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Kächele, H. (2013). Manualization as Tool in Psychodynamic Psychotherapy Research and Clinical Practice—Commentary on Six Studies. Psychoanal. Inq., 33(6):626-630.
(2013). Psychoanalytic Inquiry, 33(6):626-630
Manualization as Tool in Psychodynamic Psychotherapy Research and Clinical Practice—Commentary on Six Studies
Horst Kächele, Ph.D.
It is an honor to comment on six fine articles on these recently developed treatments that share the distinctive features of using treatment manuals. The first generation of shorter psychodynamic treatments like Malan (1976), Mann (1973), Sifneos (1979), and Davanloo (1980) were presented in a traditional textbook format. The term manual had not yet become popular. What is a manual? The New Oxford American Dictionary described it as “a book of instructions, esp. for operating a machine or learning a subject; a handbook: a computer manual | a training manual."
In the seventies of the last century, the term manual began to replace the textbook notion; Lester Luborsky (1984) pointed out that “less than a decade ago a small revolution in psychotherapy research style demanded that an official ‘manual’ be devised for each psychotherapy so that methods and theories could effectively be implemented and compared” (p. 19). He proudly pointed out that his concise primer on the principles of supportive-expressive psychotherapy was one of the first such manuals of which a first version, entitled “The Task of the Psychotherapist” was copyrighted on April 5, 1976. The result was a carefully designed guide for the practice of psychoanalytically oriented psychotherapy for practitioners, researchers, and supervisors.
According to Luborsky (1984, p. 4) therapeutic manuals need to fulfill the following three criteria:
a) The specification of technique needs to be as complete as the type of treatment permits.
b) The manual should make clear the treatment principles and the approaches which the therapist is supposed to perform.
c) The manual should have an accompanying set of scales to measure the degree to which the therapists have complied with its main technique.
Psychotherapy manuals should ensure that therapists do what they are supposed to do according to the specified theoretical and technical framework (i.e., ensuring adherence). The first step in the development of manual consists in defining and clarifying the elements that are characteristic to a particular therapy method. For this reason, Gill recognized the importance of describing the elements of therapeutic approaches in his preface to to Strupp and Binder´s (1984) guide to “time-limited dynamicpsychotherapy” (Gill, 1984, p. VII).
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