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Donald F. Klein, MD
Department of Psychiatry Columbia University College of Physicians and Surgeons and New York State Psychiatric Institute 722 W 68th St, Room L-224 New York, NY 10032

Lauren B. Smith
New York

Arch Gen Psychiatry. 1997;54(10):929-930.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

IN THIS issue of the ARCHIVES, Carroll¹ argues for a psychotherapeutic context, standardized by manualization, for pharmacotherapy trials. This may well succeed in lowering the attrition rate and improving compliance,² but the superiority of detailed manuals over goal-oriented, supportive therapy has not been demonstrated. Therefore, standardization by manuals is premature.

THE ADOPTION OF MANUALS

Manual-based psychotherapy has become standard in psychotherapy research, to provide a distinct, operationalized, replicable structure. In comparative psychotherapy trials, manuals ensure adequate differentiation between therapies, thus allowing strong statements as to what was actually done.^3,4 However, since it has not been shown that manuals increase the treatment efficacy or diminish outcome variance, their required use See also page 923 compared with manual-free, supportive psychotherapy has not been shown to be necessary. Such a manual requirement may expensively address a nonexistent problem.

RESEARCH ON THE EFFICACY OF MANUALS

Schulte et al⁵ compared the . . . [Full Text PDF of this Article]

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