Evaluating Adherence and Flexibility in the Use of a Manual in Clinical Practice

Abstract

The value of the use of evidence-based treatment manuals in clinical practice has been a controversial topic within the field of clinical psychology. One of the most significant areas of debate surrounds the perception of how treatment manuals are used. Are they rigid treatment prescriptions, not to be deviated from, and as a result their use may lead the clinician to miss important idiosyncratic aspects of the client? Or, should they be used flexibly, insuring that clinicians apply the essential evidence-based treatment strategies, but at the same time allowing for modifications to address unique clinical aspects of the client? I examined the case description provided by Edwards and Kannan (2006) with an eye on the balance of adherence to the manual and clinical flexibility. Overall, there was an excellent balance of the two. However, there were several examples noted where adherence to the manual may have limited clinical flexibility. Ideally, sensitizing clinicians to these issues will increase their comfort in using manualized treatments and facilitate their use in the most effective way possible by allowing for clinical flexibility.