Evaluating the treatment manual as a means of disseminating empirically validated psychotherapies.

Psychotherapy manuals evolved from the needs of researchers and are rapidly becoming a major medium for disseminating empirically validated treatments. For manuals to provide an effective means of dissemination, specific issues must be considered, including (a) efficacy and practitioner adherence in research versus clinical practice; (b) the difference between rule-governed adherence to a treatment manual and flexible, integrative practice; and (c) the desired structure and content of treatment manuals. Studies should compare the process and outcome of manual-based treatments in experimental versus clinical settings, and the effects of alternative forms of manual-based training. Systematic description of common factors and clinical strategies can also help to disseminate the effective elements of a treatment.