As global climate becomes warmer, the maintenance of the structure and function of Mediterranean forests constitutes a key challenge to forest managers. Despite the need for forest adaptation, an overall evaluation of the efficacy of current management strategies is lacking. Here we describe a theoretical framework for classifying management strategies, explicitly recognizing trade-offs with other, untargeted ecosystem components. We then use this framework to provide a quantitative synthesis of the efficacy of management strategies in the Mediterranean basin. Our review shows that research has focused on strategies aimed at decreasing risk and promoting resistance in the short-term, rather than enhancing long-term resilience. In addition, management strategies aiming at short-term benefits frequently have unintended consequences on other adaptation objectives and untargeted ecosystem components. Novel empirical studies and experiments focusing both on adaptation objectives and multiple responses and processes at the ecosystem level are needed. Such progress is essential to improve the scientific basis of forest management strategies and support forest adaptation in the Mediterranean basin.