The gaze, the mirror and representation of a self in the treatment of a young boy with pervasive developmental delay and marked autistic features

Abstract

This paper explores the ways in which the ‘recognition of a self’ aspect of mirroring, as epitomised by the mother’s gaze of her newborn at the breast, served to set development in motion in the case of Adam, a little boy of four and a half, who was referred for psychotherapy after receiving a diagnosis of pervasive developmental delay with marked autistic features. The paper uses detailed clinical material to track Adam’s development of a representation of his self and his object and his use of the mirror in this process. The author shows how Adam went from not recognising his reflection in the mirror to seeing the reflection of himself in the therapist’s eyes and then using the mirror to support his exploration and internalisation of the permanence of his self and his objects as well as their physical and psychic characteristics and functions. The author also seeks to demonstrate ways in which Adam’s use of the mirror facilitated emotional engagement and working through of painful aspects of the infantile transference: these included primitive anxieties related to being seen and taken into the mind by the object; feelings of terror and loss inherent in experiencing the self and the object as separate; and intense rivalry and envy of the other occupants of the object’s mind. Lastly, the author seeks to show how Adam’s work at the mirror linked to the emergence of verbal language and the development of symbolic thinking.

Keywords:

• autistic states
• mirror
• mirroring
• self
• traumatic disillusionment
• infantile transference

Acknowledgements

Sue Reid and Meira Likierman’s supervision helped me immeasurably in the first two years of Adam’s therapy. Maria Rhode’s comments about the material and her supervision of my work with Adam in the last three years of his psychotherapy allowed me to think about how he passed from the mirroring eyes to the discovery of internal landscapes. I am deeply grateful for her careful rereading of this paper and her thoughts and insights, which permeate the paper and which I have interwoven with my own. I am equally grateful to my colleague Alain Taieb for believing that Adam could benefit from psychoanalytic psychotherapy and supporting the work throughout. I am also grateful for Tony Lee's careful rereading of the paper and for all the added references to developmental research related to the material. This is a tribute to Adam’s mother whose courage and love for Adam helped him to bear the pain that development entailed.

Notes

1. I should like to acknowledge Tony Lee for bringing these ideas to my attention.