Interpersonal change in brief supportive psychotherapy.

As a substudy of a manual-based outcome study of the Beth Israel Brief Psychotherapy Program, the authors studied the efficacy of supportive psychotherapy in personality change, with particular attention to changes that outlast the period of treatment. They examined results from the Inventory of Interpersonal Problems (IIP) at intake, 40th-session termination, and 6-month follow-up in the first 20 subjects randomized to the supportive group. Eight subjects (40%) dropped out, but their initial IIP scores did not differ from those of follow-up completers. Six of 10 subjects with complete 6-month follow-up data showed significant improvement in interpersonal problems (4 cases P < 0.001; 2 cases P < 0.05). In a case method design, using the IIP mapped to an interpersonal circumplex model, the authors graphically demonstrate lasting positive changes in interpersonal functioning in subjects treated with supportive psychotherapy.

A randomized prospective study comparing supportive and dynamic therapies. Outcome and alliance.

The authors report preliminary results of Brief Supportive Psychotherapy (BSP) in the Beth Israel Brief Psychotherapy Program for a sample with primarily Cluster C Axis II disorders. This study compares 24 patients treated with BSP with 25 patients treated with Short-Term Dynamic Psychotherapy (STDP). STDP was chosen because its confrontational methods contrast dramatically to BSP, which emphasizes building self-esteem, reducing anxiety, and enhancing coping mechanisms. Videotaped therapies were based on manualized 40-session protocols. Similar degrees of improvement were seen in BSP and STDP at termination and at 6-month follow-up. A study of therapeutic alliance in BSP showed stable and high levels of alliance in good-outcome cases and more variability in poor-outcome cases. These preliminary findings are consistent with other studies and suggest supportive psychotherapy may be effective for many patients, leading to significant and lasting change.

The role of theory in teaching supportive psychotherapy.

Because supportive therapy is not based upon a theory of mind or personality or psychopathology, it should not be thought of as a unique modality of treatment but rather as a body of techniques or tactics that function with various theoretical orientations as a "shell program" functions with a computer's operating system. The therapist's operating system is the theoretical orientation gives direction to his/her interventions. In the past, supportive therapy has generally been explained in terms of its departures from the model of expressive therapy. The techniques and rationales of supportive therapy have now been articulated so that they can be taught along with the techniques and rationales of expressive therapy. It is important that students not absorb the tenets and tactics of expressive therapy as a monolithic model for all therapy. Supervision of psychotherapy should pay ample attention to the "coaching" function aimed at mastering technique, which is as important as teaching about psychopathology or encouraging personal growth.

The mock trial in psychiatric staff education.

The mock trial is an important educational technique that has seldom been reported in the medical literature. In this paper we describe the evolution of mock trials as a regular component in the educational program for our multidisciplinary staff. The mock trial is not only an excellent strategy for teaching about the interface between psychiatry and the law, but also for teaching about malpractice, documentation, and medical reasoning. The most effective presentation used an actual case from our facility, practicing attorneys, and an experienced judge in a condensed version of a trial.

Supportive therapy as the treatment model of choice.

Supportive and expressive techniques in psychotherapy can be located on a continuum. Traditionally, psychotherapy has been oriented toward the expressive end of the continuum, applying the model of psychoanalytic or expressive therapy to all therapy. The authors propose that for most patients, the model for individual dynamic psychotherapy should be based on concepts from the supportive end of the continuum.

Swimming in Aplysia brasiliana: behavioral and cellular effects of serotonin.

