This article reports a systematic review of the literature examining therapists' views and experiences of utilizing treatment manuals. Key databases were searched and a thematic narrative analysis was conducted. Twelve articles were identified. The literature contains four distinct subthemes: (i) exposure to and use of manuals; (ii) therapists' beliefs about manuals; (iii) therapist characteristics, such as age/gender/training and (iv) characteristics of the work, such as client group. The analysis finds that clinicians who have used manuals appraise them positively, and view them as facilitating flexibility, allowing for therapeutic relationship and keeping therapy on track. The review is a helpful contribution to the literature and is a prompt to practitioners to consider their own views and exposure to manualized treatments and how this relates to generating the ‘hard’ outcome data that governments and service commissioners internationally find credible and persuasive. Practitioner points The positive appraisal of manuals is increased through exposure to them in clinical practice or research settings. Clinicians may wish, therefore, to seek out opportunities to use manuals. Clinicians are rarely exposed to manuals, which presents a potential topic for training courses to address.