Psychotherapy manuals evolved from the needs of researchers and are rapidly becoming a major medium for disseminating empirically validated treatments. For manuals to provide an effective means of dissemination, specific issues must be considered, including (a) efficacy and practitioner adherence in research versus clinical practice; (b) the difference between rulegoverned adherence to a treatment manual and flexible, integrative practice; and (c) the desimd structure and content of treatment manuals. Studies should compare the process and outcome o f manual-b& treatments in experimental versus clinical settings, and the effects of alternative forms of manual-based training. Systematic description of common factom and clinical strategies can also help to disseminate the effective elements of a treatment.Psychotherapy treatment manuals are a relatively recent innovation and have met with mixed reactions fiom both researchers and practitioners. On the positive side, manuals allow us to standardlze techniques, dlscriminate between alternative approaches, and evaluate the adherence and competence with whch treatments are administered in a controlled clinical trial