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This paper reports the main findings of a large-scale study of subsidized psychoanalysis and long-term psychotherapy. More than 400 people in various phases, before, during and after subsidized psychoanalysis or long-term psychodynamic psychotherapy, were followed up for a period of three years with personal interviews, questionnaires and official statistics. Our analyses revealed progressive improvement the longer patients were in treatment--impressively strong among patients in psychoanalysis--on self-rating measures of symptom distress and morale. Improvement, however, was equally weak in both groups on a self-rating measure of social relations. Dosage factors (treatment duration and session frequency in combination) partly accounted for the outcome differences between those referred to psychoanalysis and those referred to long-term psychotherapy. Attitudes and ideals among therapists and analysts concerning the goals and means of psychotherapy were also associated with patient outcome, although in rather complex ways. A significant part of the outcome differences between patients in psychoanalysis and in psychotherapy could be explained by the adoption, in a large group of therapists, of orthodox psychoanalytic attitudes that seemed to be counterproductive in the practice of psychotherapy but not in psychoanalysis. It is suggested that this effect may be a negative transfer of the psychoanalytic stance into psychotherapeutic practice and that this may be especially pronounced when the attitudes are not backed up by psychoanalytic training.

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In a case-finding sample of 1,824 substance abusers, personality organization (PO) was related to data on drug abuse. Heavy versus light abuse differentiated significantly between borderline PO (BPO) and neurotic PO (NPO), whereas psychotic PO (PPO) was characterized by inconsistent pattern of abuse in terms of heaviness. In terms of drug choice, all combinations with alcohol were associated with lower PO.

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In a quasi-experimental design, four groups were compared, (a) patients who had terminated psychoanalysis of more than two years' duration; (b) patients who had terminated individual psychotherapy of more than two years' duration; (c) patients who had terminated various kinds of low-dose psychotherapies; (d) patients who had not been in any recent psychotherapy. Repeated follow-up questionnaires, roughly one and two years after termination, showed that psychoanalysis and long-term therapy patients had superior outcomes on measures of Symptom, social adjustment, and existential attitudes, in comparison with patients without any recent therapy or patients who had been in various kinds of low-dose therapies. During the second year of follow-up, the differentiation among the groups increased, with psychoanalysis developing in a more positive way than the other treatments.

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As a test of the possibility clinically to predict psychotherapy outcome for individual patients, eight psychotherapist judges rated 30 patients for suitability for psychotherapy and predicted individual outcomes of psychotherapy. Unknown to the judges, 15 of the patients had been in psychotherapy (T group), whereas the remaining 15 had not (NT group), but all patients had been rated with respect to change. The hypothesis was confirmed that judges would be able to predict change in the T group better than in the NT group, but that their suitability ratings would be equally predictive of change in the two groups. It was concluded that psychotherapeutic change was a systematic effect over and above initial status, large with some patients, small with others, but reliably so.

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In a case-finding sample of 1,824 drug abusers in the greater Stockholm area, personality organization (PO), according to Kernberg's theory, was assessed by using a standardized questionnaire, with the clients' contact persons as informants. Twenty percent of the sample were diagnosed as psychotic PO (PPO), 40% had a clear borderline PO (BPO), and 40% a high BPO or a neurotic PO (NPO). This distribution agreed closely with that found in a comparison sample of social service clients. However, in the NPO and BPO groups, the mean scores were higher for the social service clients than for the abusers. A clustering into nine sub-clusters revealed interesting differences within each PO.

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Treatment utilization and personality organization in a case-finding sample of 1824 drug abusers in the greater Stockholm area were assessed by using a standardized questionnaire, with the client's contact persons as informants. Level of personality organization was strongly associated, negatively with the number of concurrent treatment contacts, problems of coordination between concurrent treatment agents, and was positively correlated with agreement between treatment agents in the assignment of principal treatment responsibility and their opinions about the appropriateness of this assignment. Psychiatric ICD-9 diagnosis was not associated with any of these variables.

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The influence on patient compliance of the dentist's attitudes to his or her job and to his or her patient was studied in a sample of 82 patients. The dentist's attitudes were assessed at the beginning of dental treatment. Treatment consisted of cleaning, depuration and motivation. At follow-up examination after six months, attendance at follow-up and the development of plaque, calculus and gingivitis were significantly predicted by the dentist's attitudes. A causal model, which also included factors of patient involvement, was developed. The compliance-producing factors were, primarily, the establishment of sympathy and an informal relationship between dentist and patient. The patient's habit of regularly making visits to a dentist, in a complex way, also contributed to compliance.

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Eighty-two dental patients were interviewed at the beginning of treatment in order to assess a number of psychosocial variables relevant to the prediction of compliance with treatment recommendations. Treatment consisted of cleaning, depuration and motivation. The patients were followed up after six months by measuring the development of plaque, calculus and gingivitis. In support of our hypothesis, it was found that variables that were related to patient involvement contributed strongly to the prediction of the oral health variables. The patient's visiting habits and initial attitudes were of particular prognostic value. The results with a set of variables conceptually unrelated to patient involvement were mixed and generally not as positive. Attendance at follow-up was predicted equally well by both kinds of variables, but generally not by the same variables as those that predicted oral health.

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A community-based case-finding sample of 1824 narcotic abusers in Stockholm County was used to standardize a set of rating scales in order to reflect levels of personality organization (PO), in the spirit of Kernberg's theory. PO is assumed to be a function of the ego's capacity to endure inner and outer stress, which manifests itself in the frequency and depth of regressions and the rate of recovery from them. The principles of a method, Rating Ego Balance, for charting the person's characteristic pattern of regression are presented, and its psychometric properties are described on the basis of item response theory. The scales have satisfactory reliabilities and maximal discrimination at subneurotic levels of PO. They show strong construct validity in relation to Kernberg's theory.

