Use of Treatment Manuals in Comparative Outcome Research: A Schema-Based Model

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Abstract
The use of treatment manuals in clinical practice is purported to increase internal validity by ensuring specific, identifiable, and replicable treatments. In the present article, four factors in treatment manuals that should contribute to treatment integrity are singled out and addressed: (1) specification of model, (2) specification of relation between model and therapeutic practice, (3) circularity between model and actual practice, and (4) adoption of a natural attitude during therapy performance. Further, it is argued that theoretical contrast analyses and the accentuation of contrasting aspects in practice contribute to the differentiation of two or more treatments. A schema view of treatment manuals is developed and the implications for central issues in the field are inferred.

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