Manualized Treatment. A related, hotly debated
issue is whether manual-based treatments should be
used in clinical practice. Treatment manuals were
originally developed by psychotherapy researchers
to ensure that treatment protocols were standard-
ized across patients. However,manualized treatment
has also been used outside the research context in
clinical practice. Some have criticized manual-based
treatment for“undermining”the clinical judgment
of clinicians, for not being tailored to patients with
multiple problems (comorbid conditions), and for
ignoring therapist effects on outcome (Davison &
Lazarus, 1995; Garfield, 1996; Wilson, 1998).
In addressing these and other criticisms, Wilson
(1998) points out that manual-based treatment has
greater clinical utility than it is given credit for. The
psychological testing and clinical judgment literature
suggests that clinical judgment and clinical prediction
are limited and are likely to be outperformed by an
empirically supported manualized treatment that
prescribes for the therapist the methods of interven-
tion for a given problem. Second, there are no data to
support the position that manual-based treatments
are inferior to treatment-as-usual with regard to
comorbid psychological problems (Wilson, 1998).
In fact, manual-based treatments might be used to
treat comorbid problems sequentially or concur-
rently. Third, Wilson (1998) argues that manual-
based treatments actually encourage clinical innova-
tion because they help identify patients who do not
seem to respond to“first-choice”treatments. It then
becomes possible and necessary to modify protocols
to treat these individuals successfully. Finally, Wilson
(1998) points out that manual-based treatments, like
other forms of treatment, require clinical skill and a
positive therapeutic alliance. He does acknowledge
that treatment manuals need to become more
“therapist friendly”and suggests providing more
practical guidelines as well as more discussions of
commonly encountered problems in implementing
the treatment.
We would like to highlight a few additional
advantages of manual-based treatment. This form
of treatment is more focused, often more engaging
from the patient’s perspective, and easier to teach,
supervise, and monitor (Wilson, 1998). Finally, the
clinicians who master manual-based treatments will
be much more attractive to managed care compa-
nies because these treatments are recognized as effi-
cacious and efficient (Marques, 1998; Strosahl,
1998). Marques (1998) predicts that clinicians will
be required to use manual-based treatment proto-
cols to maintain their provider status for managed
care organizations. For all of these reasons, it is
important that clinical psychology trainees receive
thorough training in manual-based, empirically
supported treatments (Calhoun, Moras, Pilkonis,
& Rehm, 1998). Table 11-5 presents a preliminary
set of guidelines for training in empirically sup-
ported treatments.T A B L E 11-5 Guidelines for Training in Empirically Supported Treatments (ESTs)
■ Include videotapes that illustrate the conduct of the central components of the EST in the training program.
■ Rely mainly on audio- or videotapes of therapy sessions for supervision, rather than on trainees’self-reports.
■ Use adherence measures developed for the EST to systematically and frequently evaluate each trainee’s progress.
■ Training material that illustrates common errors in the implementation of central components of an EST are
efficient training aids.
■ Group supervision using audiotapes of sessions might be more efficient than individual supervision in terms of
rate of learning.
■ Expect to provide supervision on a minimum of three to four prototypical cases for the EST and a minimum of
four more nonprototypical cases to develop minimally adequate skill performing it.
■ Include instruction in ongoing evaluation of a patient’s response to the EST.
SOURCE: Adapted from Calhoun, K. S., Moras, K., Pilkonis, P. A., & Rehm, L. P. (1998). Empirically supported treatments. Implications for training.Journal of
Consulting and Clinical Psychology, 66, 151–162.
PSYCHOLOGICAL INTERVENTIONS 339