“…Although the merit in common practitioner concerns about manualized approaches (Addis, Wade, & Hatgis, 1999) may be questioned (Fonagy, 1999), the empirical literature indicates that treatment manuals do not ensure effective delivery of therapy (Binder, 1993;. However, based on a small number of studies that produced conflicting results, and given the limitations of study methodology, it is less clear whether that which is gained in adherence to specific techniques through manuals (CritsChristoph et al, 1998;Henry, Strupp, Butler, Schacht, & Binder, 1993;Hilsenroth, Defife, Blagys, & Ackerman, 2006;Multon et al, 1996) may be at the expense of other therapeutic factors and therapeutic progress (Strupp & Anderson, 1997).…”