ABSTRACT
Manualised treatments promote adherence by therapists and clients to effective interventions and are under-utilised (Wilson 1997). However, highly structured treatments can feel impersonal and need to take some account of each individual's unique circumstances. This requires skill on behalf of the therapist (Padesky and Greenberger 1995). Each session needs to review homework and then cover the next topic to be addressed, but also take account of the client's response to therapy, and (to a limited extent) process issues and current events in the client's life which may interfere with their ability to make the best use of the programme. The therapist needs to be aware of these issues, discuss them in brief where necessary but not to allow them to prevent `sticking to business'. Exceptions to this would be where you might suspend the programme because a client was losing weight towards or within the anorectic range or had a signi®cant personal crisis.
