
other human beings who must operate within the existing social structure, 
are arguably just as likely to be affected by socialization. Privatization of 
life is a product of a society highly focused on, and dominated by, private 
individuals, private spaces, and private institutions. This privatization has 
reshaped the context in which social workers live and practice (Fisher & 
Karger, 1997).  

Reconcilable Differences

Perceptions, warranted or not, can spur debates that assume strong points 
of contention and criticism. In reality, it is not important to choose a side, but 
rather to create a common ground that includes and unites both schools of 
thought. Instead of seeing social work as a dichotomy between clinical social 
work and social action, or framing it as a choice between serving the wealthy 
versus the poor, it is more productive to recognize how both practices have 
a place under the social work umbrella. Jane Addams and Mary Richmond, 
though differing in philosophy and practice, both practiced social work. Their 
foundations of social work established two approaches, but one common 
goal remains that still resonates today, “...to enhance human well-being and 

benn

 Journal of Student Social Work, Volume IV    ��  



help meet the basic human needs of all people, with particular attention to 
the needs and empowerment of people who are vulnerable, oppressed, and 
living in poverty. And in addition to... pay attention to the environmental 
forces that create, contribute to, and address problems in living” (National 
Association of Social Workers, 1999). Social work problems occur on the 
individual and societal level (McLaughlin, 2002) and among all economic 
classes. Although dichotomous thinking, pitting one extreme side against 
the other, may be a useful tool for highlighting the core issues, it also 
oversimplifies the debate. Instead, there should be recognition of the critical 
interplay between society and individual functioning, and vulnerability and 
suffering among all communities. Private troubles are public issues and 
vice versa. Social workers, no matter where they practice and with whom, 
should not look at social problems and ignore the individual, and cannot 
examine the individual without looking at the lasting effects of social issues 
(McLaughlin).

Leading the Profession Forward

The conflict between the differing philosophies and approaches of social 
work’s public and private sector has the potential to encourage the growth 
and evolution of the profession. Today we may continue to be haunted by 
Abraham Flexner’s ghost. His belief that social work was not a profession 
continues to challenge the purpose and legitimacy of the field (Austin, 1983). 
Similar to the controversy and eventual professional growth that ensued after 
Flexner’s statement, the field’s current reevaluation of purpose and practice 
propels the profession forward. Professional insecurity, stemming from 
historical and current debates, is forcing the field to critically reexamine its 
ethics and mission, and inevitably make change (McLaughlin, 2002). The 
changing face of social work is not a deviation from its historical mission, but 
rather a modern logical progression that will continue to evolve and change 
on interconnected fronts in years to come. What is needed is a blending of 
social work’s versatile objectives toward an improved quality of life for all 
(McLaughlin). Social work’s greatest challenge, its diversity of method and 
focus, has arguably been its greatest strength. It is important to focus on the 
mission of the profession and ethical commonalities that unify us all, both in 
the public and private sectors, under a common professional identity.

the privatization of social work

��    Journal of Student Social Work, Volume IV



References

Austin, D. M. (1983). The Flexner myth and the history of social work.  
 Social Service Review, 3(11), 358-375.
Fisher, R. & Karger, H. J. (1997). Social work and community in a private  
 world: Getting out in public. White Plains, NY: Longman.
Goldstein, H. (1973). Social work practice theory: An historical perspective.  
 In H. Goldstein (Ed.). Social work practice: A unitary perspective.  
 Chapel Hill, North Carolina: University of North Carolina Press.
Herron, W., & Welt, S. (1992). Money matters: The fee in psychotherapy  
 and psychoanalysis. New York: The Guilford Press.  
Kassan, L. (1996). Shrink rap: Sixty psychotherapists discuss their work,  
 their lives, and the state of their field. New Jersey: Jason S. Aronson Inc.
Luthar, S. S. (2003). The culture of affluence: Psychological costs of material  
 wealth. Child Development, 74, 1581-1593.
Linsley, J. (2003). Social work salaries: Keeping up with the times? The  
 New Social Worker, 10(1), 1-7.
McLaughlin, A. M. (2002). Social work’s legacy: Irreconcilable differences?  
 Clinical Social Work Journal, 30(2), 187-200.
National Association of Social Workers (NASW). (1999). Code of Ethics of  
 the National Association of Social Workers: Preamble. Retrieved October  
 10, 2005, from http://www.socialworkers.org/pubs/code/code.asp
National Association of Social Workers (NASW). (2001). Practice Research  
 Network of the National Association of Social Workers. Retrieved  
 October 10, 2005, from http://www.naswdc.org/naswprn/default.asp
Van Heugten, K., & Daniels, S. (2001). Social workers who move into private  
 practice: The impact of the socio-economic context. British Journal of  
 Social Work, 31(5),739-755.

Jenna Benn is a first year master’s student at CUSSW within the 
Social Enterprise and Administration Practice Method, in the World 
of Work field of practice. She is currently placed at Weston United 
Supported Housing in Harlem, New York.  She holds a bachelor’s 
degree in History and a double minor in Psychology and Jewish 
studies from Mcgill University in Montreal, Quebec. Her email 
address is jeb2127@columbia.edu.

benn

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