Prevention & Treatment, Volume 3, Article 16, posted June 2, 2000
Copyright 2000 by the American Psychological Association

IN MEMORY OF NEIL S. JACOBSON

Neil, You're Clinically Significant:
You Did Make a Meaningful Difference

Donald H. Baucom
University of North Carolina

Correspondence concerning this article should be addressed to Donald H. Baucom, Davie Hall, CB #3270, Psychology Department, University of North Carolina Chapel Hill, Chapel Hill, North Carolina 27599-3270.
E-mail: don_baucom@unc.edu

This 1984 article that Neil Jacobson senior authored is now 15 years old. However, it continues to be cited widely in the literature, and it has scientific importance for both methodological and substantive reasons. In addition, embedded in this article are factors that tell us about the attitudes, life, and work style of Neil Jacobson. From a scientific perspective, this is one of the first investigations to apply the statistical techniques for assessing clinical significance published by Jacobson and his colleagues. As Steve Hollon acknowledged in a recent obituary of Jacobson, Neil did more than anyone else in the field of clinical psychology to emphasize the importance of clinical significance. I had the pleasure of serving, along with Neil, as one of the therapists on Neil's doctoral dissertation, which was one of the first well-controlled treatment studies of behavioral couple therapy. As we progressed through that investigation, provided treatment to the couples, and saw the findings, Neil and I had many thoughtful discussions about the results. The data clearly indicated that the couples had improved statistically, but as the therapists, we had an internal sense of whether these changes were meaningful for some couples or whether we were relying on p values. Neil took such issues seriously and committed himself to investigating them. At present, his statistical strategies for assessing clinical significance have extended far beyond the area of behavioral couple therapy and are widely used throughout the field. In all of his empirical investigations, Neil was consistently sophisticated methodologically. Moreover, he was a methodological innovator. The innovation came from his hands-on knowledge of the populations with which he worked and the central clinical issues that he was addressing. He knew whether a couple had been truly helped—whether the intervention made a significant impact on their lives—and he wished to demonstrate this statistically.

Neil was quite aware that applying these statistical techniques in the 1984 article would be humbling. I was pleased to serve as a coauthor on this article, but it really did not require a great deal of effort. Neil was a "doer" and a leader. I remember sitting together in a hotel room at a convention along with the other coauthors of this study, with Neil presenting the findings to us. The findings were rather modest. Overall, the results indicated that only slightly more than half of the couples had improved in response to treatments that we had been investigating for years. In addition, only about one third of the treated couples moved from the distressed to the non-distressed range. Previous reviews of the efficacy of couple therapy suggested much higher success rates based on less stringent criteria. As we, the investigators for this article, discussed the results of our own studies from a clinical significance perspective, I was most pleased that there was no suggestion or hint that we should look at the data in other ways to make the outcomes look more positive. The numbers spoke for themselves; they challenged us to rethink many of our ideas, and Neil took the lead in presenting the findings to the public.

This exemplifies one of Neil's most striking characteristics. He was always passionate about his research ideas, whether basic research or new treatment interventions that he had developed. Over the span of the 27 years that I knew Neil both as a professional colleague and as a close friend, he was always convinced that he had found the major breakthroughs that would alter the ways in which we provided assistance to couples. Once the data were collected, Neil was the first to critically evaluate the outcomes and push forward with new ideas when needed. Consequently, his interventions continued to evolve over the years, culminating in his collaborative work with Andy Christensen on integrative couple therapy. It was this process of commitment to the highest scientific standards—revising his own clinical ideas based on the data, evaluating those new ideas rigorously, and continuing with this process—that made Neil such a delight to have as a colleague and to watch as a true star in our field.

Above, I have already alluded to the second important scientific contribution of this work. In addition to the methodological contribution, this study is merely one example of Neil's commitment to and focus on psychotherapy outcome research. He has published more treatment outcome research on couple therapy than anyone in the field. When Neil graduated from the University of North Carolina in 1977, he had already completed one of the first well-controlled treatment outcome studies of behavioral couple therapy. Two years later, his classic book on marital therapy, coauthored with Gayla Margolin, was published. From that point on, Neil quickened the pace. He explored a number of important issues for marital researchers from a treatment perspective, including criteria development for nonspecific or placebo control groups and evaluation of their efficacy relative to behavioral couple therapy; component studies to dismantle a multifaceted behavioral intervention; the application of couple interventions to individuals experiencing depression, either with or without marital distress; and comparative outcome studies pitting his and Christensen's integrative therapy against more traditional behavioral couple approaches. The creativity exemplified in this work, the scientific rigor and overall high quality, and the quantity of research in this domain of couple outcome research are extraordinary.

In addition to these methodological and scientific contributions exemplified in this one study, the multiauthored article tells us something about Jacobson and his approach to psychology. Neil was a consummate leader and one of the most effective collaborators I have ever worked with or observed. His confidence in his own ideas led him to seek out collaborators from around the world to explore exciting issues. His friendships were at least as important to Neil as his scholarly contributions. In many instances, he integrated these two beautifully, and I was delighted to be among those individuals who shared both. Neil was a close friend and colleague for 27 years, beginning in graduate school. Our passion for Carolina basketball, southern cuisine, and intellectual debate bound us from the beginning. Some of Neil's ideas seemed outrageous, but he consistently sparked me and others to think critically and to reexamine our assumptions. He then usually invited us to collaborate, and working with such a high-energy, competent individual was always a delight.

Along with many others, I will miss Neil for the outstanding scholarly contributions that could have continued for decades. Much more importantly, I will miss him as a dear and devoted friend and a figure who is larger than life. You know that an individual has made extraordinary contributions to a field when that person is referred to by first name only. Neil, thank you for a heck of a ride; we miss you.