Download - The Safran Lab

most therapists do not administer therapy "by the book" (Garfield, 1996). Given these
clinical realities, very few therapists administer theoretically pure treatments in clinical
practice (Norcross & Goldfried, 1992).
Research costs. Although costs occur in all psychotherapy research, some are
specific to the development of treatment manuals (Dobson & Shaw, 1988). Development
costs include the time required for the distillation of the treatment techniques, the time
required to prepare the treatment manual, and the time required for the development of
measures to assess treatment fidelity. Once the methods have been established, there are
certain costs associated with using manualized treatments, including those of rigorous
therapist training, those associated with monitoring therapy, those associated with
feedback delivery to the therapists, and those resulting from the loss of therapy cases due
to insufficient representation of the treatment manual.
Schoolism. Another criticism of treatment manuals is that they potentially
promote schoolism, such that integrative approaches may be inadvertently devalued, as
well as codifying a stagnant set of acceptable techniques (Najavits et al, 2000; Dobson &
Shaw, 1988; Wilson, 1998).
Therapist adherence versus therapist competence. Waltz and colleagues (1993)
define therapist adherence as the extent to which therapists use interventions and
approaches prescribed by the treatment manual and avoid the use of interventions
proscribed by the treatment manual.
There are several methods of assessing therapist adherence. The simplest method
is using a checklist of techniques and rating the occurrence or nonoccurrence of
20