Lester Bernard Luborsky (1920–2009).

The field of psychotherapy research has lost one of its founding fathers. Lester Bernard Luborsky, born in Philadelphia on May 15, 1920, to Meyer and Celia Luborsky, immigrants from Eastern Europe, died on October 22, 2009. Lester Luborsky is best known as one of the pioneers of empirical research on psychodynamic psychotherapy. Indeed, he operationalized many of its concepts. His core conflictual relationship theme (CCRT) method was a breakthrough in the formalization of clinical psychodynamic concepts (Luborsky & Crits-Christoph, 1998, Understanding Transference: The Core Conflictual Relationship Theme Method, APA Books). Until the end of his life, Lester was a strong believer that psychotherapy is effective and that different psychotherapies are equally effective (a belief known as the “dodo bird verdict”). On the basis of a qualitative review of about a hundred comparative treatment studies, Luborsky, Singer, and Luborsky (1975, Archives of General Psychiatry, 32, 995–1008) first concluded that all psychotherapies were equally effective. Lester’s early contribution to psychosomatic research attempted to delineate the onset conditions for the appearance of both psychological and somatic symptoms. Using his symptom-context method, he compared the content of clients’ narratives preceding the appearance of symptoms in psychotherapy to sections of a psychotherapy session preceding a randomly selected control event. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Active Ingredients in Individual Psychotherapy: Searching for Common Factors.

Every serious school of psychotherapy has its own theory--often only vaguely formulated--concerning the active ingredients in psychotherapy. Many of these theories are presented as mutually exclusive. The author presents an overview of some of the important, primarily psychoanalytically founded, theories of the factors in individual psychotherapy that are responsible for inducing change. It is impossible to pinpoint any single factor that is crucial in every therapy. What is needed is a nondogmatic, multiple-factor model that successfully incorporates the knowledge obtained from the many existing theories of psychotherapy-induced change. In practice, it is often difficult to maintain the traditional distinction between specific and nonspecific factors, just as it is difficult to distinguish the roles played by purely therapeutic factors--relating to the technique of the therapist--and by extratherapeutic factors. The author also addresses the epistemological status of the various claims put forward, by the many different theories of psychotherapy, concerning the active ingredients in psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Understanding transference: The CCRT method.

Reviews the book, Understanding transference: The CCRT method by Lester Luborsky and Paul Crits-Cristoph (1990). Understanding transference: The CCRT method presents a detailed overview of the research of Lester Luborsky, Paul Crits-Christoph, and their colleagues at the Penn Center for Psychotherapy Treatment and Research. Luborsky is one of the pioneers of psychoanalytic process research over the past 30 years. Since the late Seventies, he has elaborated the concept of the core conflictual relationship theme (CCRT). In this important book, the authors describe the evolution of the concept, present research in a number of areas using the CCRT, and give clinical applications of the CCRT. Reflecting the title, the authors are also interested in comparing the CCRT with Freud's writing on transference. Another aspect of the group's work is an interest in the concept of narrative, both as a unit of study and as a theoretical issue. In this review, Rosbrow tries to explain their concepts, elaborate key findings which are striking and clinically significant, and discuss theoretical issues--both those raised explicitly by the authors and also those stimulated by reading this book. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Individual psychodynamic psychotherapy of schizophrenia: Empirical evidence for the practicing clinician.

Practicing psychodynamically oriented clinicians need empirical evidence to support the use of individual psychodynamic psychotherapy for the treatment of individuals with schizophrenia. The purpose of this article is to provide psychodynamically oriented clinicians with that needed empirical evidence. A review of the meta-analytic research on the use of individual psychodynamic psychotherapy was conducted. It is concluded that strong empirical support exists for the use of individual psychodynamic psychotherapy in the treatment of schizophrenia. In addition, several suggestions are made to help clinicians apply the meta-analytic evidence to their daily clinical work. Limitations of the available evidence are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Couples psychotherapy: A psychodynamic model.

Psychoanalytic assumptions and goals need not be viewed or approached from a purely individual analytic perspective. Families and especially marriages offer a unique opportunity for systems-oriented intervention to add therapeutic depth by addressing psychodynamic interactions in vivo. Doing so requires integration in therapy, as well as in theory, of the manner in which individual psychodynamics manifest in primary interpersonal systems. A model is presented which aims at translating and instilling a useful degree of analytic insight in members of marital or family systems. Insight into transferential distortions and behavior is facilitated by introducing the metaphor of unconscious "hopes" and "expectations" in the interactive contexts of conjoint and individual sessions. It is suggested that such an expansion of systems-oriented approaches is a crucial step in adding depth and durability to change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ratings of Therapist Dynamic Activities and Alliance Early and Late in Psychotherapy.

