The couple and the psychotherapeutic group.

In some situations, when two spouses participate in the same psychotherapeutic group, we find that the group, in order to function, threatens the individual and the couple "envelope." As a result, defenses become rigid and the therapeutic process is blocked, as illustrated by two clinical vignettes. Based on this approach, the characteristics of couples for whom participation in a couple group is contraindicated are conceptualized. In order to prevent the formation of a process in which defenses are hardened, leading to the blocking of therapy, and to exploit the positive potential found in the therapeutic group, an alternative model is proposed in which the spouses are treated in two sub-groups simultaneously.

Self-evaluation of psychotherapeutic competence.

The authors investigated the process of change of self-evaluation of therapeutic competence in psychotherapists enrolled in a postgraduate training programme of psychotherapy. An analysis of the relationships between self-evaluated therapeutic skills and level or stage of formal training was performed. The results of this study suggest that a higher level of self-evaluated therapeutic skill among applicants was followed by a decline in self-evaluation as the training progressed, and a gradual increase in self-evaluation towards the end of formal training. The findings reveal a curvilinear pattern of change which suggests specific internal cognitive/emotional processes leading to the formation of a professional self-image as a psychotherapist.

Mental health work with Gulf War evacuees: the use of a transitional therapeutic space.

This paper describes the intervention of a mental health team formed during the Persian Gulf War to provide assistance to people evacuated from their homes after they were seriously damaged or destroyed by Iraqi Scud missiles. The intervention was based on the view that a crisis upsets the person's emotional equilibrium, resulting in a new and alien emotional state, which is frightening to the person involved by virtue of its strangeness. The disturbance may result in the development of a frozen, rigid unadaptive internal state, i.e. trauma. The mental health team used the interaction between external and internal realities, within a transitional space which enabled the development of a potential space.

Lymphocyte beta 2-adrenoceptors mirror precisely beta 2-adrenoceptor, but poorly beta 1-adrenoceptor changes in the human heart.

To study the relationship of changes in human lymphocyte beta-adrenoceptors to changes potentially occurring in solid tissues we studied 16 patients undergoing elective coronary artery bypass grafting and determined the density of lymphocyte beta 2-adrenoceptors [by (-)125I-iodocyanopindolol (ICYP) binding] in comparison to beta-adrenoceptor density and responsiveness (contractile responses to isoprenaline) in the corresponding right atria. Lymphocyte beta 2-adrenoceptor density (with a range of 278-2442 ICYP binding sites/cell) was significantly correlated with beta-adrenoceptor density in the corresponding atria (54.8-171.6 fmol ICYP bound/mg protein, r = 0.784, P less than 0.001). In these atria the levels of beta 1- and beta 2-adrenoceptors (assessed by non-linear regression analysis of competition curves of the selective beta 2-adrenoceptor antagonist ICI 188,551 with ICYP binding) were approximately .70 and 30%, respectively. Lymphocyte beta 2-adrenoceptor density, however, correlated significantly better with atrial beta 2-adrenoceptor (r = 0.8441; P less than 0.001) than beta 1-adrenoceptor (r = 0.6226, P less than 0.05) density. On 12 of the 16 atria (electrically driven with 1 Hz at 37 degrees C) isoprenaline (10(-9) to 3 X 10(-6) mol/l) caused positive inotropic effects. The maximum increase in contractile force evoked by saturating concentrations of isoprenaline (mean: 3.52 +/- 0.62 mN), however, correlated equally well with beta 1- and beta 2-adrenoceptor density in the corresponding atria (r = 0.6834 and 0.6567, respectively). These results indicate that changes in lymphocyte beta 2-adrenoceptors can be taken as a precise index of changes of beta 2-adrenoceptors in other (solid) tissues; beta 1-adrenoceptor alterations, however, are only poorly reflected in the lymphocytes.

Regional distribution of beta-adrenoceptors in the human heart: coexistence of functional beta 1- and beta 2-adrenoceptors in both atria and ventricles in severe congestive cardiomyopathy.

We evaluated the amount of beta 1- and beta 2-adrenoceptors in human right and left atrium as well as in right and left ventricular wall obtained from heart transplant recipients who suffered from end-stage congestive cardiomyopathy. The total number of myocardial beta-adrenoceptors was assessed with the nonsubtype selective beta-adrenoceptor radioligand (-)[125I]iodocyanopindolol (ICYP); concomitantly, the number of beta 1-adrenoceptors was determined with the selective beta 1-adrenoceptor radioligand (-)[3H]bisoprolol. The number of beta 2-adrenoceptors was calculated by subtracting (-)[3H]bisoprolol binding sites from ICYP binding sites. With this technique, a beta 1/beta 2-ratio of approximately 65/35% for both atria and of approximately 75/25% for both ventricles was found. Identical results were obtained when the beta 1/beta 2-ratio was calculated indirectly by nonlinear regression analysis of competition curves of the selective beta 1-adrenoceptor antagonist bisoprolol and the selective beta 2-adrenoceptor antagonist ICI 118,551 with ICYP binding. In addition, on atria and on ventricles, adenylate cyclase was activated by norepinephrine (presumably by beta 1- and beta 2-adrenoceptor stimulation) and by procaterol (by beta 2-adrenoceptor stimulation). It is concluded that in the human heart functional beta 1- and beta 2-adrenoceptors coexist on both atria and both ventricles. In end-stage congestive cardiomyopathy, there appears to be a selective down-regulation of cardiac beta 1-adrenoceptors, whereas beta 2-adrenoceptors are obviously not affected. This may explain the beneficial effects of beta 2-adrenoceptor agonists in severe heart failure.

Human beta-adrenoceptors: relation of myocardial and lymphocyte beta-adrenoceptor density.

In human right atria obtained from 21 patients during open-heart surgery, beta-adrenoceptor density [assessed by iodine-125-labeled (-)-cyanopindolol binding] and responsiveness (positive inotropic responses to isoprenaline) were linearly related to the beta-adrenoceptor density in the corresponding circulating lymphocytes. This direct relation of human myocardial and lymphocyte beta-adrenoceptor alterations, therefore, makes it possible to monitor drug- or disease-induced beta-adrenoceptor changes in tissues not easily accessible in humans.

Emotional and cognitive factors in the borderline profile.

Profiles of ego functions of borderline patients are studied. Three ego functions were found to be significantly more disturbed: reality testing, object relations, and defense mechanisms. Further analysis of these and their subfunctions reveals a significant difference between emotional and cognitive factors. Emotional-internal functions are the more disturbed. This consistent difference illuminates the style of functioning of borderline patients.