Measuring adherence and competence of dynamic therapists in the treatment of cocaine dependence.

This article presents the development of a new 82-item rating scale of therapist adherence and competence for supportive-expressive (SE) dynamic psychotherapy for the treatment of cocaine dependence. Sixty-four items are rated for adherence, appropriateness, and quality of prescribed interventions. As part of the pilot/training phase of the National Institute on Drug Abuse Collaborative Cocaine Treatment Study, two independent expert judges rated 32 audiotapes of SE therapy sessions with cocaine-dependent patients, 10 tapes of cognitive therapy (CT) sessions, and 10 tapes of individual drug counseling (IDC) sessions. Reliability was acceptable for adherence but poor for quality and appropriateness. SE therapists used more expressive (interpretative) techniques than did either CT therapists or IDC counselors, and they used more supportive techniques than did IDC counselors.

Repetitive relationship themes in waking narratives and dreams.

The aims of the study were to see whether the core conflictual relationship theme (CCRT) measure can be reliably applied to dreams and to evaluate the degree to which the main components of the CCRT are present in both dreams and waking narratives in psychotherapy. For 13 psychoanalytic cases, the reliability of the CCRT was found to be good. Dreams and narratives were found to contain significant degrees of similarity in their CCRT components and similar and high level of negativity in both dreams and waking narratives. The results support the concept of a central relationship pattern that can be expressed in common in both waking narratives and dreams.

A hierarchical model of opiate addiction. Failures of self-regulation as a central aspect of substance abuse.

In this paper, we first examine and recast the research literature on opiate addiction in the light of a hierarchical model of self-organization. The hierarchical model consists of five modes of psychological and psychobiological functioning defined epigenetically. Research and theories of opiate addiction are classified as to their primary modal emphases. We then describe failures of self-regulation as particular vulnerabilities along the first three modes of the hierarchy. A measure of this construct, the Scale for Failures in Self-Regulation (SFSR), a projective measure that utilizes Thematic Apperception Test responses, is introduced for the study of opiate addicts. The SFSR was administered to normal and opiate-addicted subjects in order to examine the predictive and explanatory power of the hierarchial model. A multivariate analysis of variance showed the addicts to have greater difficulties in self-regulatory functioning than normal subjects. In terms of the hierarchical model, the implications of these findings for the questions of severity of illness, psychotherapy technique, and future research are discussed.

[Problems of autologic incus interposition in cholesteatoma operations (author's transl)]. / Zur Problematik der autologen Ambossinterposition beim Cholesteatom.

Our clinical study proves whether or not the warning is justified not to reimplantate autologic ossicula in cholesteatoma operations in order to avoid recidives. After interposition of the autologic incus in 18 patients we found cholesteatome recidives--originating from the incus--in two cases. According to histological studies, even the most careful preparation cannot avoid that some cells of the epithelium remain on the ossicula, from which a cholesteatoma recidive may develop. Clinical studies show rather low rates of recidives compared with the histological findings. Possibly remaining squamous epithelium cells in autologic ossicles need not always cause recidives. Clinical and histological studies lead to the demand that because of the possibility of cholesteatoma recidives autologic ossicula should not be reimplated in cholesteatoma operations.