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The contributions of Luborsky and his associates in this book constitute a significant advance in systematic empirical research. The authors describe the development of their research methodology for the study of the therapeutic process and the achievements resulting from its utilization in the Penn Psychotherapy Project.
The Penn Project addressed the question of the predictability of therapeutic outcome through studies of pretreatment qualities of therapist and patient and the interaction of the participants in the therapeutic process. The 73 subjects were a varied group of nonpsychotic patients, chiefly outpatients in a clinic setting. The therapists differed widely in experience but shared a psychodynamic orientation. Of the 42 therapists, 12 were characterized as Freudian and 32 as eclectic. The treatment was generally described as of medium length, with 8 sessions a minimum for inclusion in the study and 32 sessions the median. Two-thirds of the patients were moderately to much improved by the measures of outcome. None of the patients were seriously worse after treatment.
With regard to methodology, three approaches among a wide array proved most useful. The health-sickness rating scale served as a measure of outcome. Helping alliance scales were used to determine and follow the nature of the therapeutic alliance. Luborsky introduced his most creative measure, the examination of the Core Conflictual Relationship Theme, to study the process itself. The CCRT method identifies recurring patterns in the patient's narrative as the unit of study. Each unit consists of an expression of the patient's wishes, the response of the other person, and the patient's response in turn. The method thereby explores relationships and conflict in the same narrative segments. Transference and countertransference phenomena are obviously included in the data but are not specified as such. The CCRT patterns are found to be consistently present throughout the process of tr