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Clinical significance of a treatment effect is indicated when a treated patient, after discharge, cannot be distinguished clinically from a person who is functioning on some criterion level in terms of adjustment and normality. This principle is demonstrated in a questionnaire follow-up of patients at a day hospital. Defining the criterion level, a sex- and age-matched nonpatient group completed the same questionnaire. On the basis of the questionnaires, four judges independently guessed whether or not each respondent was an ex-patient. The agreement among the judges was high, and their classification agreed with that of a discriminant analysis in eventually declaring approximately 25% of the patients to be nonpatients. A simple model was proposed to account for the judges' performance.

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Envy and admiration are analysed as alternative ways, in essential respects contrary to each other, to cope with situations of relative deprivation, when one becomes aware of having less of some good than some other has. In terms of phantasies and with respect to the organisation of the objects, envy is a paranoid-schizoid phenomenon, with hopelessness, persecutory phantasies, and object-splitting, whereas admiration is in the depressive position, with hope, sympathy, and compartmentalisation of the admired trait out of its whole-object context. The close relations between envy and admiration and narcissism are pointed out, as are the differences between admiration and idealisation.

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All borderline patients admitted at a day hospital during a 6-year period were followed up with a postal questionnaire after 3-10 years. Patients who had chosen to leave the treatment within 4 months were analyzed as a separate group, and these drop-outs and the remaining patients were compared with a group of well-adjusted people who were assumed to represent the functional norm. The patients who remained in treatment were clearly posited at a level of functioning between the norm and the drop-outs, although the variation among them was quite large. Depending on the stringency and content of the criterion of clinical significance, 25-75% of the patients remaining in treatment fell within the range of the norm group versus 20-50% of the drop-outs. The patients who had benefited most since termination had differed favorably from the other patients already at admission to treatment, but not as much as had the drop-outs. The drop-outs, however, at admission also had more ambivalent or negative attitudes towards treatment.

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The definitional criteria of the 3 systems (DSM-III, DIB and Kernberg) have been compared. While there is rather weak agreement between the criteria of DIB and those of DSM-III, there is no agreement at all between Kernberg's criteria and those of the other 2 systems. When the 3 systems are compared in terms of empirical diagnosis, the agreement between DSM-III and DIB is moderate and clearly stronger than that between Kernberg and either DSM-III or DIB. In terms of sensitivity, the Kernberg borderline comprises the DSM-III and DIB borderlines as subsets. The findings are consistent with the idea that Kernberg's borderline concept is an instance of a severity or maturity level construct, while DSM-III and DIB are characterological constructs, orthogonally related to the level construct.

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The general inability to make clinical predictions of psychotherapeutic change, which has been suggested by previous research, is questioned in this study. It is argued and empirically demonstrated in a sample of 8 experienced psychologists and 8 psychology students that there are reliable individual differences in the ability to make accurate predictions. Above-chance accuracy is significantly frequent in the former group of judges (and nonexistent in the latter group), and performance also appears to be influenced by the conditions of the prediction task.

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In brief: In a preliminary study to evaluate possible causes of exhaustion, 48 runners who collapsed during or after an ultramarathon race were questioned about their training methods. The training profiles were compared with those of matched controls who had finished the same race without collapsing. Possible contributing factors found among the collapsed runners included inadequate training, failing to carbohydrate load, not eating a prerace breakfast, prerace illness, and hypothermia (during one race, which was run in cold, wet, windy conditions). The authors suggest that regardless of athletic ability or previous racing experience, runners may be prone to collapse during or after ultramarathon races if their prerace training and preparation are inadequate.

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1. The development of post-exercise ketosis is not abolished by the ingestion of glucose immediately after exercise, despite inducing high insulin/glucagon ratios in the peripheral (and therefore by implication in the portal) blood. 2. To investigate the possibility of autonomic control of the liver influencing its sensitivity to the major counter-regulatory hormones, we administered 50 g glucose, either on its own, or together with 0.5 mg prazosine, 40 mg propranolol, or 15 mg propantheline, to forty-seven 48 h carbohydrate-starved athletes who had just run 25 km. 3. The blood 3-hydroxybutyrate concentration rose from 0.30 +/- 0.05 (mean +/- S.E. of mean) to 0.52 +/- 0.08 mmol/l with exercise, and then to 1.32 +/- 0.40 mmol/l at 6 h after exercise in subjects who had ingested only glucose after exercise. 4. The effects of prazosine and propantheline on the blood ketone body concentration at 2 h after exercise was not statistically significant. Propranolol, on the other hand, significantly lowered the blood 3-hydroxybutyrate concentration (compared with controls) to 0.09 +/- 0.03 mmol/l at 3 h (P less than 0.01), and 0.35 +/- 0.08 mmol/l at 6 h (P less than 0.01) after exercise. 5. The plasma insulin, glucagon, glucose and free fatty acid concentrations were unaffected by propranolol, indicating that the antiketogenesis was the result of a direct effect on ketone body metabolism. 6. Since beta-adrenergic blockade has not previously been shown to have antiketogenic activity, except in somatostatin-induced hyperketonaemia, it is concluded that its effectiveness in post-exercise ketosis can probably be ascribed to a functional hepatic insulin and glucagon deficiency.

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The principles and background of 'Change after Psychotherapy' (CHAP) are described, and the instruction and procedure are detailed. The ratings are made on the basis of therapy sessions or posttherapy interviews and are guided by variable definitions in the form of numerous examples of manifest signs of various kinds of therapeutic change. The rating variables are: symptom amelioration, increased adaptive capacity, self-insight. resolution of the basic conflict, and the presence of change-facilitating extra-therapeutic conditions.

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