This article describes successes and failures in the implementation of a manualized treatment for childhood depression. The use of treatment manuals is controversial because most have been derived from lab-based treatments and may not be transportable into real-world settings. A manualized cognitive-behavioral treatment was utilized to treat a 9-year-old boy who presented with multifaceted problems (e.g., depressed mood, eating and sleeping difficulties, crying, bedwetting). The outcome was favorable yet underscored the importance of being flexible and using functional analysis. Numerous challenges were encountered, including the lack of a clear-cut diagnosis, difficulties sustaining the pace of treatment, assessing client progress, and motivating both the child and parents. Challenges are discussed with respect to implications for managed care, debates surrounding manualized treatment, and suggestions for utilizing treatment manuals.
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