Manualization: A blessing or a curse?

Abstract

This paper considers the issues involved in the use of manuals to guide the treatment of sexual offenders. I identify problems in the use of manuals, particularly their failure to encourage satisfactorily the implementation of therapeutic skills, the restrictions they place upon the therapist's ability to address the responsivity principle, the limits to which manuals can accommodate changes as a result of new evidence and the suppression of innovation. I offer suggestions for an alternative set of strategies to ensure the integrity of treatment delivery while at the same time overcoming the problems associated with manualization.

Forensic psychologists should use the behavioral experiment to facilitate cognitive change in clients who have offended

“…Fourth, clients do not need to hold a high level of verbal reasoning ability in order to engage with and understand the reasoning behind the BE. Finally, since BEs are tailor-made; they provide a clear opportunity for the forensic psychologist to engage in flexible and creative individualized treatment which is associated with increased treatment effectiveness (Barlow, 2011;Marshall, 2009;Marshall & Serran, 2004).…”

“…The BE also enables the forensic psychologist to engage in highly tailored evidence-based practice which has proved to be more effective in diminishing problematic behaviorsincluding criminal behaviors-than less tailored practice (Barlow, 2011;Beutler et al, 2011;Boswell et al, 2011;Johansson et al, 2012;Marshall, 2009;Marshall & Serran, 2004;Serran et al, 2003).…”

Where has all the psychology gone?

“…In a therapy outcome study with depressed outpatients, Castonguay, Goldfried, Wiser, Raue, and Hayes (1996) found evidence to suggest that overly rigid adherence to therapy manuals (i.e., lack of individual focus and flexibility) resulted in therapeutic alliance problems (see also Henry, Strupp, Butler, Schacht, & Binder, 1993;Marshall, 2009). …”

“…While the overarching goal of treating large numbers of offenders using evidence-based standardized treatment is laudable, such highly structured manuals suppress EBP clinical flexibility and neglect client individuality; promoting professional apathy. Highly manualized treatment also promotes rigid, authoritarian, rule-bound practice (Addis, 1997;Marshall, 2009) which is associated with poor treatment outcome (e.g., Ringler, 1977;Sweet, 1984). Novice therapists, in particular, are those most susceptible to overreliance on manuals since they lack the skills and experience to work more flexibly with clients (Addis, 1997;Beck, Rush, Shaw, & Emery, 1979).…”

“…Evidence has accrued across various psychological disciplines to show that treatment specifically tailored to client need is more successful in diminishing problem behaviors-including criminal behaviors-than less tailored interventions (e.g., Barlow, 2011;Beutler et al, 2011;Boswell et al, 2011;Johansson et al, 2012;Marshall, 2009;Marshall & Serran, 2004;Serran et al, 2003). Individualized case-based assessment and formulation represents the ÔcornerstoneÕ of psychological treatment and is associated with increased treatment effectiveness (Koerner, Hood, & Antony, 2011;Kuyken, 2006).…”