Beutler and Martin criticize Manualized Treatments

In an article describing their approach to matching treatments to patients and patient problems, Larry Beutler and Benny Martin (2000) present three criticisms of manualized treatments:

1. Neither treatment manuals nor the theories on which they are based are sufficiently flexible to allow therapists to adapt a wide variety of treatment procedures to important non-diagnostic states and needs of particular patients.

2. Manual-based training may actually increase the presence of antitherapeutic attitudes on the part of therapists.

3. Comparisons of manualized therapies have failed to demonstrate that their distinguishing methods and theories translate to differences in outcomes among any of a wide variety of patient problems.

My thoughts are:

1. Good manuals should spell out guidelines for determining when to apply the manualized approach "as is", when to modify it, and when the manualized approach is inappropriate.

2. This problem seems to me to be a result of inadequate training and supervision in the use of the manualized treatment. Whoever is training therapists should address antitherapeutic attitudes (rigidity, anger, insensitivity, and rejection) which are most common among the therapists who are most compliant with the treatment manuals. Now that manualized treatments are being sold for use without training or supervision, this could be a big problem.

3. Are manualized treatments supposed to demonstrate that they produce differences in outcomes? Isn't it sufficient for them to demonstrate that the manualized treatment produces outcomes which are at least as good as currently available treatments?

Beutler, L. F. & Martin, B. R. (2000). Prescribing therapeutic interventions through strategic treatment selection. Cognitive and Behavioral Practice, 7, 1-17.

Replies:

Re:Beutler and Martin criticize Manualized Treatments, by Linda Nauth, 10/01/00

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