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5 Manual-Based Treatment : Evolution and Evaluation

The development of manual-based psychological treatments for a wide range of clinical disorders has had a significant impact not only on clinical research, but also on clinical practice. Theory-driven, manual-based treatments have become a defining feature of evidence-based treatments for specific clinical disorders that have been evaluated in numerous randomized controlled trials (RCTs). The advantages of manual-based treatment include well-documented efficacy, less reliance on intuitive clinical judgment, and greater ease in training and supervising therapists in specific clinical strategies and techniques (Wilson, 1998a). Another nontrivial benefit has been the development of various selfhelp interventions derived from manual-based protocols (Fairburn & Carter, 1997). Nonetheless, the advent of manual-based treatment has generated considerable controversy (Addis, Wade, & Hatgis, 1999; Garfield, 1996; Wilson, 1998a). Different criticisms that have been leveled against manual-based treatment have focused not only on the use of standardized protocols (manuals; e.g., Strupp & Anderson, 1997), but also on the more general concept of empirically supported or evidence-based treatment (e.g., Garfield, 1996; Westen, Novotny, & Thompson-Brenner, 2004), and in some instances on the use of RCTs as a research methodology for