Research and Psychotherapy: The Vital Link (Book Review)
Author: Luborsky, Lester, and Ellen luborsky
Publisher: Jason Aronson
Reviewed By: William Gottdiener, Vol. XXVI, 4 (Fall 2006), pp. 37-38
Lester and Ellen Luborsky have given the field of psychoanalysis (and the larger community of psychotherapy) a gem with their book Research and Psychotherapy: The Vital Link. As a psychodynamically oriented clinical and personality researcher and as a practicing psychoanalytic clinician, I am delighted that this book has been published. Not only does it describe how clinical psychotherapy research can be done, but it also shows how practicing clinicians can apply the findings of research immediately and directly to their clinical work.
Although the book focuses on the research and practice of Supportive-Expressive (SE) Psychotherapy, which is the form of psychoanalytic psychotherapy that Lester Luborsky developed, I thought that the book applies equally well to any form of psychoanalytic treatment, and could just as easily be titled Research and Psychoanalysis: The Vital Link.
It is now more than hackneyed to write as a reviewer of a book that it will benefit both junior and senior colleagues, and most of the time when the reviewer writes such a statement, the book actually benefits only the junior colleagues, but this book is the real deal. It will benefit all colleagues. It will benefit junior colleagues who are starting out as researchers and/or clinicians and will benefit senior colleagues, because it will inform both groups about the research behind SE and how to practice it. The book also will benefit senior psychotherapists (including psychoanalysts) by providing a corrective to those psychotherapists who claim that there is no effectual way to apply psychotherapy research to clinical practice. Finally, for those who want to learn how to conduct single-case research in the context of their private practices or who want to simply publish better clinical case reports, this book will prove highly instructive.
I try to teach my students that it is possible to think of the clinical enterprise in a way that is similar to the research enterprise. When confronted with a patient, we make an intervention and look for evidence that the intervention worked. If I hypothesize that introducing the patient to himself or herself is helping the patient become consciously aware of a defensive process as well as help the patient be more clear about his or her own estranged attitudes, feelings, and behaviors, then I would expect to find evidence of that in the clinical enterprise. Thus, a patient who smiles and giggles with delight after a correct interpretation is quite possibly a patient whose defenses, momentarily, have less of a grip on the patient. Therefore, hypothesis testing is a part of regular clinical practice, albeit in a different form than occurs in formal research. But, I use this fact to show my students that clinical practice and clinical research are connected and relevant to each other.
A similar aim is evident throughout this book. The Luborskys state in the opening of the book:
“SE psychotherapy is an operational version of dynamic psychotherapy, one that is both widely practiced and well-studied, making it an ideal template to examine how clinical research and clinical practice can come together. To do that, this book will explain the principles and methods of SE psychotherapy. It will also explain research methods that lend themselves both to the study of psychotherapy and its practice” (pp. 3-4).
The authors go on to state that their book is written to provide scientific psychotherapy information for psychotherapists and to help researchers keep their work clinically experience-near.
The development of SE is grounded in psychoanalytic clinical experience. In addition, because the book provides many clinical examples that illustrate the research behind the clinical research techniques, it is relatively easy for clinicians to imagine how the research applies to their patients.
The book shows how different important psychoanalytic constructs are operationalized in SE. Transference is operationalized as the Core Conflictual Relationship Theme method (CCRT). A good therapeutic relationship is operationalized as the Helping Alliance (HA) methods, and the compromise formation that leads unconscious conflicts to become symptoms are operationalized as The Symptom-Context method (SC). The basics of conducting SE psychotherapy are the bases of all good psychoanalytically oriented psychotherapies. As quoted from the manual, SE consists of nine principles: (1) Developing a Positive Helping Alliance; (2) Evaluate the Psychological Health of the Patient [(via the Health Sickness Rating Scale, HSRS)]; (3) Establish the Structure of the Treatment; (4) Use Supportive Techniques; (5) Use Expressive Techniques; (6) Use the CCRT Method as a Guide to Understanding and Fashioning Interventions; (7) Use the Symptom-Context Method to Understand the Symptoms; (8) Encourage Self-Expression, but Avoid Giving Advice; and (9) Individualize the Treatment. In addition, the authors provide guidance on how to conduct short-term SE, although they state that short-term SE follows the same basic principles as open-ended SE, but with compressed phases that fit in the context of a 16- to 25-session time limit.
The authors go into considerable detail about their main clinical research tools, the CCRT, SCM, HSRS, and HA. They discuss the research literature and provide clinical examples to illustrate the clinical manifestation of each method. This part of the book is the most difficult due to its technical aspect. For some clinicians, especially those who are rusty when it comes to reading research reports, this section might be harder to get through. However, patience and some perseverance will pay off because this section summarizes approximately fifty years worth of clinical research and provides empirical justification for the use of psychoanalytic psychotherapy with a wide range of patients. Upon completion of this section, the reader will be up-to-date on very important contributions to psychoanalytic research (and in my opinion, very important contributions to psychological research in general).
The research section will prove especially useful for students who might have heard that no research base exists for psychoanalytic treatments or psychoanalytic constructs. All students in graduate school and in psychoanalytic training should read this section. For any student who wants to become a psychotherapy researcher, this section is as much of a must-read as is Bergen and Garfield’s Handbook of Psychotherapy and Behavior Change (Lambert, 2004). In fact, the book as a whole complements the Bergen and Garfield book (widely considered the primary research handbook for psychotherapy researchers) because the most recent edition of that book does not provide as much coverage of psychoanalytic treatment research as I think it should.
After discussing the research base for SE, the authors provide a handbook on how to actually conduct SE. Although the handbook would be an excellent primer for novice psychotherapists (I plan on using it with my students), I found that it was also a useful way to think about my own clinical work. I found myself thinking about the supportive and expressive elements in the treatments that I conduct, and how similar my own approach to psychoanalytic treatment is to what the Luborskys describe. I also realized that it would be possible to conduct single-case research on my own cases by applying their methods. Their research methods can be applied to any psychoanalytic treatment (probably to any treatment in fact), and therefore, this book should become standard reading in all psychoanalytic institute curriculums.
The authors conclude their discussion of treatment by describing how SE can be combined with psychopharmacological treatments and with other psychotherapeutic and psychosocial treatments.
Finally, the book finishes with a wealth of smart ideas for future research. Any student who is thinking of conducting a dissertation and who is psychoanalytically oriented would do well to peruse these ideas.
Reading this book gave me one of those rare opportunities in my professional life to read a book and actually agree with the authors, while at the same time learning a tremendous amount. Even though I have long been familiar with this body of research, this book tied it all together for me in a format that shows empirical sophistication of the SE research and its direct clinical applications. Furthermore, the book is well written and very accessible. Therefore, I highly recommend this book without any reservations whatsoever.
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