Good Night, Uncle Lester

Entry for 24 October 2009:

Lester Luborsky died this week. He was one of the great psychotherapy researchers, and one of my personal psychotherapy research heroes. For me, his passing leaves a world that feels smaller.

At the moment, I can’t remember exactly when I first met Lester. Probably at my first SPR meeting in San Diego in 1976. Of course, I would have been too shy to introduce myself to him then. Later, I came to know him, not as well as I eventually knew Han Strupp, the other comparable titan of psychotherapy research, but nevertheless with a great deal of fondness and as an essential fixture in that world.

Lester made a great many contributions to psychotherapy research, and had a big impact on my development as a psychotherapy researcher. Here are a few of these:

1. Along with Ed Bordin, he pioneered the modern concept of the therapeutic alliance (which he called the “helping alliance`”). Unlike others who began working on this topic in the 1970’s, he was careful to credit the influence and seminal work of Carl Rogers, even though his theoretical orientation was psychodynamic. I loved his “counting signs” approach to looking for spontaneous client alliance markers at the beginnings and endings of sessions. (A personal favorite, which I quoted to my students again recently: Client [weeping]: “I’m not getting better… and you’re getting worse.”)

2. His development of the Core Conflictual Relationship Method (CCRT) made the Freudian concept of transference available to all of us in a theory-neutral, user-friendly form. I found CCRTs essential for understanding significant change events, and incorporated the method into my Comprehensive Process Analysis method.

3. Lester’s development of the Symptom Context Method might have been one of his more obscure contributions, but for me it was a key inspiration for the development of the Significant Events genre of therapy research. Although he focused on client in-session manifestations of psychodynamic or clinical symptoms (e.g., momentary forgetting), it was easy to apply to his approach of comparing session transcripts immediately before and after targeted therapy events to moments of therapeutic change.

4. When it came to understanding the broad sweep of comparative therapy outcome research, Bill Stiles, David Shapiro, and I, along with others, followed in Lester’s footsteps: He picked up the analogy between the Dodo Bird’s verdict in Lewis Carol’s Alice in Wonderland and the state of comparative outcome research (“Everybody has won and all must have prizes”) from Saul Rosenzweig, and we picked it up from Lester. Later, he took Jeff Berman’s work on researcher allegiance and in 1999 did the definitive meta-analytic study showing that virtually all the available variance in comparative outcome studies can be attributed to researcher allegiance effects (that is, when comparing active therapies, researchers tend to find results favoring their approach to therapy).

5. He also wrote one of the first therapy manuals, in the early 1980’s, describing a simplified psychodynamic approach he called supportive-expressive therapy. “Oh!”, some of us said, “You mean it’s possible to write a manual for a nonCBT therapy?” And so we did…

6. Most important for me, however, was Lester’s creative, can-do genius for inventing methods for particular purposes, jury-rigging if necessary, but basically saying, "What can I do with the data I have to answer that question, or to address that doubt about what’s going on here?" His example has inspired me throughout my career to think creatively about method.

Others will undoubtedly have their own lists of favorite Lester contributions to add to these, for he did many other things than I can even remember at this point. For example, not many people know that he originated Axis 5 of the DSM-IV, now known as the Global Assessment of Functioning (only his original version was better than what eventually got into the book).

In the end, though, what I remember Lester most and best for is simply his presence: The tall, thin, slightly eccentric figure he presented (often carrying a special pillow for his back); his elfin smile as he presented some clever way of showing something. Generally, he was usually there, a presence slightly in the background, not in the front but back a bit, and always ready to point something out if he felt it needed to be.

I always found his to be a kind presence, friendly and supportive. He followed my work, wrote letters supporting my tenure and promotion. In 1993, at the first North American SPR meeting, I had to say something official, and found myself comparing SPR to a family, complete with brothers, sisters, cousins, parents, grandparents, aunts and uncles. Afterwards, I sat up late talking in one of the lounge areas, as one does at conferences. Lester wandered by, and I felt what could only be described as a wave of love washing over me; I found myself saying, “Goodnight, Uncle Lester.” For that is exactly what Lester Luborsky felt like to me: a slightly eccentric but totally inspiring uncle (probably on my mother’s side), the kind who is always having adventures and inventing things. He was my hero.