Assessing the Role of Treatment Manuals: Have They Become Necessary but Nonsufficient Ingredients of Change?

We argue that the controversies and ambivalence surrounding treatment manuals are in part due to three somewhat inconsistent functions that these manuals serve, or may soon be serving: (1) to provide detailed guidelines to clinicians, (2) to operationalize developmental steps in psychotherapy research programs, and (3) to serve as a list of options that might soon be guiding, and potentially dictating, treatment reimbursements. We also argue that although the slow pace of scientific development is at odds with the immediate needs of clinicians, the inconsistency between the first and second functions of treatment manuals is not a problem per se - it simply reflects the intrinsic dilemma underlying the Boulder model. A key problem, however, is the possibility that our current state of empirical knowledge might be used in the near future as the main basis for prescribing psychotherapy (i.e., the inconsistency between the second and third functions of manuals). Treatment manuals are described as necessary but nonsufficient tools that may be best used as the "first line of attack" in narrowly defined treatment conditions. The creation of a new task force is suggested to delineate such treatment conditions, to generate possible guidelines for addressing clinical situations that have not yet been empirically investigated, and to recommend future research directions to improve psychotherapy effectiveness. Finally, clinicians and researchers are encouraged to use a treatment strategy that has been empirically supported to entice third-party payers to fund future psychotherapy research.