MANUAL-BASED TREATMENT AND CLINICAL-PRACTICE

The role of empirically supported, manual-based treatments in clinical practice is controversial. This article attempts to clarify misunders tandings that may impede their effective use. Manual-based treatments encourage focal interventions, facilitate training and supervision of therapists, and expedite clinical audit. They are consistent with an a ctuarial approach to treatment, which, on average, is likely to prove superior to subjective clinical judgment. Treatment manuals can provid e greater flexibility and self-correcting features than is often assum ed. Comorbidity does not exclude their use. Far from hampering innovat ion, their use is likely to spur new developments. Manual-based treatm ents require specific therapeutic skills. Although effective, empirica lly supported manuals fall short of helping large numbers of patients. Treatment manuals must become more ''therapist friendly'' by includin g richer practical details on their use, as well as greater specificat ion of some of the ''nonspecific'' factors in therapy.