MANUAL-BASED TREATMENTS - THE CLINICAL-APPLICATION OF RESEARCH FINDINGS

In addition to their now required use in controlled outcome studies, t reatment manuals offer important advantages for clinical practice. Man ual-based treatments are often empirically-validated, more focused, an d more disseminable. They are useful in the training and supervision o f therapists. Criticisms of manual-based treatments center on five mai n themes: they are conceptually at odds with fundamental principles of cognitive-behavioral therapy; they preclude idiographic case formulat ion; they undermine therapists' clinical artistry; they apply primaril y to research samples which differ from the patients practitioners tre at; and they promote particular 'schools' of psychological therapy. Th is paper emphasizes the inherent limitations of idiographic case formu lation. It is argued that treatment manuals are consistent with an act uarial approach to assessment and therapy, which, on average, is super ior to individual clinical judgment. Available data suggest that stand ardized treatment is no less effective than individualized therapy. Ma nual-based treatment demands therapist skill in its implementation. In suitably chosen therapists these skills are more a function of traini ng than amount of clinical experience. Treatment manuals are likely to encourage a pragmatic approach to therapy and should not discourage c linical innovations.