Manual-based treatment and clinical practice

The role of empirically supported, manual-based treatments in clinical practice is controversial. This article attempts to clarify misunderstandings 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 actuarial approach to treatment, which, on average, is likely to prove superior to subjective clinical judgment. Treatment manuals can provide greater flexibility and self-correcting features than is often assumed. Comorbidity 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 helping large 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.