Addressing Individual Client Needs in Manualized Treatment

Abstract

One consequence of the evidence-based practice movement is the proliferation of manualized interventions. Clinicians voice a number of concerns about the use of treatment manuals. These include concerns that manuals impede the therapeutic relationship and discourage flexibility in addressing the individual needs of clients. One manualized intervention called parent-child interaction therapy (PCIT) has shown exceptional promise in the treatment of child behavioral problems. PCIT is a parent-mediated behavioral intervention aimed at reducing externalizing behaviors in children by changing parenting practices. The manual includes session scripts for clinicians, a proscribed sequence of intervention activities, and checklists for clinicians and parents to document that intervention is completed in the prescribed manner. Three cases are presented in which clients vary by personal characteristics and individual needs. Case descriptions reveal how this manualized intervention was adapted successfully to address the needs of a variety of families. Implications for therapeutic relationship are also discussed.

Preventing Pressure Ulcers in People with Spinal Cord Injury

“…Although such solutions seem straightforward, to our knowledge they have not been explicitly typologized in previous publications on the manualization process. 26,27 Strategies for tailoring an intervention in each of the above ways, as well as for identifying the limits of such changes, should be routinely included in treatment manuals as well as training sessions.…”

Manualized Treatment Programs for FSD: Research Challenges and Recommendations

“…Whether decision-making rules are based on recommendations from the literature (e.g., [13]) or designed specifically for the FSD manual, it is recommended that these decision rules be incorporated into the treatment manual before the research trial begins to improve fidelity to the treatment manual and aid treatment descriptions [57]. The descriptions of such procedures should allow the reader to gain a comprehensive understanding of how much manual flexibility was incorporated into the study and how these decisions came about.…”

Manualization: A blessing or a curse?

“…Most clinicians declare that they do not like manualized interventions (Dennis, Fetterman & Sechrest, 1994;Silverman, 1996) because, they say, their use impedes the development of the therapeutic relationship by distracting both the therapist and client (Aarons, 2005;National Advisory Mental Health Council, 2001). According to the respondents, this happens because in order to maintain fidelity, therapists feel obliged to take the manual into the treatment room (Herman-Smith, Pearson, Cordiano & Aguirre-McLaughlin, 2008). In addition, and most importantly, therapists object to the restrictions imposed by a manual that does not allow them the flexibility they need to respond to the unique features of clients (Addis & Krasnow, 2000;Beutler, 1999).…”

“…In addition, and most importantly, therapists object to the restrictions imposed by a manual that does not allow them the flexibility they need to respond to the unique features of clients (Addis & Krasnow, 2000;Beutler, 1999). For example, in the application of parentÁchild interaction therapy, which is guided by a detailed manual (Eyberg & Calzada, 1998), it has been shown that the manual does not allow the flexibility necessary to deal with the common occurrence of unique features of both children and their parents (Hembree-Kigin & McNeil, 1995;Herman-Smith et al, 2008;Webra, Eyberg, Boggs & Algina, 2006). Similarly, in the manualized treatment of adult attention deficit hyperactive disorder (ADHD) (Safren et al, 2005), the need to modify the treatment to accommodate idiosyncratic features has been demonstrated clearly (Mitchell et al, 2008).…”