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


  • Jeremy D. Lichtman



Tourette Syndrome, Tics Disorders, Comprehensive Behavioral Intervention for Tics (CBIT), Habit Reversal Training (HRT), cognitive-behavioral training (CBT), Attention Deficit Hyperactivity Disorder (ADHD), manualized therapy, individualized case formulat


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.

Author Biography

Jeremy D. Lichtman

Jeremy D. Lichtman






Case Study