Some limitations on therapeutic effectiveness: the "burnout syndrome" in psychoanalysts

Problems of maintaining psychoanalytic therapeutic effectiveness during a professional lifetime are discussed. Psychoanalysts are subject to paradoxical emotional and characterologic demands, uncompensated by the usual gratifications available in the healing professions. Problems arising from the analyst's character and the paucity of data in the field are discussed. "Burnout" syndromes are liable to occur in those working in a setting of great emotional intensity demanding high degrees of affective awareness and control, empathy and tolerance of uncertainty. Masochistic and narcissistic forms of "burnout" syndrome are described as they occur in psychoanalysts. The profession, as well as the individual, can help to prevent these syndromes.     

The limitations of "vulnerability" as a protection for human research participants

Vulnerability is one of the least examined concepts in research ethics. Vulnerability was linked in the Belmont Report to questions of justice in the selection of subjects. Regulations and policy documents regarding the ethical conduct of research have focused on vulnerability in terms of limitations of the capacity to provide informed consent. Other interpretations of vulnerability have emphasized unequal power relationships between politically and economically disadvantaged groups and investigators or sponsors. So many groups are now considered to be vulnerable in the context of research, particularly international research, that the concept has lost force. In addition, classifying groups as vulnerable not only stereotypes them, but also may not reliably protect many individuals from harm. Certain individuals require ongoing protections of the kind already established in law and regulation, but attention must also be focused on characteristics of the research protocol and environment that present ethical challenges.     

Some limitations of analysis

Abstract :  This paper ¹ considers some of the difficulties that exist in reconciling the 'treatment' and the 'cultural' aspects of analytic ideas and practice; the extent, for example, to which analysis is both ordinary, and extra-ordinary in more than one way. The implications for this for the place of analysis and analytical psychotherapy in the mental health services is considered along with the ways in which there is a diversity of views about the importance of maintaining the presence of analytic ideas and analytic practice in hospitals and clinics. Some of the limitations of analysis are discussed where analytic ideas and methods move away from their application to patients and patients' material into the wider world.     

Capacity limitations in visual word processing

The ability of subjects to process English words in a spatially parallel manner was examined in several redundant-target detection tasks. When redundant targets were identical in a given display, processing limitations were evident in a task that required subjects to make semantic categorizations of words. However, parallel processing of identical redundant target words was exhibited in a lexical decision task that required a structural analysis of letter strings, but not an analysis of word meaning. The difference in performance in the two tasks suggests that the capacity for semantic processing is limited. Analyses designed to examine whether the redundancy gain in Experiment 2 could be attributed to limited capacity processing in conjunction with positional preferences provided evidence against this possibility. In addition, these analyses suggested that the processing times for the redundant targets in Experiment 2 might be positively correlated. In the third and fourth experiments, the redundant-target displays contained two different words. Processing interference, in the form of a redundancy loss, was evident in the lexical decision task, but not in the semantic categorization task, confirming a difference in the mode of processing between the two tasks. The results provide evidence against the unlimited-capacity, parallel processing hypothesis of late selection theories of attention.     

Capacity limitations in human information processing

The nature of processing demands during a letter-match task was investigated in an extension of the Posner and Boies (1971) paradigm. In Experiment I, a visual probe was employed in addition to an auditory probe in two different experimental conditions. The shape of the auditory probe reaction time (RT) function was similar to that found by Posner and Boies. However, in contrast to their findings, RT was greatly increased shortly after presentation of the first letter for the visual probe function. It was concluded that perceptual as well as postperceptual limitations on processing capacity exist. A second experiment provided further support for this hypothesis.     

The limitations of the object relations model

The position expressed in this paper is that there is no drive without object, and no object relationship except in the context of the drives. If primacy is to be attributed to any of the factors involved in mental functioning, it should be to the workings of the pleasure-unpleasure principle; the latter cannot be conceived as independent of the realm of the drives. A clinical case is presented in order to demonstrate why and to what extent it can be severely restrictive to attribute ultimate motivating primacy to a hypothetical object-seeking tendency conceived of as operating outside the sphere of the drives.     

Imagery limitations in totally congenitally blind subjects

Research on totally blind subjects performing tasks that involve visual imagery has often shown that they do not behave differently from matched sighted subjects, even when their blindness is congenital. If visual imagery is based on visual perception, such tasks may not required visual imagery. In the present article visual images are considered as representations maintaining some properties of visible objects and constructed on the basis of information from various sources. Owing to the absence of visual experience, the limitations of such representations are explored in a series of experiments requiring memorization of single nouns, pairs of nouns, or triplets of nouns associated with a cue noun. Recall by blind subjects was impaired when multiple interactive images (with noun pairs and triplets) are formed. The poorer recall of blind subjects reflected also loss of order information. Recall was better for both groups with locative noun cues and high-imagery targets.     

Hemispheric resource limitations in comprehending ambiguous pictures

Ambiguous pictures (Roschach inkblots) were lateralized for 100 msec vs. 200 msec to the right and left hemispheres (RH and LH) of 32 normal right-handed males who determined which of two previously presented words (an accurate or inaccurate one) better described the inkblot. Over the first 32 trials, subjects receiving each stimulus exposure duration were less accurate when the hemisphere receiving the stimulus also controlled the hand used to register a keypress response (RH-left hand and LH-right hand trials) than when hemispheric resources were shared, i.e., when one hemisphere controlled stimulus processing and the other controlled response programming. These differences were eliminated when the 32 trials were repeated.     

Explanatory limitations of cognitive-developmental approaches to morality

In response to Gibbs' defense of neo-Kohlbergian models of morality, the authors question whether revisions in Kohlberg's model constitute a coherent refinement of the cognitive-developmental approach. The authors argue that neo-Kohlbergian measures of moral development assess an aspect of morality (the most sophisticated forms of moral reasoning available to people) that plays a relatively minor role in determining the moral judgments and behavioral decisions people make in their everyday lives. Attempts to conceptualize stages as schema and to redefine moral decision-making in terms of automaticity will not solve these problems. Flexibility is an important aspect of moral maturity. Observed relations between stages of moral development and various forms of social conduct do not establish that the structures of moral reasoning that define stages of moral development exert a significant causal impact on moral behavior. Although cognitive-developmental approaches are equipped to account for some aspects of morality, a more general framework that organizes the insights from other theoretical approaches is needed.