title: Do treatment manuals undermine youth-therapist alliance in community clinical practice?
abstract: OBJECTIVE
  Some critics of treatment manuals have argued that their use may undermine the quality of the client-therapist alliance. This notion was tested in the context of youth psychotherapy delivered by therapists in community clinics.
  
  
  METHODS
  Seventy-six clinically referred youths (57% female, age 8-15 years, 34% Caucasian) were randomly assigned to receive nonmanualized usual care or manual-guided treatment to address anxiety or depressive disorders. Treatment was provided in community clinics by clinic therapists randomly assigned to treatment condition. Youth-therapist alliance was measured with the Therapy Process Observational Coding System--Alliance (TPOCS-A) scale at 4 points throughout treatment and with the youth report Therapeutic Alliance Scale for Children (TASC) at the end of treatment.
  
  
  RESULTS
  Youths who received manual-guided treatment had significantly higher observer-rated alliance than usual care youths early in treatment; the 2 groups converged over time, and mean observer-rated alliance did not differ by condition. Similarly, the manual-guided and usual care groups did not differ on youth report of alliance.
  
  
  CONCLUSIONS
  Our findings did not support the contention that using manuals to guide treatment harms the youth-therapist alliance. In fact, use of manuals was related to a stronger alliance in the early phase of treatment.
authors.affiliation: Department of Psychology, University of California, Los Angeles, USA. dlanger@jbcc.harvard.edu
authors.forename: David A
authors.initials: DA
authors.lastname: Langer
authors.forename: Bryce D
authors.initials: BD
authors.lastname: McLeod
authors.forename: John R
authors.initials: JR
authors.lastname: Weisz
mesh_terms: D000293:Adolescent; D001008:Anxiety Disorders / Q000523:psychology / Q000628:therapy*; D002648:Child; D003155:Community Mental Health Centers; D003866:Depressive Disorder / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008370:Manuals as Topic; D011369:Professional-Patient Relations; D011613:Psychotherapy / Q000379:methods*; D016896:Treatment Outcome