Manual-based treatments: The clinical application of research findings

Journal/Book: Behav Res Ther. 1996; 34: The Boulevard, Langford Lane, Kidlington, Oxford, England OX5 1GB. Pergamon-Elsevier Science Ltd. 295-314.

Abstract: In addition to their now required use in controlled outcome studies, treatment manuals offer important advantages for clinical practice. Manual-based treatments are often empirically-validated, more focused, and more disseminable. They are useful in the training and supervision of therapists. Criticisms of manual-based treatments center on five main themes: they are conceptually at odds with fundamental principles of cognitive-behavioral therapy; they preclude idiographic case formulation; they undermine therapists' clinical artistry; they apply primarily to research samples which differ from the patients practitioners treat; and they promote particular 'schools' of psychological therapy. This paper emphasizes the inherent limitations of idiographic case formulation. It is argued that treatment manuals are consistent with an actuarial approach to assessment and therapy, which, on average, is superior to individual clinical judgment. Available data suggest that standardized treatment is no less effective than individualized therapy. Manual-based treatment demands therapist skill in its implementation. In suitably chosen therapists these skills are more a function of training than amount of clinical experience. Treatment manuals are likely to encourage a pragmatic approach to therapy and should not discourage clinical innovations.

Note: Review GT Wilson, Rutgers State Univ, Grad Sch Psychol, Busch Campus, POB 819, Piscataway, NJ 08855 USA

Keyword(s): COGNITIVE-BEHAVIORAL-THERAPY; BULIMIA-NERVOSA; INTERPERSONAL PSYCHOTHERAPY; OUTCOME RESEARCH; DEPRESSION; EFFICACY; JUDGMENT; ISSUES; MODELS; FUTURE

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