The present study examines the concurrent and predictive relationships between therapist psychodynamic-interpersonal activity and therapist-rated alliance. Ratings from 45 patient and therapist dyads engaged in short term psychodynamic psychotherapy from a point early (3rd or 4th session) and late (the session at which 90% of the treatment was completed) in treatment were used. The results suggest that therapists who have positive views of the alliance early in treatment also have positive views of the alliance later in treatment. Therapists who used psychodynamic-interpersonal activities early in treatment also made use of psychodynamic-interpersonal activities later in treatment. Moreover, the use of psychodynamic-interpersonal activities early in treatment was positively related to both global and specific aspects of therapist-rated alliance late in treatment. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

What Is Interpersonal Behavior? A Post-Cartesian Approach to Problematic Interpersonal Patterns and Psychotherapy Process.

Most efforts to learn about interpersonal behavior reflect a shared set of key commitments. These commitments, in turn, reflect the Cartesian framework with its split between person and world. Guided by the recent work of certain developmental psychologists interested in social interaction (e.g., Fogel, 1993; Kaye, 1985) and by an alternative philosophical perspective that regards the person's involvement in practical activities as fundamental (Heidegger, 1962; Merleau-Ponty, 1962; Wittgenstein, 1958), the author maps out the participatory model of interpersonal behavior. According to this model, interpersonal behaviors are viewed as a person's contributions to doing something with other people. The author considers the model's implications for research by clinical psychologists on problematic behavior patterns in adults and psychotherapy process. The author also considers implications of rejecting the Cartesian framework for methodological concerns about the role of interpretation in research on interpersonal behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Toward a Constructivist Control Mastery Theory: An Integration With Narrative Therapy.

The integration of control mastery theory and narrative therapy provides a critical constructivist approach to a psychodynamic psychotherapy. The root metaphor of stories, even more than pathogenic beliefs, offers a fertile landscape in which clients' problems can be deconstructed along the theoretical lines formulated by control mastery. A heightened sensitivity to cultural and intergenerational contexts adds to the power of such interventions. Perhaps even more important, new "mastery stories" can be constructed through attention to language, bodily based experience, and the therapeutic relationship. The positive outcome of this integration is greater 'pro-plan' specificity, which is the capacity to more effectively infer and support the client's goals for therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Measuring the Real Relationship in Psychotherapy: Initial Validation of the Therapist Form.

The development and initial validation of a therapist-rated measure of the real relationship in psychotherapy (the Real Relationship Inventory--Therapist Form [RRI-T]) is reported. Using a sample (n=80) of practicing psychotherapists and on the basis of prior theory, the authors developed a 24-item measure consisting of 2 subscales (Realism and Genuineness) and a total score. This 24-item version and other measures used for validation were completed by 79 additional practicing therapists and 51 counseling graduate students (n=130). The RRI-T was found to have high reliability and sound initial validity. As theorized, the RRI-T correlated significantly with measures of working alliance, session outcome (depth and smoothness), client intellectual and emotional insight, and client negative transference. Discriminant validity was supported by a nonsignificant relation to social desirability. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychologists' Use of Touch in Individual Psychotherapy.

A national sample of 470 practicing psychologists responded to a survey regarding touch in adult individual psychotherapy. Results reflected a high degree of caution regarding physical contact with clients. Close to 90% of respondents never or rarely offered touch to clients during a session. The handshake, a socially stereotyped form of touch most likely to occur during greeting or parting, was the only form of touch that occurred with some frequency. Therapist and client gender, theoretical orientation, and touch experience of the therapist were related to the use of touch. Contrary to guidelines, touch was typically not discussed with clients when it occurred. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Classic in Psychotherapy Integration Revisited: The Dynamics of Psychotherapy in the Light of Learning Theory.

Discusses the history of psychoanalytic treatment and the dynamics of psychotherapy. The essential psychodynamic principles on which psychoanalytic treatments rest have solid observational foundations: 1) during treatment unconscious (repressed) material becomes conscious; 2) the mobilization of unconscious material is achieved mainly by interpretation of material emerging during free association and by the patient's emotional interpersonal experiences in the therapeutic situation (transference); 3) the patient shows resistance against recognizing unconscious content; and 4) it is only natural that the neurotic patient will sooner or later direct his typical neurotic attitude toward his therapist. Current studies give encouragement and hope that we shall eventually be able to understand more adequately this intricate interpersonal process and to account for therapeutic successes and failures. In the field of psychotherapy the long overdue observation of the therapeutic process by nonparticipant observers is turning out to be the required methodological tool. At present, we are witnessing the beginnings of a most promising integration of psychoanalytic theory and practice of the psychotherapies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapy, professional relationships, and ethical considerations in the myspace generation.

