Treatment manuals in clinical practice

Hickling and Blanchard (1997) [Behavior Research and Therapy, 35, 191-203] summarize the results of treating PTSD patients with a highly structured treatment manual. Presenting a 'clinician's reaction' they argue for the added value of modifying treatment manuals based on the therapist's clinical experience and claim that manuals do not provide complete treatment of patients' multiple problems. In response, I reiterate that actuarial prediction is usually superior to clinical judgment, address the treatment of co-morbid psychopathology, underscore the importance of specific therapist skills in implementing manual-based treatment, and point out ways in which manual-based treatment can be more flexible and individualized than Hickling and Blanchard imply.