Barriers to dissemination of evidence-based practices: Addressing practitioners' concerns about manual-based psychotherapies.

The last several years have seen much debate over the appropriateness and viability of empirically supported manual-based psychotherapies for clinical practice. While the majority of discussions have focused on the strengths or weaknesses of evidence-based treatments, and the differences between research and clinical practice, scant attention has been paid to addressing the actual concerns of practitioners in clinical settings. Based on the available research, and our experiences with training and supervision in manual-based treatments, we discuss practitioners' most common concerns, including (a) effects on the therapeutic relationship, (b) unmet client needs, (c) competence and job satisfaction, (d) treatment credibility, (e) restriction of clinical innovation, and (f) feasibility of manual-based treatments. Rather than arguing that these concerns are unwarranted, we suggest future directions the field must take if evidence-based treatments are to be viable and effective in clinical practice. Starting with the assumption that these treatments have much (but not everything) to offer practitioners in clinical settings leads to qualitative and quantitative research questions involving all parties with an interest in evidence-based practice.