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L Luborsky

Publications and source records attributed to L Luborsky.

14 recordsLinked to original sources
PubMed1979

Preconditions and consequences of transference interpretations. A clinical-quantitative investigation.

Our aim was to study the preconditions and consequences of transference interpretations by both quantitative and clinical methods. We selected the three specimen psychoanalytic treatments which had been studied most by clinical-quantitative research. For each patient the main data consisted of 16 interpretation contexts. The context of each interpretation included 250 patient words before and 250 patient words after the interpretation. Three judges independently rated these before and after segments for each of the 16 samples from each of the three patients. Judges tended to agree highly in rating these segments on nine variables. The before vs. after ratings showed that each patient had a different but individually typical response to the 16 interpretations, ranging from patient A who usually showed a negative response, to patient B who showed some positive response, to patient C who showed a very positive response. For each of these three patients there was a clear parallel between the positivity of the immediate response to interpretations and the outcome of treatment. Even though we have so far studied only three patients, the consistency of the results suggests that it would be worth testing in a larger group whether a sample of immediate responses to interpretations might predict the eventual outcome of the treatment. Patient factors seem central in explaining the bases for the different response of each of the three patients to transference interpretations. The Health-Sickness Rating Scale ratings showed that patient A and patient B were less healthy initially than patient C--healthier patients may be able to respond better to transference interpretations. Also, the analyses of the segments before the interpretation revealed that even before the interpretation there were differences in the three patients. These were consistent with their differing responses to interpretation; for example, patient A was rated as having less understanding than the other patients even before the interpretations. Another patient factor, the patient's readiness to experience a helping relationship, probably was significant also in explaining the differing response of the three patients to interpretations; they already differed in this experience by the third to fifth sessions, and these differences paralleled their response to interpretation.

Adult↗
PubMed1978

Our surprising inability to predict the outcomes of psychological treatments--with special reference to treatments for drug abuse.

Our ability to predict the outcome of psychological treatments, particularly for drug dependence, is examined by (1) new data on a VA sample, (2) a review of studies predicting the outcome of drug abuse treatment, and (3) a review of predicting the outcome of psychotherapy for other types of patients. For (1), the direct predictions of 13 staff members' ratings of the outcome of treatment correlated .27 with the outcome. Although staff predictions improved when grosser predictions were examined, the results are disappointing given the level of discrimination required and the modest levels of prediction attained. For (2), prediction success with drug abuse patients in other studies were also disappointing and the bases for predictions often did not hold up on crossvalidation. For (3), direct predictions in the Penn Psychotherapy Study were similar to the VA sample in level of success. Other studies produced insignificant or similarly low levels of prediction success. In our discussion we suggest that rather than relying mainly upon pretreatment status for prediction, two promising areas should be examined in future studies: (1) the patient's early response to the treatment and to the therapist, (2) the patient's environment posttreatment that should be altered to consolidate and perpetuate the gains made during treatment. In conclusion, it is true that we are surprisingly unable to predict the outcomes of psychological treatments beyond a very modest level.

Adult↗
PubMed1977

Long-term trends in transference and resistance: a report on a quantitative-analytic method applied to four psychoanalyses.

Quantitative ratings of transference and resistance were made at each session during four psychoanalyses. Ratings were then compared with the treating psychoanalysts' clinical impressions. The two relatively successful analyses showed rising transference and diminishing resistance. The two relatively less successful analyses showed more parallel curves: the long, difficult analysis showed closely associated transference and resistance curves; the failure in analysis revealed a high resistance curve, even while transference increased.

Adult↗
PubMed1976

Predicting the outcome of psychotherapy for schizophrenics. Relative contributions of patient, therapist, and treatment characteristics.

