Boundaries in the doctor-patient relationship

Boundaries in the doctor–patient relationshipis an important concept to help healthprofessionals navigate the complex andsometimes difficult experience between patientand doctor where intimacy and power must bebalanced in the direction of benefitingpatients. This paper reviews the concept ofboundary violations and boundary crossings inthe doctor–patient relationship, cautions aboutcertain kinds of boundary dilemmas involvingdual relationships, gift giving practices,physical contact with patients, andself-disclosure. The paper closes with somerecommendations for preventing boundaryviolations.     

The nature of learned categorical perception effects: a psychophysical approach

Categorical perception is often cited as a striking example of cognitive influences on perception. However, some evidence suggests the term is a misnomer, with effects based on cognitive not perceptual processing. Here, using a psychophysical approach, we provide evidence consistent with a learned categorical perception effect that is dependent on analysis within the visual processing stream. An improvement in participants' discrimination between grating patterns that they had learned to place in different categories was 'tuned' around the orientation of the patterns experienced during category learning. Thus, here, categorical perception may result from attentionally modulated perceptual learning about diagnostic category features, based upon orientation-selective stages of analysis. This argues strongly that category learning can alter our perception of the world.     

On supervising the pregnant psychoanalytic candidate

The role of the psychoanalytic supervisor is complicated when the psychoanalytic candidate is pregnant. Pregnancy is a special event that brings a unique set of opportunities, as well as problems, into the analysis, though in the past, it was usually regarded only as an impediment. The goal of this paper is to help the supervisor of the pregnant candidate to seize the opportunities and mitigate the problems. The authors make practical suggestions about the handling of maternity leave and the complex theoretical and technical issues surrounding the question of when and how to tell the patient about the analyst's pregnancy.     

Mothers and Daughters as Adults

For most women, their relationship with their mothers, both external and internal, remains important throughout life, although it may be intensely ambivalent. The tension between the ongoing process of differentiation and developing a sense of self, and also maintaining the attachments that have been present during development into adulthood, continue to be present, fluctuating with life events and changes for both daughters and mothers. The body with its similarities to the mother, mutual identification, and competitive aspects is a central area for experiencing this relationship. A patient who illustrates these processes is described.     

Changes in Sexual Orientation and Object Choice in Midlife in Women

Changes in sexual orientation or object choice in midlife can represent many different dynamics. Understanding these involves recognition of the psychological developmental issues of this period, such as changes in self concept, identity, the awareness of time, and changes in expectations and goals, such as the wish to create a family. Other needs, for intimacy and emotional richness, or the revival of wishes for closer ties to one's mother, can then become dominant and be expressed sexually. Earlier, more conventional choices can be abandoned, particularly after children are born. For some women an early homosexual relationship is replaced temporarily or permanently by a heterosexual one. This can represent permission to move outside the world of women, or a wish for a family and children. Fluidity of choice may be more characteristic for women than men and may be related to characteristics of the female body.     

The Female Body and Its Meanings

A renewed interest within psychoanalysis in sexuality and the body has stimulated a reexamination of the female body and its relationship to concepts of “femininity” and feminine body image. The role of the genitals in determining female self-concept needs to be expanded to include object relations and cultural and personal meanings. Nevertheless, specific aspects and determinants of the female body and female anatomy such as the capacity for reproduction do influence female psychology and determine experiences. These are explored in the light of recent contribution.     

Reduced chromatic discrimination in children with autism spectrum disorders

Atypical perception in Autism Spectrum Disorders (ASD) is well documented ( Dakin & Frith, 2005 ). However, relatively little is known about colour perception in ASD. Less accurate performance on certain colour tasks has led some to argue that chromatic discrimination is reduced in ASD relative to typical development ( Franklin, Sowden, Burley, Notman & Alder, 2008 ). The current investigation assessed chromatic discrimination in children with high-functioning autism (HFA) and typically developing (TD) children matched on age and non-verbal cognitive ability, using the Farnsworth-Munsell 100 hue test (Experiment 1) and a threshold discrimination task (Experiment 2). In Experiment 1, more errors on the chromatic discrimination task were made by the HFA than the TD group. Comparison with test norms revealed that performance for the HFA group was at a similar level to typically developing children around 3 years younger. In Experiment 2, chromatic thresholds were elevated for the HFA group relative to the TD group. For both experiments, reduced chromatic discrimination in ASD was due to a general reduction in chromatic sensitivity rather than a specific difficulty with either red–green or blue–yellow subsystems of colour vision. The absence of group differences on control tasks ruled out an explanation in terms of general task ability rather than chromatic sensitivity. Theories to account for the reduction in chromatic discrimination in HFA are discussed, and findings are related to cortical models of perceptual processing in ASD.