Lester Lurborsky and Supportive-Expressive Psychotherapy

Lester Luborsky (1984) was Professor of Psychology in the Department of Psychiatry at the University of Pennsylvania School of Medicine. He is particularly well-known for the manualised exposition of Supportive- Expressive Psychotherapy (SE); supportive in deriving from the supportive relationship with the therapist and expressive with respect to attempting to understand what the patient is expressing. A key element in this conceptual framework is Luborsky’s identification of the Core Conflictual Relationship Theme Method (CCRT). This model has similarities to attending to the focal issue that is at the heart of all time-limited psychodynamic psychotherapy.

Luborsky attempted to identify both the timing and the process inherent in successful therapy, and how these factors are connected to the essential partnership between the therapist and patient. Luborsky posed the question that all therapists of all persuasions need to address, namely what contributes to the curative elements in psychotherapy? Luborsky’s responses to this question may be summarised with respect to the particular capacities that both the patient and the therapist bring to the therapeutic endeavour as follows:

  • • Achieving understanding; the patient’s involvement in this understanding and the therapist’s ability to help the patient become involved in this task;
  • • The patient experiencing the relationship with the therapist as helpful and the therapist continuing to promote a helpful therapeutic experience;
  • • The patient’s ability to internalise and hold on to the gains of treatment;
  • • The ability of the therapist to enable the patient to work through the ending of treatment and its meaning in a manner that enables the patient to utilise the benefits of the treatment in the longer term.

Luborsky’s analysis of the patient’s core relationship problems is helpful in the context of addressing what he calls the ‘theme’ of the patient’s core relationship problems. He recommends that the therapist review what he calls ‘relationship episodes’ in the sessions with the patient, which offer a narrative of their interactions with other people including with the therapist. These ‘narratives’ in essence represent enactments in a condensed form. The therapeutic manual based on the Core Conflictual Relationship Theme Method devised by Luborsky, includes both quantitative as well as qualitative scoring, based on the transcript or process recording of the interaction between patient and therapist. By extending his conceptual framework to include ways of evaluating and scoring responses and assessing outcomes, Luborsky’s work created a solid evidence base for his therapeutic method.

 
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