1. Aplysia brasiliana is a marine mollusk that swims by repeated metachronal flapping movements of its bilateral fleshy parapodia. Animals with bilateral cerebropedal connective (CPC) lesions do not swim when suspended above the substrate, although tonic CPC stimulation can elicit normal parapodial flapping. Although the parapodial opener-phase (POP) cells, a previously identified group of neurons, fire synchronous bursts of efferent spikes in-phase with parapodial opening movements in both intact animals and dissected preparations, they are not likely to be primary parapodial motoneurons. These cells receive one or more large, apparently monosynaptic excitatory postsynaptic potentials (EPSPs) during CPC stimulation that are effective in producing the swimming motor program (SMP). 2. In suspended CPC-lesioned animals, injections of serotonin (5-HT) that produce an average hemolymph concentration of 10(-5) M induced full-amplitude parapodial flapping. Selected episodes of flapping were similar in frequency to normal suspended swimming. 3. In suspended CPC-lesioned animals, 5-HT injections elicited an apparently normal swimming motor program that was associated with synchronous bursts of large-amplitude efferent spikes in the parapodial nerves. In many semi-intact preparations, exposing the circumoesophageal ganglia to 5-HT elicited a similar rhythmic motor program, but usually at a lower frequency than during normal swimming or during tonic CPC stimulation. 4. In isolated-ganglion preparations, bath application of 5-HT produced immediate depolarization and tonic firing of individual POP neurons, followed by smooth and regular bursting in the apparent absence of synaptic input. In such preparations, the motor program elicited by bath-applied 5-HT differed from the one elicited by tonic CPC stimulation in that the 5-HT-elicited rhythmic bursting usually was not synchronous in different POP neurons. Tonic CPC stimulation during bath applications of 5-HT produced immediate synchronization of bursts among the POP neurons. 5. Hyperpolarization (or depolarization) of a POP neuron during bath application of 5-HT increased (or decreased) the burst period, but membrane polarization did not change the burst period elicited during tonic CPC stimulation.

Egg laying in Aplysia. I. Behavioral patterns and muscle activity of freely behaving animals after selectively elicited bag cell discharges.

Aplysia egg laying is a complex sequence of head and neck movements initiated by the release of ovulatory and neuroactive hormones from the neurosecretory bag cells. This behavioral pattern is difficult to study in reduced preparations, because they do not show ovulation or egg laying behaviors. This paper describes the use of chronically implanted electrodes to elicit normal neurosecretory activity and provides an analysis of egg laying behaviors and the underlying muscle activity in intact, freely behaving A. californica and A. brasiliana. 1. Bag cell discharges elicited with a fine wire electrode implanted in the connective tissue sheath above the cell bodies were typically without noxious behavioral side effects. 2. Following selectively elicited bag cell discharges, egg laying consisted of four rhythmic head and neck movements that were separated functionally into appetitive behaviors ('waves' and 'undulations') used to explore and prepare the substrate and consummatory behaviors ('weaves' and 'tamps') used to distribute and attach the egg string. The amount of time an animal performed consummatory behaviors was positively related to the amount of eggs deposited. By contrast, the appetitive phase of egg laying was independent of the size of the egg mass. 3. The individual behaviors and their temporal sequence were similar following selectively elicited bag cell discharges, spontaneous discharges of animals with implanted electrodes and during normal egg laying of unoperated animals. 4. Three longitudinal muscle systems occurred within the head and neck. Following a selectively elicited bag cell discharge, spatially and temporally coordinated patterns of EJP bursts of different durations were recorded chronically from each muscle group. These EJP patterns were characteristic for specific head and neck movements used in appetitive and consummatory egg laying behaviors.

Egg laying in Aplysia. II. Organization of central and peripheral pathways for initiating neurosecretory activity and behavioral patterns.

1. Central pathways for bag cell activation were identified by examining the frequency of spontaneous egg laying episodes in animals with central connective lesions. Bilateral lesions of the cerebropleural (but not the cerebropedal) connectives abolished spontaneous egg laying. In contrast, bilateral lesions of all cerebral ganglion peripheral nerves did not abolish spontaneous egg laying, suggesting that sensory input to the cerebral ganglion is not necessary for activating the bag cells. 2. Backfilling either pleuroabdominal connective labelled cell bodies in the cerebral ganglia (via the ipsilateral cerebropleural connective) that could project to the bag cells. Focal extracellular stimulation of these stained clusters activated the bag cells in isolated brains. 3. Central pathways for initiating egg laying behaviors were identified by selectively eliciting bag cell discharges in animals with central connective lesions. Bilateral lesions of the cerebropedal (but not the cerebropleural) connectives completely abolished elicited egg laying behaviors. 4. Pathways for motor output during rhythmic head and neck movements were identified by eliciting bag cell discharges in animals with peripheral nerve lesions. Bilateral lesions of the four tegumentary nerves in combination with the anterior pedal nerve completely abolished elicited egg laying behaviors, indicating that these nerves are necessary for normal motor output. A normal pattern of egg laying behaviors occurred when the four tegumentary and the anterior pedal nerves were left intact and all other pedal ganglion nerves were lesioned bilaterally, indicating that these nerves are also sufficient for normal motor output.(ABSTRACT TRUNCATED AT 250 WORDS)

Swimming in Aplysia brasiliana: identification of parapodial opener-phase and closer-phase neurons.

