Integrating Empirically-Supported Treatments into Clinical Practice


The recent movement in psychology toward utilizing empirically supported treatments (EST) has created personal and professional challenges for many clinicians.


As insurance companies and other outside forces push for treatment standardization and accountability, some therapists are caught in the middle, fearing that EST constrain clinical judgment or disregard it altogether. For such therapists, the question is: how can we make these treatment programs work for us as clinicians, rather than the other way around? Several steps may help us find the most effective solution.


  1. Do a careful diagnostic assessment. This step helps determine if an EST is an appropriate treatment choice. It includes diagnosing the presenting complaint, but also careful assessment for comorbid conditions potentially impacting treatment. This is important even when working in specialty clinics or with particular patient populations treating an adolescent with anxiety disorder becomes a completely different endeavor when there is a comorbid substance abuse condition. Using a structured interview or your own clinical interview format, be sure you are covering the full range of possibly psychopathology, as this will aid in selection of the best possible treatment fit for your patient.


  1. Know the manual you are using well. If we do choose an EST treatment approach for patients, it is helpful to review the manuals as well as the recent research on the particular EST. Even the most popular manualized treatments are under constant revision and testing from their developers. By being thoroughly familiar with a treatment manual as well as up-to-date on the research, we enhance our ability to use the EST interventions effectively and flexibly.


  1. Make the treatment your own. After patient factors such motivation for therapy, therapist factors and patient-therapist relationship are the most important predictors of treatment outcome. Consulting a manual to help select intervention strategies does not mean that what we bring into session sense of humor, warmth and empathy, ongoing evaluation of patient needs is less valuable. How we deliver the interventions suggested in the manuals is potentially as important as whether we deliver them. We need to use clinical judgment to best deliver a message or strategy so that the patient can hear and integrate it.


Having a good formulation of patient diagnosis and dynamics, understanding the EST we select well, and implementing it in a manner consistent with therapist style and personality, will all aid in appropriately integrating manuals into clinical practice. It optimizes effective care to patients, who benefit from the tailoring of generic interventions to their specific needs. Further, it still allows clinicians to respect and utilize the training and experience they bring into treatment.



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Phoebe Moore, PhD, is a post-doctoral research fellow with the Stanford University School of Medicine. She can be reached by email at The column editor, Kasey Saltzman, can be reached at 401 Quarry Road, MC 5719, Stanford, CA, 94305 or by email at



California Psychologist * November/December 2002