Mechanical/Algorithmic Versus Flexible/Creative Clinical Practice: How Underlying Principles Bridge the Gap

In the case of "Hiro" (Lichtman, 2017) I described the successful use of Comprehensive Behavioral Intervention for Tics (CBIT) in a young boy with Tourette Syndrome (TS). In three different commentaries on this case, authors noted important concepts regarding the use of manuals in treating TS; how an understanding of underlying principles is important in flexible use of manuals; and how training impacts the treatment of TS. In my response to these commentaries, I hope to continue the conversation of how to use manuals in psychotherapy in general as well as in the treatment of TS in particular. Specifically, I hope to address the seeming dichotomy between a mechanical, algorithmic approach to treatment versus a flexible, creative approach, and to ultimately show that an understanding of the underlying principles guiding manualized treatment provides room for ingenuity that proves this dichotomy false.