‘I caught you!’ Part 1: maturing separateness within the area of mutuality

ABSTRACT

This paper, the first of two parts, aims to highlight the unique contribution that intensive psychoanalytic psychotherapy can make with complex cases where, in the absence of an engagement with another mind, self and ego development have been severely arrested. Intensive therapy with a boy aged four who was diagnosed with autism at the age of two is examined, to illustrate how the mind is both internally driven and relationally responsive. This work illustrates how the experience of analytic mutuality enables the development of the child's mental capacity for representation and symbolic thought, as well as relationality. Autistic encapsulation is understood as a psycho-physical protective reaction, rather than a psychodynamic defence mechanism. Clinical vignettes demonstrate how the therapist gradually emerges in the child's mind as an object to relate to and be made use of, alleviating arrested development and enabling the child to evolve from an almost mute, ‘undrawn’, confused and confusing child, into a latency boy with social, academic and behavioural skills.

KEYWORDS:

• Psychogenic autism
• adhesive identification
• psychoanalytic mutuality
• effects of neglect and violence

Acknowledgments

I am so grateful to Anne Alvarez's generous support, containment and guidance throughout this work. Without Anne, this work would not have been possible. I would also like to thank Alexandra de Rementaria and Rachel Acheson for their thoughtful editing of this paper.

Disclosure statement

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

Notes

1. Tao's mother gave written consent for scientific presentation and publication purposes at the end of the work. Eight years after this, I wrote this paper and contacted Tao (who by then was 18) and his mother to renew consent. They were given the opportunity to read the paper, which they accepted, and both gave consent for it to be published.

Additional information

Notes on contributors

Sheila Levi

Sheila Levi is a senior child and-adolescent psychotherapist, adult psychoanalyst, and chartered clinical psychologist. She works full time in private practice, teaches at Birkbeck University. Sheila previously worked for 15 years as a Highly Specialised Clinical Psychologist in Barnet, Enfield and Haringey Mental Health Trust Tier 3-4 services. This included work in adult services for asylum seekers and refugees and learning difficulties services, and in children and adolescent mental health services (CAMHS) with high risk, complex needs adolescents, and with children, adolescents and their families with moderate to severe learning difficulties and neurodevelopmental disorders. Coming from an ego psychology background through her clinical psychology training at Bogazici University – Istanbul, Turkey, she chose to do her analytic trainings in the UK, due to her interest in integrating object relations theory with theory of mind thinking. She has managed several applied psychoanalytic community projects in Turkey, Israel, and London. She specialises in psychodiagnostic and complex case studies, and has presented in various national and international conferences and scientific meetings in the UK. She has previously published papers and book chapters.