Portal de Periódicos da CAPES

Manualizing manual development.

2002; Wiley; Volume: 9; Issue: 4 Linguagem: Inglês

10.1093/clipsy.9.4.416

1468-2850

Drew Westen,

Mental Health and Psychiatry

In response to Carroll and Nuro, I suggest that attention to three issues might help address some of the conflicts between proponents and critics of manualization (and, correlatively, between psychotherapy researchers and clinicians). The first is when and how clinicians should be integrated into manual development and dissemination. Both the clinical utility (external validity) and “marketability” of many experimentally derived treatments might improve by involving clinicians earlier in the manual development process rather than primarily at the dissemination stage. The second is what might be called the “uncommonly differentiated factors paradox” in experimental treatment research: the demands of experimental investigation in the real world often conflict with the demands of clinical practice in the real world. Experimental design considerations lead researchers to create “pure” treatments that attempt to minimize common factors, whereas the fluidity, tenacity, and comorbidity of symptoms in clinical practice lead clinicians to apply more “impure” treatments that maximize the benefits of both common and specific factors. The third issue is the likelihood that different kinds of manualization are appropriate for different kinds of treatments and disorders. Highly specific, prescriptive manuals may be more appropriate for shorter-term treatments and treatments focused on specific associative connections. Principle-oriented manuals may be more appropriate for longer-term treatments and treatments of generalized affect states and repetitive interpersonal patterns.