Manual-based treatment and clinical practice: Hangman of life or promising development?

Wilson (this issue) argues for the advantages of manual-based treatments for enhancing therapeutic outcomes. While largely agreeing with Wilson about the advantages of manuals, I argue here that manuals have been with us since the early 1960s, that their use has done little to enhance patient outcome, and that the field would be best served by tracking patient progress on a routine basis, a task that does not require manual development. Empirical science has much to contribute to positive patient outcome; its greatest direct effect will be felt when clinicians monitor outcome and connect this outcome to the behaviors and attitudes of a particular therapist.