Does Manual Guided Treatment Enhance or Hinder Therapeutic Alliance?

According to a new study, manual guided treatment actually enhances the therapist-client alliance initially, but has no advantageous impact on therapeutic outcome over time. David A. Langer of the University of California, Los Angeles, Bryce D. McLeod of Virginia Commonwealth University and John R. Weisz of Harvard University and Judge Baker Children’s Center, collaborated on a study in order to dispel the growing concern that treatment manuals that guide therapists in the delivery of therapy, impede the important alliance between client and therapist that is fundamental to an effective outcome. “Alliance, as typically defined, encompasses the affective and collaborative aspects of the client-therapist relationship,” said the team. “Alliance may play a critical role in both behavioral and non-behavioral treatments for youths because youths rarely self-refer and may resist engaging in treatment. The researchers followed 76 young people from local mental health clinics who were part of the Youth Anxiety and Depression Study to determine their results. They used the Primary and Secondary Control Enhancement Training (PASCET) and the Coping Cat (CC) to evaluate depression and anxiety in the participants.

The youths were divided into two groups. The first group received manual guided treatment for an average of 17 sessions. The second group received usual care, given by therapists through traditional methods that they had used before and had deemed effective. The researchers discovered that early in the treatment, the manually guided youths reported a much higher level of alliance than the usual care group. However, the alliance converged during the middle and end of the treatment phase. “One possible interpretation of these findings is that using treatment manuals may enhance alliance early in therapy,” said the researchers. “Perhaps youths respond well to early structure and clear treatment agendas of manualized treatments.” Because youths are usually resistant to treatment, the team believes their findings are important. They added, “Thus, a critical task for therapists is to build enough of an alliance early in treatment to engage youths in the treatment process.”

Langer, David A., Bryce D. McLeod, and John R. Weisz. “Do Treatment Manuals Undermine Youth–Therapist Alliance in Community Clinical Practice?” Journal of Consulting and Clinical Psychology 79.4 (2011): 427-432. Print.

© Copyright 2011 by By John Smith, therapist in Bellingham, Washington. All Rights Reserved. Permission to publish granted to

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Sallie


    August 14th, 2011 at 4:38 AM

    Structure is so important to teens, whether they like to admit it or not. I think that over my lifetime I have seen teens who have been given a ,ot of structure in the home and teens who were given free reign. It always seesm that the ones who had the structure and discipline early in life were more successful than those who were allowed to do anything that they wanted. So i guess this still holds true in therapy situations too.

  • Dra Q La

    Dra Q La

    August 14th, 2011 at 6:51 PM

    A manual always follows the ideal scenario.But in real-world,ideal is rarely the case.Although a guide may help in better treatment,it will not be as good when it comes to the relationship between the therapist and the client.A relationship cannot be shaped as per a book,no matter what.

  • mia michelle

    mia michelle

    August 15th, 2011 at 4:36 AM

    The thing that strikes me as a little off here is that sometimes things do not always go by the book and a good therapist is going to be able to recognize the situations where things are not necessarily fitting the mold. So if that is the case then why follow the manual? You have to think outside of the box a little from time to time to hit the right nail on the head. I know that structure is good but there can still be that same structure, just modeled to fit the individual needs of the patient.

  • elvin


    August 15th, 2011 at 10:13 AM

    if I’m a therapist and am asked to follow the books word to word then I’m not doing enough justice to my profession and to my skills as a NO would be my answer.

  • Brandon


    August 16th, 2011 at 7:53 AM

    A manual should be a guide but by no means the end all and be all of treatment. Think how you would have felt as a kid if you thought that someone supposedly trying to help you was strictly going just by the book and making no efort to really learn who you were. I think that kind of would have made me feel bad and I am willing to bet the same for the rest of you. So while the manual can be a good starting point, there has to be more to success in treatment than just that.

  • Mr Z

    Mr Z

    August 16th, 2011 at 1:10 PM

    Treatment methods need to be followed as per the guide because it is most often the professionals over-medicating the clients or something that messes things up. Yes, it is the clients that come in with a problem. But you are the one who is there to help them out of this. Any slip from you would be disastrous.

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