1. In freely behaving Aplysia brasiliana, spontaneous swimming in the laboratory occurred primarily in the dark hours of the day-night cycle. Suspending an intact animal above the substrate elicited continuous parapodial flapping with the same frequency and amplitude as spontaneous swimming. Parapodial flapping with decreased frequency and amplitude could still be elicited by suspending minimally dissected, but not more radically dissected, preparations. 2. In otherwise intact animals, severing the cerebropedal connective (CPC) bilaterally abolished suspended parapodial flapping, but normal flapping was elicited by tonic stimulation of the distal CPC. In minimally dissected preparations, tonic CPC stimulation elicited parapodial flapping, but with reduced frequency and amplitude. 3. During normal parapodial flapping, chronically implanted electrodes on parapodial nerves recorded the swimming motor program (SMP). The whole-nerve SMP consisted of rhythmic bursts of large-amplitude efferent units in phase with parapodial opening, with no observable activity during parapodial closing. By contrast, simultaneous electromyogram (EMG) recordings from antagonistic parapodial muscles showed antiphasic bursts of activity during opening and closing. The SMP was inhibited by touching food to the animals' lips. 4. Parapodial nerve backfills, using nickel chloride, labeled several cell clusters in the ipsilateral pedal ganglion. Two of these clusters were located caudally: one tightly clustered medial group had large cell bodies, and another, more distributed, lateral group had small cell bodies. The two clusters were identified in semi-intact preparations and isolated brains, using tonic CPC stimulation to elicit a fictive SMP recorded in parapodial nerves, and intracellular electrodes to characterize and stain individual cells. 5. The large parapodial opener-phase (POP) neurons were normally silent. At the onset of CPC stimulation, POP neurons depolarized and fired tonically, and then burst rhythmically in phase with each other, and one for one with large-amplitude axon spikes observed extracellularly in parapodial nerves during the fictive SMP. Intracellular firing of POP cells, singly or in pairs, never produced observable papapodial movements or one-for-one responses in parapodial muscles. Lucifer yellow-filled POP neurons showed a process (with a pronounced rostral loop) that gave off many short, fine neurites in the pedal neuropile before branching into two or three axons projecting into different parapodial nerves. 6. The smaller parapodial closer-phase (PCP) neurons normally discharged tonically at low frequencies.(ABSTRACT TRUNCATED AT 400 WORDS)

Chromatophore motor fields in the squid, Lolliguncula brevis.

Chromatophore motoneurones in Lolliguncula brevis are known to originate in the suboesophageal lobes of the brain and to project directly to the mantle and fin through bilateral stellate ganglia and fin nerves. The chromatophore motor fields of stellar and fin nerves were investigated by stimulation of the cut end of individual nerves in a semi-intact preparation. This elicited expansion of yellow and brown chromatophores in distinct motor fields. Brown chromatophores extended over the entire mantle, whereas yellow chromatophores were limited to the dorsal and lateral mantle areas. Combined nerve stimulation and lesions demonstrated substantial overlap between adjacent chromatophore motor fields and innervation of individual chromatophores by different stellar nerves.

A review of supportive psychotherapy.

Although supportive psychotherapy techniques are more widely used than expressive or insight-oriented techniques, particularly with hospitalized or chronically ill patients, supportive treatment strategies have been underrepresented in the literature and not adequately taught to therapists in training. The authors review the diverse definitions and goals of supportive therapy as related to two major types of objectives. They stress the distinction between the supportive relationship, which is present to some extent in all psychotherapy, and supportive treatment, and they examine the inverse relationship between expressive and supportive therapy. Finally, selected elements and techniques of the conduct of supportive therapy, such as style of communication, respect, praise, advice, self-disclosure, and interpretation, are discussed.

