My opinion on the use of therapy manuals is often asked of me as a student. The utility is quite clear on paper: they are for operationalizing, testing effectiveness, managing protocol. However, once that’s been established is it appropriate then to use it?
My initial thoughts are to reject the notion of using manuals in treatment simply for the sake that it removes, or at the very least, limits the involvement of the person variable in the room. That is to say that it opens to door for robot therapy, and manufactured, cookie-cutter, recipe formats for giving psychology back to the people. This is of course slightly ridiculous and very dichotomous of me to suggest as there will inherently be differences in case presentation simply as a function of being human and existence that will vary the design from context to context. However, I still retain my reservations, as I have fallen victim even without manuals, to feeling stuck in a routine of repetition when working in a very similar population. I am speaking of course of my work in college counseling, and the emphasis on anxiety, adjustment, and emotional regulation. Sometimes it felt as if I were stuck in a single class stuck on repeat and completing its psychoeducational cycle time and again. This made me feel very cautious of losing my client’s voice and made me fear being absent from the room. I needlessly forced myself to review each detail that I could call to mind in the absence of my clients to remind myself of their person, simply because I can and felt I ought to and not because I should for any fault of my own. I scrutinized the intonation of their voice, the colour of their hair, their eyes, the way they held themselves, the way their breath hitched if they were to cry, the puckering of their lips…and so and so forth. I memorized the essence of their person to validate their being—as if they’d even asked me to!
As I sit here and labour over the minutia of my experiences and my passion to defend the essence of my clients, their heart and soul so to speak, I am reminded of my station as a graduate student. I am reminded of my obligations to advocate for the efficacy of a treatment manual, and of evidence-based approaches. Not to say one is mutually exclusive of the other, certainly! That I should, in effect, recall the benefit of a structure, a conceptualization model, a progression timeline and map, and a failsafe navigator to justify my own efficacy. That somehow this validates my training and my treatment. Look what I’ve done mum, aren’t you proud? Here are my data and here is the statistically significant improvement. That as long as I follow this brick road, anyone can follow along and continue the journey, and understand not only where I’ve been but where I am going and will end. That I should defend the system from which I descend.
Take a breath and take ease. I am more than the collective. More than the system. Although it may guide me, and I may return to it in my times of need should I lose my footing. I am welcome to stray from the path. Pick berries and smell flowers. Explore.