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

ABSTRACT

This paper is the third of a triptych of papers. The word ‘triptych’ refers to traditional religious paintings, where three panels are joined with hinges. Each of the three papers in this triptych outlines certain aspects of my patient Sam’s fourteen year psychotherapy. When these papers are read together, they provide a detailed exploration of the most noteworthy changes I have observed in Sam over the fourteen years of our therapeutic relationship. This third and final part deals with the way that Sam’s defensive structures have developed and shifted over fourteen years. It integrates material from all three papers, and makes a foray into theorising about some possible aetiological sources of ASD, emphasising psychodynamic aspects. Taken together, the three papers are my effort to map out the important psychodynamic changes in Sam’s functioning across fourteen years of treatment.

KEYWORDS:

• alpha function
• adhesive identification
• autism
• autistic rituals
• autistic-contiguous position
• autistic shapes
• beta elements
• caregiving field
• castration
• autistic defences
• existential anxieties
• ingratiation
• mantling
• sadomasochism

Acknowledgement

I would like to acknowledge and thank my editors, Maria Papadima and Alexandra de Rementeria, for their supportive and unswerving efforts in transforming one horribly oversized manuscript into three publishable articles.

Disclosure statement

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

Notes

1. Emanuel (2015, p. 58) comments that autistic people have the most difficulty processing sensory data within interpersonal situations, including ‘the feeling of affection that is implied and experienced by individuals sharing a hug.’ Though this is true, the point is precisely that erotic and affectionate aspects of hugs were not the crucial issue for Sam, but instead, the autistic-contiguous contact with a skin surface.

2. Tustin suggests an experiment to understand the notion of an autistic shape. She tells us: ‘Forget your chair. Instead, feel your seat pressing against the seat of the chair. It will make a ‘shape’. If you wriggle, the shape will change. Those ‘shapes’ will be entirely personal to you. The autistic child’s attention becomes so focused upon these entirely personal ‘shapes’ that the chair, as such, is not important to him ….’

3. See, Acquarone and Acquarone (2016) for details (especially pages 22 and 44–45). They comment that ‘Early events determine which circuits in the brain will be reinforced and retained and which will be pruned’ (p. 45). They additionally note that if the process of synaptic pruning ‘is affected, it can lead to sensory overload in the child’ (p. 22).

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. Robin is honoured to participate as a member of the Child Department of Psychoanalytic Education, ASD Committee of the American Psychoanalytic Association.