Let's imagine a psychologist has already been trained in how to use, say, cognitive therapy to treat depression. If that psychologist wanted to begin administering manualized CT for depression, is it typical that he or she would obtain extra training to be able to utilize the manual correctly, or is the use of the manual something that psychologists usually figure out for themselves? Thanks!
Using Treatment Manuals=Extra Training?
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I think any psychologist can probably figure out how to apply a decently-written manual without training (I have). Probably any student can - manuals are like that, they're designed to minimize use of practitioner indepedent judgement and minimize variability between treaters (which, they actually don't do that well, IMHO), and offer you a cookbook.
I was trained to apply a manualized treatment as my fourth-year practicum experience. It was a great experience, and I learned a lot of things about research and practice I still use today, but as a general rule I don't find most treatment manuals offer the kind of flexibility needed to meet the needs of patients in the real (non clinical research) world.
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I've completed multiple formal trainings for manualized treatment protocols, and while I think someone can get by with just the manual, it is best to get formal training and mentorship. There was much more depth in the session reviews (listening to tapes/recordings), more exploration of the supportive research, and lastly more discussion about case selection/exclusion. Manualized treatments aren't without their faults, and I think the variability of the treatment increases if someone goes at it without formal training and mentorship.
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I agree with T4C, as I have been trained in a manual based treatment. Formal training really helps give you a more complete understanding of the interventions being used and how to deliver them in session. This is especially true when that training is combined with audiotape review from an expert in the treatment. To be honest, I am not a huge fan of the notion that "I went to a workshop" ergo "I can competently deliver the treatment." As food for thought, think of how many years it takes to develop a treatment manual. To say that you can deliver it well, after a few hours of training and/or just a quick read, seems somewhat unrealistic. That is my opinion on the matter and is definitely up for debate.
In contrast, however, I would agree that some manuals are easier to use than others. This is especially true if the individual learning the manual has advanced experience working with the population being treated and/or has expertise in the theoretical orientation informing the manual. In such cases, I think successful delivery of the manual can occur with less formalized training. Having said that, though, I think it is hard to argue that formalized training would not significantly improve treatment delivery for even this subset of providers. Expertise in anything one does probably wont hurt matters. While this also my opinion, I think it is less up for debate.
Moving back to the OPs original example, I do not believe that cognitive therapy is a treatment that can be done well with little formalized training. Socratic questioning is a difficult skill, as is setting up successful behavioral experiments that address core beliefs. While training in a manual might not be ideal for this treatment, I believe that supervision by a therapist with advanced knowledge and experience in the treatment is necessary for training. Again, that is only my opinion. I am sure that others will disagree on that point.
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Rather than taking graduate courses, I think the norm is to be trained on manualized treatments during your practicum experiences. Take a look at your prospective school's training sites. Maybe you can get a good idea of the orientation of the supervisors there. You can also ask other students what they have used during their prac experiences to get a better idea of what to expect.
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While manualized treatment looks like a natural fit for the classroom, I think it is best experienced in the practica setting because there are many things that will not be in context if someone does not have some experience under their belt with basic frameworks. I found manualized treatment to be easier after some experience because you can differentiate some of the nuances between the manualized treatment's adapting core principles of a framework, compared to actually just implementing the framework.
