AMBIT and branded therapies

Our emphasis is increasingly on trying to offer AMBIT as a supportive - yet highly structured - framework for excellent local adapatation, rather than trying to force it onto the market as another "branded" therapy. Local "use-instances" of AMBIT are already directed at a range of different sub-populations, in different cultural milieux - see the signposting TiddlyManuals.com site.

In many ways AMBIT (and tiddlymanuals) is about empowering local services to clarify and build the most effective possible "Treatment as Usual", marrying evidence based practice (provided by our slowly-developing 'core' manual (here) with practice based evidence via the growing number of locally-adapted wiki treatment manuals, where teams manualize their own practice transparently, sharing and refining best practice in a collaborative network of 'open source' practitioners.

There is much emphasis on ensuring ease of implementation for AMBIT, and adaptability; this is most obviously represented in the form of tiddlywiki manuals, but is of course also one of the distinguishing features of mentalization per se; mentalization is exactly that psychological function seen as offering 'steerage' and 'navigation' through the complicated social universe which we inhabit - it is absolutely about supplying adaptability for the mentalizer!

In contrast to some other more rigidly-manualized approaches (which I could unfairly caricature as promoting a rather non-mentalizing stance that "We Know Best"), this is an alternative approach to the insistence that the rest of a service ecology should bend itself to the will of the manual-as-a-thing-in-itself. Our hypothesis is that most (if not all) well-conducted therapeutic techniques act to stimulate mentalizing, and indeed this is probably the 'curative feature' of all successful therapy; that there are many different ways to stimulate and support this most human of functions is hardly surprising!

A potential criticism of the fluid, dynamic approach to manualization that is exemplified by tiddlymanuals is that "it is impossible to perform a trial on "it" as there is no fixed or stationary "it" to test!" - Not so! It is quite possible to "freeze" a tiddlymanual by removing all the team editing capabilities for the duration of the trial. I have envisaged a sort of audit cycle that would consist of a cyclical pattern of locked-down outcomes evaluation, followed by a period of team-driven manualization, during which the lessons of the past year, and resolutions for the next, would be 'written in' to the team's manual. At present those teams just starting to try out manualizing themselves are tending to do it in "real time" - manualizing those practice issues that arise in the course of day to day work, which I am happy about. It seems to me that in this way teams develop a stronger sense of connection between "their" manual and their daily working expertise, as well as ensuring that they manualize live (rather than irrelevant) material.