is a well-known exponent of the social constructivist view of the analytic process; that is, according to Hoffman, one in which the analyst is involved in the construction, rather than merely the discovery, of the patient's psychic reality. In his book, Ritual and Spontaneity in the Psychoanalytic Process: A Dialectical Constructivist Point of View, he explores from this perspective many (currently) widely debated aspects of the psychoanalytic treatment situation, and contrasts his findings with those of classical psychoanalysis as he understands it. This latter point of view, which he calls objectivist or positivist, he characterizes as a rationalist stance, an intellectual belief that the psychoanalytic therapies are based on "very specific, rather narrowly defined approaches or treatments to the amelioration or cure of symptoms or to further psychological development" (p. viii). By comparison, the constructivist point of view does not understand the analyst as the uninvolved applier of defined methods to a defined reality. It sees the analyst as profoundly involved subjectively in a reality that he helps to create, and rather than turning to objective methods for "cure," keeps a sharp eye out instead for "partially blinding emotional entanglement, for the uniqueness of each interaction, for uncertainty and ambiguity, for cultural bias, for chance, for the analyst's creativity, for the moral dimensions of choice, and for existential anxiety in the face of freedom and morality" (p. xii). The constructivist analyst understand the psychoanalysis not as working upon by the analyst of the patient's

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The shape of the coronary arterial pressure-flow relationship results from the interaction of a number of poorly understood physiological factors. Experiments in which coronary inflow and outflow pressures were coupled so that driving pressure was held constant showed that changes in inflow or outflow pressures altered coronary blood flow: coronary vascular resistance varied inversely with changes inflow pressure below 50 mm Hg and with changes in outflow pressure below 80 mm Hg. The magnitude of the influence of inflow pressure on resistance also depended on the fixed level of outflow pressure, the influence being large when the outflow pressure was low, and small when it was high. Inflow and outflow pressures, then, are two physiological factors which are determinants of the shape of the pressure-flow relationship, and their interaction contributes to the degree of curvature found in a particular relationship. These findings suggest that the use of linear regression in the interpretation of pressure-flow relationships results in poor estimation of resistance and zero-flow pressure. Other experiments measuring regional coronary blood flow using radionuclide-labeled microspheres resulted in the same inverse relationship between inflow pressure and resistance, regardless of mural depth, indicating that inflow pressure may influence resistance by distending vessels, rather than by causing sequential cessation of perfusion in successive transmural layers.