The pervasive use of Internet technologies has created new ethical dilemmas for psychology trainees and professionals. In particular, Web sites that allow users to post personal information have sparked controversy regarding the amount of freedom psychologists should have in placing personal information online and how discovering such information may impact professional relationships, including the therapeutic relationship. Results from a graduate student survey (N = 302) address the prevalence of the use of online social networking sites, security measure efforts that limit public access, incidents of client access to psychotherapists’ personal Web sites and Internet use by psychotherapists to obtain client information, and their subsequent effect on the therapeutic relationship. Using applicable ethical principles and standards, we provide recommendations for the field in an effort to decrease potential harm and maximize areas of opportunity for psychologists and constructive professional relationships. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist Variables That Predict Symptom Change in Psychotherapy With Chronically Depressed Outpatients.

The present study examines the contribution of psychotherapist variables to change in depressive symptoms in a large clinical trial comparing the efficacy of the cognitive-behavioral analysis system of psychotherapy, the antidepressant nefazodone, and the combination of both in the treatment of chronic depression. Greater change on the Hamilton Rating Scale for Depression (HRSD) was associated with greater emphasis on the therapeutic relationship, lower overall psychotherapy caseload, therapist psychodynamic orientation, and supervisory status. There was no relationship between HRSD change and therapist sex, age, or years of experience. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapy as a problem in learning theory.

This reprinted article originally appeared in Psychological Bulletin, 46, 366–302. (The following abstract of the original article appeared in record 1950-01904-001.) A learning theory interpretation of psychotherapy is offered to effect a rapprochement between psychotherapy and general psychology, and to organize some of the phenomena of clinical practice within the framework of systematic behavior theory. 66-item bibliography. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Conflict and counterproductivity in supervision—when relationships are less than ideal: Comment on Nelson and Friedlander (2001) and Gray et al. (2001).

In this comment, suggestions for research and practice pertaining to conflictual supervision relationships (M. L. Nelson & M. L. Friedlander, 2001) and counterproductive events in supervision (L. A. Gray, N. Ladany, J. A. Walker, & J. R. Ancis, 2001) are given. Studies that attempt to identify the "good enough" supervisor are also recommended. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship between adult attachment style and therapeutic alliance in individual psychotherapy: A meta-analytic review.

The present study examined the relationship between adult attachment style and therapeutic alliance in individual psychotherapy. Search procedures yielded 17 independent samples (total N = 886, average n = 52, standard deviation = 24) for inclusion in the meta-analysis. Results indicated that greater attachment security was associated with stronger therapeutic alliances, whereas greater attachment insecurity was associated with weaker therapeutic alliances, with an overall weighted effect size of r = .17, p .10) with the exception of the source of alliance ratings; results indicated that patient-rated alliance demonstrated a significantly larger relationship with attachment compared with therapist-rated alliance (Qbetween = 3.95, df = 1, p = .047). Implications for clinical practice and future research are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Alliance in individual psychotherapy.

This article reports on a research synthesis of the relation between alliance and the outcomes of individual psychotherapy. Included were over 200 research reports based on 190 independent data sources, covering more than 14,000 treatments. Research involving 5 or more adult participants receiving genuine (as opposed to analogue) treatments, where the author(s) referred to one of the independent variables as “alliance,” “therapeutic alliance,” “helping alliance,” or “working alliance” were the inclusion criteria. All analyses were done using the assumptions of a random model. The overall aggregate relation between the alliance and treatment outcome (adjusted for sample size and non independence of outcome measures) was r = .275 (k = 190); the 95% confidence interval for this value was .25–.30. The statistical probability associated with the aggregated relation between alliance and outcome is p     

Therapist immediacy in brief psychotherapy: Case study I.

The authors examined immediacy (i.e., discussions about the here-and-now therapeutic relationship) in a 12-session case of individual interpersonal psychotherapy. Therapist immediacy during immediacy events most often focused on parallels between external relationships and the therapy relationship, encouraging expression of immediate feelings, processing termination, therapist expressing disappointment/sadness/hurt and inquiring about the client's reactions. Client involvement was slightly higher before and after than during immediacy events. On the positive side, therapist immediacy seemed to help the client express her immediate feelings about the therapist more openly, feel closer to the therapist, and become less defended. On the negative side, the client felt somewhat awkward and pressured when the therapist used immediacy. Limitations and implications for practice and research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)