Modular vs. Manualized Therapy

Today, my friends, we get into the weeds of mental health treatment. This is like the advanced course after you’ve completed 101 and maybe 102 of understanding therapy. It may not seem super relevant, but knowing these distinctions as a consumer of therapy helps you to advocate for yourself to have the best treatment possible. It also allows you to seek out your own resources in a way that’s more likely to lead you to achieving optimal mental health.

You already know about psychotherapy (versus supportive counseling) and evidence-based treatment (versus empirically supported therapies). Everything we’ll discuss today falls under the umbrella of evidence-supported therapy.

Researchers want to make sure that all therapists are doing the same thing in treatment so that the therapy itself can be a constant variable. If Dr. Smith and Dr. Williams are both supposed to be doing a certain treatment for PTSD but they are saying and doing completely different things each session, that doesn’t help us learn much about whether this therapy works for PTSD. The best approach in research is to use a manualized therapy.

A manualized treatment follows a certain structure. Everyone in treatment will receive the same therapy components in a particular order. Sometimes there are even scripts to be followed by the therapist. This ensures that the patient receives “the good stuff” (AKA the quality components of treatment) rather than just whatever Dr. Carter feels like talking about today.

Now, this is a good thing, but obviously manualized therapy could run into some issues like the clinician talking like a robot, keeping the therapist from having a personality or bringing in relevant examples, or giving everyone the same thing no matter how they might differ.

There are some therapies that just inherently are manualized treatment. Some well-known manualized therapies include: Parent-Child Interaction Therapy (PCIT), Dialectical Behavior Therapy (DBT) and Radically Open DBT, Coping Cat, Cognitive-Behavioral Therapy (CBT) for Insomnia, and Prolonged Exposure (PE) for PTSD.

Because of the way these work, the therapist might have to read a script at times, but that does not mean this is their first time ever doing therapy or they have no idea what to say. Someone more experienced will be able to jump off the page a bit and it will not seem like they are reading these words for the very first time. A good therapist will add a little razzle dazzle while staying true to the manual.

Modular therapy, on the other hand, involves taking the evidence-based “modules” of therapy and then putting them together in a cohesive way for the individual patient/family.

Modules might include: psychoeducation (learning about a disorder or treatment), relaxation training, thought restructuring, mindfulness, exposure therapy, social skills training, or parent management training.

The therapist will be using components of therapy that would be found in a manualized treatment but they may go in a different order or pull in components from 2-3 different interventions. This takes some real skill and so this is not what you would expect of a therapist-in-training. This allows the therapist to treat the typical person we see: someone who may be experiencing at least two different mental health conditions and needs support for multiple problems.

My treatment involves both manualized and modular therapies. For example, if I am doing PCIT with a family, there are just certain components that must be completed in order to graduate from therapy. We can’t skip around willy nilly in the manual. If I am doing Exposure and Response Prevention (ERP) for Obsessive-Compulsive Disorder (OCD), I am more likely to use a modular approach. I will be doing the components that you would find in a therapy manual, but I am not reading off a script and there is not a particular order in which to do exposures.

Both manualized and modular therapies have their advantages and disadvantages. Manualized therapy can get a bad rap for being too formulaic. Unless it’s just being done incredibly poorly, that’s actually a good thing for your therapist to be following a procedure rather than just free associating. Would you want your surgeon to walk in and decide they’d prefer all the handwashing to occur after the surgery today instead of before? Modular therapy requires strong assessment and conceptualization of the case before beginning treatment, which can take some time when you’re in a hurry to begin feeling better.

In addition to having a sense of what’s going on in the therapy space, understanding this idea of therapy “modules” would allow you to develop your own mental health treatment plan if you were not able to access therapy for whatever reason. You could pull together quality resources to learn more about your condition or problem to solve and understand which components will be part of what you will need to do to tackle your challenges on your own.

Stay tuned because there is a larger reason I am explaining this. I have something in the works to help bridge the gap for people who can’t currently afford or commit the time to therapy... ;)