Supervision and privacy in psychotherapy training.

Supervision is an essential element of training in psychotherapy, and the issue of privacy in relation to the supervisory process is an important one. The authors examine the attitude toward privacy implicit in each of the two major models of supervision, the so-called didactic and countertransference models. They consider the ways in which supervision, particularly the countertransference model, and the use of audiovisual devices intrude on the privacy of the therapist and the therapy. Finally, they consider how the institutional and professional structures within which supervision takes place deal with the issue of privacy.

Elements of the private therapeutic interview.

A previous paper explored the differences between a psychiatric interview that is entirely private and one observed by way of a mechanical device. The attempt to explore such differences raises questions about what are the special elements in the private interview that rely heavily on privacy. This paper focuses on 1) the specific rhythms that are worked out within each patient-therapist dyad; 2) the quality of the concentration of one individual on another; 3) the capacity for undoing, or taking back, previously stated positions; and 4) the difference between the intimacy developed through privacy in everyday social situations and that achieved in the therapeutic relationship.

The private versus the public psychiatric interview.

As videotaping, one-way screens, and other audiovisual aids are used more frequently for teaching and research purposes in psychiatry, it becomes increasingly important to define how the fact of observation changes the traditionally private psychiatric interview. The author defines the difference between the public and private interview, reviews the pertinent literature, and describes personal experiences with a variety of observational situations. He focuses on how observation affects the concentration of the therapist, how it changes the social uniqueness of the therapy situation, and how, with the addition of a potential audience, the one-to-one situation may become more like a group situation, in which different psychological mechanisms may be employed.

Macrophage-hybridomas: generation, structure, and function.

We report the generation of macrophage-hybridomas, obtained by somatic cell fusion between macrophage-enriched C3H.eB spleen cell population, and a drug-resistant MPC-11 myeloma cell line, designated as 4T00.1L1 clone. Screening for hybridomas possessing macrophage properties was carried out by assaying the presence of two macrophage-specific enzymes: lysozyme and nonspecific esterase. Two hybridomas, E2-7 and E2-10, were selected for further studies. We found that clones of E2-7 (E2-7.7) did not express Fc receptors but possessed cell-surface Ia molecules. In contrast, clones of E2-10 (E2-10.20) possessed Fc receptors but were devoid of Ia molecules. E2-7.7 did, however, express Fc receptors after mitomycin treatment, whereas E2-10.20 eliminated the expression of Fc receptors after treatment with mitomycin C. Opsonized erythrocytes were phagocytized by E2-10.20 cells, but not by E2-7.7. Phagocytosis was thus correlated with the possession of Fc receptors. Testing the response of KLH-primed lymph node cells to KLH-pulsed hybridoma cells, we found that E2-7.7 cells caused antigen-specific lymphoproliferative response, whereas E2-10.20 did not. Thus, antigens could be presented by E2-7.7 but not by E2-10.20 cells. The response was shown to be mediated by T but not by B lymphocytes. The difference in antigen-presenting capacity could not be attributed to differences in antigen uptake by the different hybridomas, because the two hybridomas manifested the same level of pinocytosis. Both hybridomas produced IL1. The differences in the properties of the two hybridomas may indicate that the normal partners represent two distinct subpopulations of macrophages. The segregation of functional properties among the hybridoma clones may lead to a clarification of the dependence of distinct functions on defined molecular structures.

Difficulties in the integration of psychological and medical practices.

The authors, who support in principle the important goal of integrated psychological and physical care, discuss five sources of difficulty in the practical application of such integration: 1) differences in values and, consequently, in systems of practice, 2) training influences, 3) differences in dealing with emotions, 4) conflicting patient expectations, and 5) limitations on the degree of intimacy tolerable in professional relationships. They suggest that practitioners and educators take these difficulties into account without abandoning a holistic perspective.

Antiemetics in patients receiving chemotherapy for cancer: a randomized comparison of delta-9-tetrahydrocannabinol and prochlorperazine.

Delta-9-tetrahydrocannabinol (THC) is an effective antiemetic as compared with placebos in patients receiving chemotherapy for cancer. In this study we compared THC with prochlorperazine (compazine) in a randomized, double-blind, crossover trial with patients who had failed to benefit from standard antiemetic therapy. Regardless of the emetic activity of the chemotherapeutic agents, there were more complete responses to THC courses (in 36 of 79 courses) than to prochlorperazine (in 16 of 78 courses). Of 25 patients who were treated with both drugs and who expressed a preference, 20 preferred THC (P = 0.005). Among patients under 20 years of age there was a higher proportion of complete responses to THC courses (15 of 20) than among older patients (21 of 59 courses; P = 0.004). Increased food intake occurred more frequently with THC (P = 0.008) and was associated with the presence of a "high." Of 36 THC courses resulting in complete antiemetic responses, 32 were associated with a high. We conclude that THC is an effective antiemetic in many patients who receive chemotherapy for cancer and for whom other antiemetics are ineffective. (N Engl J Med 302:135--138, 1980).

Formerly-addicted-now-controlled opiate users.

Preliminary data are reported on 10 former heroin addicts who have maintained long-term occasional patterns of heroin use. Emphasis is placed on the degree of their past addiction and present control. The implication of the existence of such users for etiological theories, treatment, and further research are discussed.