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interventions that are prescribed or proscribed by the treatment manual (Waltz et al.,
1993). A more detailed way of assessing adherence is with frequency ratings. Frequency
ratings indicate the frequency or extensiveness of interventions used during the session
rather than only their presence or absence.
Waltz and colleagues (1993) define therapist competence as the extent to which
therapists conducting the interventions take the relevant aspects of the therapeutic context
into account and respond appropriately to these contextual variables (Waltz et al., 1993).
Unfortunately, treatment manuals seldom explicitly state criteria for assessing therapist
competence and researchers often make the erroneous assumption that adherence to the
treatment manual is equivalent to therapeutic skill or competence. This flawed belief fails
to determine whether a treatment was actually given a fair test because a thorough
investigation of the therapist's competence is not assessed (Waltz et al., 1993).
Another disadvantage of treatment manuals and a frequently expressed concern is
that manuals represent a "cookbook" approach that places too much emphasis on
technical adherence, overvaluing fidelity at the expense of therapeutic competence
(Binder, 1993). Furthermore, the emphasis placed on treatment fidelity oversimplifies the
therapy process and can result in the misuse of techniques (Addis, 1997; Crits-Christoph,
1993). Thus, because treatment manuals place so much value on treatment techniques,
they may underplay the need to assess and ensure therapist competence.
The benefits of therapists' adherence to treatment manuals on the outcome of
therapy are unclear as findings on this relationship have been inconclusive (e.g., Binder,
1993; Crits-Christoph et al, 1991).
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