Patients' representations of psychotherapy: a new focus for psychodynamic research.

This article presents a psychodynamic framework and research methods for investigating the significance of patients' internal representations of therapy-with-their-therapists. In this article, 2 instruments developed for this purpose--the Therapist Representation Inventory and the Intersession Experience Questionnaire--are introduced, and their psychometric characteristics are described. Also, findings from a series of studies conducted with these instruments are summarized. Finally, the types of questions these instruments appear to be well suited to are proposed for addressing in future research.

A subtle clue to the histopathologic diagnosis of early alpha 1-antitrypsin deficiency panniculitis.

An excisional biopsy specimen of a lesion of several days' duration in an 18-year-old woman revealed moderate splaying of neutrophils between collagen bundles throughout the reticular dermis and incipient necrosis of the dermis and subcutaneous fat. Mild infiltration of neutrophils and macrophages was seen in the septal and lobular panniculus. A biopsy performed on one of the patient's more chronic lesions demonstrated dermal necrosis, degeneration and fibrosis of septa, acute lobular panniculitis with a large number of neutrophils, and foci of subcutaneous fat necrosis with islands of sparing. Splaying of neutrophils between the collagen bundles in the reticular dermis appears to be the earliest histopathologic finding of alpha 1-antitrypsin deficiency panniculitis.

Clinical responses of A and B practising psychotherapists to schizoid and neurotic patient prototypes.

Eighty-three male psychotherapists varying on A-B type and experience orally responded to tape-recordings of simulated schizoid and neurotic patients in the privacy of their own offices. Five dimensions of therapist response were studied: accurate empathy, positive social-emotional reactions, negative social-emotional reactions, length of response and proportion of declarative statements. Although the simple A-B interaction effect was not found, significant second-order interactions were found for both accurate empathy and positive reactions which indicated that the predicted interaction effect tends to be upheld for inexperienced therapists but attenuated or reversed for experienced therapists. A significantly reversed interaction for experienced therapists' response length was also found. Examination of the results from this study and previous studies suggested a revision of the A-B interaction hypothesis: for inexperienced therapists, As will be more effective with schizoids/schizophrenics than Bs, whereas Bs will surpass As with neurotics; for experienced therapists, however, this interaction will be attenuated or reversed. Speculations about underlying processes in A-B interaction phenomena were offered.

Clients' representations of their therapists over the course of psychotherapy.

Using a cross-sectional design, the forms, functional themes, and corresponding affects of clients' (n = 88) representations of their therapists were compared across three distinct time phases of therapy: up to one year, between one and three years, and more than three years. Results indicated that clients in the beginning phase of therapy were less likely to employ representations in the service of continuing the therapeutic dialogue in-between sessions, and less likely to use representations to relieve the pain associated with missing the therapist during separations than clients who have been in therapy for more than one year. Clients in all three phases of therapy most commonly felt comforted and accepted when evoking therapist representations in between sessions.

Diffuse neonatal hemangiomatosis: a new constellation of findings.

Diffuse neonatal hemangiomatosis is a rare, frequently fatal disease characterized by multiple cutaneous and visceral hemangiomas. The skin, liver, lungs, intestines, and central nervous system are the most commonly affected organs. Death can result from high-output cardiac failure as a result of arteriovenous shunting. In this report we present a new constellation of findings in a patient with diffuse neonatal hemangiomatosis, namely, an absent corpus callosum, ectopia cordis (sternal agenesis) with median abdominal raphe, and tricuspid atresia.

Scanning electron microdensitometry.

Diffraction arid partial coherence cause errors in the measurement of small-scale photographic detail by microdensitometers and projection systems. The optical imaging nonlinearities can be avoided by scanning the silver distribution with a narrow beam of energetic electrons and counting the secondary quanta that are excited. It is found that the number of low energy (secondary) and high energy (backscattered) electrons emitted from various emulsion types as well as the characteristic Ag x-ray fluorescence are measures of the local silver concentration. A mechanism for the secondary electron contrast, which is only in part due to surface relief, is proposed. Spatial frequencies up to 2280 1p/mm have been retrieved by such scanning electron beam probes.

Conducting psychotherapy with psychotherapists II: clinical practices and collegial advice.

This study examined psychotherapists' experiences in conducting treatment with fellow mental health professionals. 349 psychologists (35% response) rated the extent to which their therapeutic approach with psychotherapists differed from their approach with laypersons of comparable intelligence, socioeconomic status, and diagnosis. Respondents also provided recommendations for conducting effective treatment with this elite clientele. Psychologists indicated that their practices with fellow psychotherapists were in most respects similar to those used with laypersons; 55 of the 78 items were rated of equivalent frequency. Practitioners' self-characterization as "a therapists' therapist" was related to the manner in which they treated mental health professionals. Broadly speaking, two types of advice were offered: to cultivate a warm and collaborative therapeutic relationship and to maintain proper boundaries. Recommendations for clinical work and future research on psychotherapists' psychotherapy are advanced.

Cutaneous mucormycosis resembling superficial granulomatous pyoderma in an immunocompetent host.

Primary cutaneous mucormycosis is uncommon and occurs mainly in immunosuppressed or diabetic patients or after localized trauma. We report a case of cutaneous mucormycosis in an immunocompetent man in whom no definite precipitating factors could be identified; initially, superficial granulomatous pyoderma was suspected clinically. The lesion was successfully treated with debridement, local wound care, parenteral administration of amphotericin B, and ultimately by surgical excision and split-thickness skin grafting.

The development and validation of a measure of the psychiatrist's authoritative domain.

In order to examine issues relevant to the authority which patients bestow upon psychiatrists the present authors constructed the Psychiatrist's Sphere of Influence Scale (PSIS). The PSIS is a 68-item Likert-type questionnaire which asks patients to specify the skills which they believe belong to the psychiatrist's authoritative domain. Patients being treated in day hospital (N=82), inpatient (N=113), and outpatient (N=121) settings were individually administered the PSIS along with various discriminant and construct validity measures. The findings indicated that the PSIS is an internally consistent, factorially complex, relatively stable measure of the roles which are ascribed to psychiatrists. Neither the social desirability nor the agreement response set represents important contaminants of the PSIS. Moreover, individual differences on the PSIS appear to be predictable, within broad limits, from patients' positions in the social structure, their preferred styles of help seeking in hospital and therapy settings, and their generalized orientations toward power and authority. A tendency to blur the boundaries between "psychiatric" and "nonpsychiatric" roles appears to be concentrated among patients who are middle-aged or older, minimally educated, of lower socioeconomic status, inclined toward an authoritarian conception of the good patient and the good hospital, and who endorse traditional family role relationships. The implications of these findings for the manner in which psychiatrists exercise their authority were discussed.