Manual-based treatment and clinical practice.

Abstract

The role of empirically supported, manual-based t n a tments in clinical practice is controversial. This article attempts to clarify misunderstandings that may impede their effective use. Manual-based treatments encourage focal interventions, faciliite training and supervision of therapists, and expedite clinical audit. They are consistent with an actuarial approach t o treatment, which, on average, is likely t o prove superior t o subjective clinical judgment. Treatment manuals can provide greater flexibility and self-correcting features than is often assumed. Comohidity does not exclude their use. Far from hampering innovation, their use is likely to spur new developments. Manual-based treatments require specific therapeutic skills. Although effective, empirically supported manuals fall short of helpinglarge numbers of patients. Treatment manuals must become more "therapist friendly" by including richer practical details on their use, as well as greater specification of some of the "nonspecific" factors in therapy.

A meta-analysis of psychodynamic psychotherapy outcomes: Evaluating the effects of research-specific procedures.

“…Early psychodynamic psychotherapy manuals reported time-limited, focal forms of treatment (e.g., SupportiveExpressive Psychotherapy, Luborsky, 1984; Time-Limited Dynamic Psychotherapy, Strupp & Binder, 1984), and more recently, contemporary longer-term treatments have been manualized (e.g., Transference focused psychotherapy, Clarkin, Yeomans, & Kernberg, 2006;Mentalization-based treatment, Bateman & Fonagy, 2004). The introduction of manuals, primarily as a research tool for operationalizing interventions under empirical investigation, appeared to also offer the potential for improving outcomes through delivering adherent empirically based treatments (Wilson, 1995(Wilson, , 1996, superior to reliance on the clinical judgment of therapists (Drozd & Goldfried, 1996;Wilson, 1998). However, based on national practitioner surveys (e.g., Addis & Krasnow, 2000), a reluctance to incorporate manualized methods is not unique to psychodynamically informed therapists.…”

Complexity and Nonlinear Dynamics in Psychotherapy

“…Specific effects can occur even before the specific treatment components were realized and brought into action in a treatment program. [11][12][13][14][15][16] For example: cognitive restructuring takes place before the beginning of irrational beliefs treatment in cognitive behavioral therapy, or reduction of compulsions before the flooding begins. 3.…”

Cognitive-behavioral therapy and nutritional counseling in the treatment of bulimia nervosa and binge eating

“…1 Achieving behavior change of the sort described above demands expertise in psychological treatment such as CBT. This requires formal professional training and specific therapeutic expertise in the principles and procedures of behavior change (Wilson, 1998). It would be misleading to believe that nutritionists and dieticians can routinely provide such therapy unless they have had specialized training in CBT, which is rarely the case.…”