High-functioning autism: changes over fourteen years of psychoanalytic psychotherapy: part two

ABSTRACT

This paper is the second of three, outlining different aspects of my patient Sam’s fourteen years of psychotherapy. This second paper focuses on two aspects in the work. The major issue involves Sam’s psychosexual development from eleven to twenty-four years of age, emphasising the autistic level of the Oedipus complex. The second issue is the decline and eventual disappearance of Sam’s autistic rituals, which he had used in his treatment. The discussion of his psychosexual development includes the perverse and sadomasochistic aspects tied into his sexuality, along with powerful castration anxieties, which were also tied into annihilation anxieties. More recently, Sam has been consciously concerned with behaving ‘appropriately’ with women, but with unconscious fears of his own sexual impulses regarding being bullying and aggressive. Autistic rituals were not uncommon in the early part of Sam’s treatment. I outline in detail the last autistic ritual he showed me, during his sixteenth and seventeenth years. No further rituals have been observed from Sam’s eighteenth year onward. I conclude with some observations on how Sam responded to the sudden switch from in person to online psychotherapy in March 2020.

KEYWORDS:

• Annihilation anxiety
• autism
• autistic-contiguous position
• autistic rituals
• castration anxiety
• existential anxieties
• part objects
• Oedipus complex
• projective identification
• separation
• symbolic equation

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1. Other aspects of this graphic novel, the sadomasochistic ones, were discussed in Part One of this triptych in Volume 47(1) of this Journal.

2. A ‘mohel’ refers to the person who performs the circumcision in the Jewish rite, the bris or brit milah.

Additional information

Notes on contributors

Robin Holloway

Robin Holloway is a Registered Psychologist providing psychoanalytic psychotherapy to children, adolescents, and adults in Toronto, Canada. Robin has two doctoral degrees. One is in educational theory and the other in developmental/clinical psychology. He is a graduate of CICAPP (The Canadian Institute for Child and Adolescent Psychoanalytic Psychotherapy) for which he is now a supervisor and a teacher. Robin is in private practice at The Willow Centre in Toronto, Canada. At The Willow Centre, Robin has the privilege of working with a small group of like-minded clinicians where together we can discuss cases, and where he has had the unique opportunity of discussing aspects of this paper with his enormously helpful colleagues. Before joining his colleagues at The Willow Centre, Robin worked for over 20 years in the Child and Family Services department of a public hospital where he participated in weekly assessments of children referred for possible autism spectrum disorder. Inspired by this experience and by hearing Anne Alvarez speak about autism to a group of graduate psychoanalytic psychotherapists (the Canadian Association of Psychoanalytic Child Therapists), Robin went on to develop a special interest in children with autism and Asperger’s. This in turn has led to several publications, including this one.