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Every theory of psychotherapy is composed of a myth and an associated ritual. A myth is a conceptual scheme for explaining clinical problems. A ritual is based upon a myth and is a model of the clinical change process. This article goes far beyond the observation that theories of psychotherapy consist of a myth and a ritual to propose that they share a common underlying structure. The central purpose of this article is to delineate this structure. This structure constitutes a metamodel of theories of psychotherapy. The article shows how the metamodel is a fresh conceptual tool (a) for understanding, analysing, comparing and contrasting, and integrating the basic concepts and principles of theories of psychotherapy and (b) for building case formulations and treatment plans from a theory of psychotherapy.

IN 1860, Gascoyen1 reported an association between cutaneous nevi, intestinal lesions, and gastrointestinal (GI) bleeding. Bean2 separated the blue rubber-bleb nevus syndrome (BRBNS) from other cutaneous vascular lesions and gave the syndrome its name.Demonstration of these lesions has been performed by way of angiography, laparotomy, and autopsy. This case is an example of the BRBNS in which the diagnosis of the GI lesion was made by endoscopy.

Non-depressed individuals exhibit a self-serving attributional bias, taking more credit for success than for failure. Clinically and subclinically depressed people are less self-serving, often to the point of making similar attributions (explanations) for successes and failures. The present studies evaluated a schematic account of these distinct attributional biases. Subclinically depressed and non-depressed participants completed measures of attributional bias (the relative strength of ability attributions for success versus failure), schemabased optimism (the relative expectedness of success versus failure) and self-schemas of competence. Two studies evaluated a hypothesis derived from the schematic account: the greater the perceived competence and optimism, the more self-serving the attributional bias. As predicted, (a) attributional bias scores covaried with optimism and competence scores in both magnitude and valence (or direction), (b) depressed-non-depressed differences in attributional biases paralleled differences in competence and optimism and (c) when attributional bias scores were adjusted for the effects of optimism or competence, depressed-non-depressed differences in attributional biases were eliminated. The schematic account raises questions about the common assumptions that attributional patterns are traits, and that they play a central role in the aetiology and treatment of depression.

The present study investigated depressives' level of engagement in altruistic activity. Thirty-three depressed and 114 nondepressed college students indicated whether or not they had recently performed each altruistic and egocentric activity on a checklist. In addition, their standards regarding altruistic behaviors were assessed. Compared to normals, depressives reported a significantly lower level of egocentric activity, but they did not differ from normals in their level of altruistic activity. Depressives exhibited significantly higher altruistic standards. Altruistic standards covaried with altruistic activity level in normals but not in depressives. These results were interpreted from the perspective of a formulation that posits that self-preoccupation in depression tends to reduce the accessibility of altruistic standards and thus diminishes the likelihood of altruistic behavior.