The fault is not in our manual

Dauphin, Barry

Manuals exist for all forms of therapy, of course, but are not meant to be followed in lock-step fashion. They provide models with which to consider the precepts of their therapeutic schools or approaches and some examples to illustrate basic concepts.  Yet, the Empirically Supported Treatment (EST) movement has been successfully convincing third party funders (such as insurance corporations and state and federal governments) that the use of more rigid sets of procedures used in conjunction with specific diagnoses will serve as a cost control mechanism.  Validation proceeds on the basis of strict adherence to the manual. The EST movement, which has an ironically religious fervor, seeks to link treatment validation to healthcare policy and the rules/procedures which govern the implementation of such policy. In such a world, one could very well risk skirting professional ethics to use procedures that have not been “validated.” No wonder that those who think about their psychoanalytic work as something different from “implementing procedures” are leery about manuals.  Manuals aren’t the problem, though. Instead we must confront the position that the only good treatment research is one that rigidly follows procedures more appropriate for drug research and that there is no difference, in principle, in treating people with drugs or doing psychotherapy.