This study was designed to assess the relative prognostic importance of patient factors, therapist characterists, and treatment mode. The sample was 100 schizophrenic outpatients referred to a community mental health center following psychiatric hospitalization. Patients were randomly assigned to either group (N=50) or individual (N=50) psychotherapy. Criteria were rehospitalization and two clinician ratings--adjustment and social effectiveness--at a two-year follow-up. The best predictor of rehospitalization was the number of previous hospitalizations. The best predictor of adjustment status at two years was pretreatment adjustment level. Also, patients with good prognostic indices made relatively large gains. Predictors of outcome for group-treated patients did not differ from those for individually treated patients. Controlling for initial status, treatment mode was almost as good as predictor of adjustment gains as were other patient factors.

Antipsychotic Agents↗
PubMed1975

Comparative studies of psychotherapies. Is it true that "everywon has one and all must have prizes"?

Tallies were made of outcomes of all resonably controlled comparisons of psychotherapies with each other and with other treatments. For comparisons of psychotherapy with each other, most studies found insignificant differences in proportions of patients who improved (though most patients benefited). This "tie score effect" did not apply to psychotherapies vs psychopharmacotherapies compared singly-psychotherapies did better. Combined treatments often did better than single treatments. Among the comparisons, only two specially beneficial matches between type of patient and type of treatment were found. Our explanations for the usual tie score effect emphasize the common components among psychotherapies, especially the helping relationship with a therapist. However, we believe the research does not justify the conclusion that we should randomly assign patients to treatments-research results are usually based on amount of improvement; "amount" may not disclose differences in quality of improvement from each treatment.

Behavior Therapy↗
PubMed1975

A context analysis of psychological states prior to petit mal EEF paroxysms.

This is the first report in the literature of an application of the rigorous symptom-context method for determining the nature of the psychological antecedents of petit mal EEG paroxysmal activity. The activity is defined by the presence of a 3 cycle/second spike and wave on the EEG which is recorded concurrently while the patient is speaking his thoughts freely during interviews. The content of the patient's speech before each petit mal episode is compared with the content of speech during nonparoxysmal periods. Three petit mal patients were examined in this way for four sessions each. (Total petit mal EEG paroxysms for patient no. 1 were 19, patient no. 2 were 25, and patient no. 3 were 55.) For the first patient, strong psychological antecedents were found before petit mal EEG paroxysms as compared with comparison periods from the same patient. These consisted of such usual negative affects as feeling depressed and blocked. For the two other patients, only a few psychological antecedents discriminated significantly and these were not of the same type across the three patients. We conclude that the patients differ in amount and type of psychological antecedents. The differences may be attributed to differences in the type of petit mal and/or differences in the psychological component to the petit mal. The differences among the patients are probably not related to the average length of the paroxysms since we have shown that the relationships with the duration were generally silences than during the patient's speech (for two of the three patients)--talking probably requires more focused attention than silence; more focused attention or activity tends to reduce these episodes.

Adolescent↗
PubMedDate not supplied

Estimating one's own systolic blood pressure: effects of feedback training.

This study was aimed at discovering the ability of subjects to estimate absolute levels of systolic blood pressure after feedback of daily blood pressure information. Twenty-one subjects were studied who had shown a variation of at least +/- 20 mm Hg in systolic pressure during 8 days of base-line measurements. Subjects' estimates were found to be moderately accurate even before any specific blood pressure information feedback was given (mean error was +/- 12.4 mm Hg). Then during 15 days of information feedback, subjects' accuracy improved, e.g., for 10 subjects who were given correct information feedback the mean error was +/- 7.4 mm Hg, a highly significant improvement. This is a high degree of accuracy-especially in comparison with the mean variation of +/- 5.8 mm Hg from 1 min to the next in their systolic blood pressure. The learning of one's range of blood pressures appeared to be the principal component of the improvement. Range information had been provided by giving the subject his range of fluctuation for the 8-day base-line period, and by daily blood pressure information feedback immediately after each estimate. Two types of estimators were distinguished: Those who were relatively accurate versus those who were inaccurate in estimating at their own extremes of blood pressure. Those who were inaccurate at their own extremes (1) paid less attention to the feedback of information they were provided with as well as to the internal cues from their own blood pressure and (2) were more field independent.

Attention↗