TY - JOUR AU - Kramer, Ueli PY - 2009/07/07 Y2 - 2024/03/29 TI - Between Manualized Treatments and Principle-Guided Psychotherapy: Illustration in the Case of Caroline JF - Pragmatic Case Studies in Psychotherapy JA - PCSP VL - 5 IS - 2 SE - Case Study DO - 10.14713/pcsp.v5i2.970 UR - https://pcsp.nationalregister.org/index.php/pcsp/article/view/970 SP - 45-51 AB - <div>My case study of &quot;Caroline&quot;&mdash;a 26 year old presenting with depression, PTSD symptoms, and a history of sexual abuse as a teenager&mdash;represents a &quot;third way&quot; between (1) a strict adherence to a manualized treatment, and (2) a principle-guided therapy, in which the therapy follows particular theoretical concepts, but depends on the therapist&rsquo;s clinical judgement to flexibly apply them to the individual case. Specifically, in my therapy with Caroline (Kramer, 2009), I employed Foa and Rothbaum&rsquo;s (1998) cognitive-behavioral, &quot;Prolonged Exposure&quot; (PE) manual for PTSD, but deviated from it in certain ways based upon my evaluation of Caroline&rsquo;s individualized goals and reactions using Grawe and Caspar&rsquo;s &quot;Plan Analysis,&quot; which is a cross-theoretical model for assessment and treatment planning. In their commentaries on my case study of Caroline, Caspar (2009) and Haldimann-Balli (see Appendix in Kramer, 2009) support my use of this third way. On the other hand, the other commentators&mdash;Muller (2009) and Hembree and Brinen (2009)&mdash;critique my handling of the case, arguing that strict adherence to the Foa and Rothbaum manual would have resulted in a more cost-effective therapy. In this article, I respond to the important issues raised by the four commentators. &nbsp;</div><div><br /></div> ER -