One consequence of the evidence-based practice movement is the proliferation of manualized interventions. Clinicians voice a number of concerns about the use of treatment manuals. These include concerns that manuals impede the therapeutic relationship and discourage flexibility in addressing the individual needs of clients. One manualized intervention called parent—child interaction therapy (PCIT) has shown exceptional promise in the treatment of child behavioral problems. PCIT is a parent-mediated behavioral intervention aimed at reducing externalizing behaviors in children by changing parenting practices. The manual includes session scripts for clinicians, a proscribed sequence of intervention activities, and checklists for clinicians and parents to document that intervention is completed in the prescribed manner. Three cases are presented in which clients vary by personal characteristics and individual needs. Case descriptions reveal how this manualized intervention was adapted successfully to address the needs of a variety of families. Implications for therapeutic relationship are also discussed.
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