Therapy manuals and the dilemma of dynamically oriented therapists and researchers

The presence of therapy manuals in clinical settings is increasing and the related concepts of adherence and competence are becoming familiar. The benefits of manuals for research and training are evident. However, negative clinical effects have also been reported. Dynamically oriented clinicians and researchers who use manuals face a dilemma. Although there is a need to control aspects of technique for research and training purposes, there is also a need not to control the process of therapy because unpredictability is an intended part of the process. Issues associated with the dilemma are reviewed and a possible solution is provided that has proven helpful in an active clinic and research setting. It involves the use of manuals that emphasize general guidelines rather than detailed technical behaviors.