There has been an exponential increase in the number of treatment manuals since the 1970’s. But only 13% are cited in treatment guidelines such as NICE. Further there is no evidence that these tomes have made a difference to routine practice.
NHS Talking Therapies swears allegiance to NICE Guidelines, but documentary evidence of compliance with the Guidelines has been conspicuously, totally absent in the 200+ cases I have reviewed. This is the subject matter of my Keynote address to the Spanish Society of Clinical Psychology on May 30th 2026, ‘All Talk and No Action’.
Initially the treatment manuals were all diagnosis specific. But in recent decades they have been increasingly transdiagnostic. The new conventional wisdom has been that manuals are the ‘problem’, perpetuating the idea of diagnosis. But this position is no longer tenable. Flexibility without fidelity has become the new norm, with idiosyncratic formulation ruling. Making a formulation ‘stick’ depends on a person’s position in the hierarchy, with academic clinicians running CBT courses at the top, marketing themselves with ever more manuals.There has been no independent audit of the legacy of these manuals at the coal-face.
Dr Mike Scott