Spontaneous and elicited bag cell discharges in gonadectomized Aplysia.

The neuroendocrine bag cells of the hermaphroditic marine gastropod, Aplysia, secrete peptide hormones that induce release of ripe eggs from the ovotestis. The egg string is subsequently deposited on the substrate by means of a complex sequence of rhythmic head and neck movements. Gonadectomy (removal of the ovotestis) was performed in two closely related species of Aplysia to prevent completely the synthesis, build-up and release of eggs. Chronically implanted electrodes were used either to monitor spontaneous bag cell discharges (A. brasiliana) or to selectively elicit bag cell discharges (A. californica) in gonadectomized and mock-operated animals. Gonadectomized animals showed the normal occurrence of spontaneous bag cell discharges in the complete absence of eggs, indicating that feedback from ripe eggs in the ovotestis is not necessary for normal activation of the bag cells. However, gonadectomized animals showed a significant decrease in specific head and neck movements following elicited bag cell discharges. This finding indicates that, once the bag cells fire and the eggs are released, input from the eggs is necessary for normal expression of the behaviour associated with egg deposition.

Localization and stimulation of chromatophore motoneurones in the brain of the squid, Lolliguncula brevis.

The relatively simple chromatophore system of the squid, Lolliguncula brevis, was studied with combined behavioural, morphological and electrophysiological methods in order to understand how the chromatophore patterns in the skin are organized at the level of the posterior chromatophore lobes (PCL). There are nine simple chromatic components of patterning in L. brevis. Retrograde transport of horseradish-peroxidase from chromatophores in the mantle skin established that the chromatophore motoneurones are located in the PCL. Focal threshold stimulation of the PCL in perfused, semi-intact preparations showed that the motor fields of individual chromatophore motoneurones are compact, including 2-60 chromatophores, generally of the same colour. Adjacent motoneurones in the lobe do not necessarily have adjacent motor fields in the skin.

Temperature dependence of egg laying in Aplysia brasiliana and A. californica.

The temperature dependence of egg laying was examined in winter-caught Aplysia. Cold-water Aplysia californica and warm-water A. brasiliana were individually housed in the same large aquarium for 16 days at 15 degrees C, and then for 16 days at 20 degrees C. Initially, the majority of the A. californica were not reproductively mature (as determined by injections of atrial gland extracts) whereas all of the A. brasiliana were reproductively mature. When the temperature was increased from 15 to 20 degrees C, both species showed a marked increase in the frequency of egg laying. At both temperatures, A. brasiliana laid eggs more frequently but produced smaller egg masses than A. californica. We conclude that increased egg laying in A. californica was attributable both to facilitation of oogenesis in previously reproductively immature animals and to increased activity of the bag cells which release an egg-laying hormone. Increased egg laying in A. brasiliana was attributable primarily to increased bag cell activity.

Neuroethological studies of reflex plasticity in intact Aplysia.

Multi-unit recording of siphon nerve activity in intact Aplysia california with chronically implanted cuff electrodes provided a monitor of activity in a central pattern generator, the Interneuron II (Int II) network, which produces large siphon and gill contractions both spontaneously and after tactile stimulation of the siphon. The phase-response curve of the Int II oscillator for single stimuli at different phases of the cycle showed a "refractory" period early in the cycle after which most stimuli phase advanced the oscillator and caused a short-latency Int II burst and a large contraction. The amplitude of gill withdrawal and the duration of siphon withdrawal in response to different stimulus intensities depended on whether an Int II burst was triggered. Activation of the Int II oscillator transformed the reflex from one that was graded smoothly with stimulus intensity to one in which nearly maximal responses were elicited even by weak stimuli. Entrainment and habituation training both involved monotonous repetition of a stimulus at specific intervals. With repeated siphon stimuli, nearly maximal reflex responses were maintained in intact animals as long as the Int II oscillator was entrained, whereas habituation was associated primarily with failure to entrain the oscillator. Long-term sensitization of the reflex was characterized by large and prolonged withdrawal responses. Sensitized animals showed significantly more triggered Int II bursts than did controls. In addition, digital spike-train analysis indicated that individual siphon motoneurons showed significantly increased background activity which often persisted for several minutes.