Many clinicians feel frustrated when they are “mandated” to use TREATMENT MANUALS with patients. Here are some points to consider:
1. Treatment manuals are either well designed or poorly designed. WELL DESIGNED MANUALS are easy to use, present exercises in a logical series of progressive skill-building steps, and have exercises to practice the skills in real-life situations.
2. The language in well-designed manuals avoids both “PSYCHO-BABBLE”, highly technical psychological language, and RECOVERY TALK, the heavy use of 12-Step language, slogans, and platitudes.
Therapists require training in how to use a manual in individual and group therapy. They also need experience in treating the addiction or related problems that is the focus of each manual. Here are the basic steps that therapists need to take to become proficient in “manualized” treatment:
Step 1: Understand the therapeutic purpose of the workbook and the goal of each exercise. Review the way the sequence of information, questions, and suggested activities are used . Use each exercise to take the patient on a journey of new understanding.
STEP 2: Take ownership of the manual content by integrating it into your own personal style and be prepared to clarify or elaborate on the concepts in the manual in words, ideas, and examples that you are comfortable with.
STEP 3: Adapt the use of the manual to the structure and needs of the program you are working in.
STEP 4: Adapt the use of the manual to the needs of each individual patient. The key question is: Does the manual meet the needs of the patients? If yes, the manual can be a valuable addition to traditional psychotherapy. If no, don’t use the manual.
Using a manual that does not address the important problems of a patient is the equivalent of giving patients the wrong medications. DON’T DO IT! Match specific manuals to the individual needs and treatment plans of patients.
It is important for therapist to work with management when adapting the use of manuals for use within a specific clinical program. How clinical staff negotiate with management for the appropriate use of treatment manuals is critical. Some negotiation styles cause head-to-head conflicts and power struggles. Others invite a collaborative process of evaluation that looks for the most effective way to use the manual with an individual patient.
Here are ways that the use of the manual can be adjusted to meet patient needs:
1. Sometimes the content of the manual needs to be delivered in smaller or bigger “chunks” of information that fit the patient’s cognitive ability and learning style.
2. Sometimes patients will respond better if the information is delivered in a different order. Feel free to adjust the sequence to match the patient’s interests and needs.
3. Skip sections of the manual that don’t fit the needs of the patient, or repeat knowledge and skills the patient already has.
4. The manual can be augmented with other handouts and exercises that can powerfully adjust the clinical approach guided by the manual.
5. Manuals are designed to have the exercises completed as homework assignments. These assignments help patients prepare for individual, group, and psycho-educational sessions.
6. When patients present workbook assignments in groups, it is usually not a good idea to have patients read their answers to each questions. This puts people to sleep. It is better to have a group reporting form that asks patients to answer these questions:
(1) What’s the most important thing that you learned from doing the exercise?
(2) What parts of the exercise were most difficult for you to complete?
(3) What parts do you want the group to help you understand and apply to your own situation?
(4) What can you do differently in your recovery as a result of what you learned by completing this exercise?
(5) How can what you learned help you to move forward in your recovery plan?
Treatment manuals provide guidelines and tools for patients to move forward in therapy. When used properly they can enhance the treatment process. Manuals ARE NOT straight jackets that restrict creativity and clinical reasoning.
Most importantly, treatment manuals don’t DO anything. The clinician who understands their value can use them to make their job easier and to improve the effectiveness of treatment. Well designed treatment manuals help therapists accomplish more while investing less time and energy.
Here are some well-designed and useful manuals to use in addiction treatment and relapse prevention:
TREATMENT MANUALS THAT WORK