‘Paralysed associations’: countertransference difficulties in recognising meaning in the treatment of children on the autistic spectrum

Abstract

Children with autism can have a paralysing effect on the clinician’s capacity to associate freely: connections that seem obvious on reflection may be impossible to notice in the child’s presence. The author argues that this situation can be reached by more than one pathway, and that the degree of the child’s bodily and emotional cohesion is an important factor. Children may seek to immobilise the therapist’s thought processes through projective identification, whether to communicate their own experience of paralysis or because these thought processes are equated with a parental intercourse that produces a ‘baby’ (as described by Bion and Britton). Vignettes are offered to illustrate how the therapist may be nudged into overlooking this baby as well as a potentially growing part of the child that is identified with it, with important consequences for development. A second possible pathway appears to involve the much more primitive mechanism of adhesive identification, in which the child’s sense of continuing existence depends on sticking to the therapist’s surface and any movement can lead to a sense of bodily disintegration. In the clinical illustration, the therapist felt physically constrained and unable to recognise links in the material: it is suggested that this was in resonance with the child’s fear that movement, whether physical or mental, meant losing parts of his body and must be avoided at all costs. These levels can mask each other, and it seems essential to attend to both in order to avoid impasse or the overlooking of essential aspects of the child’s experience.

Keywords:

• adhesive resonance
• countertransference
• meaning
• paralysis of thought
• projective identification

Acknowledgements

Grateful thanks to Caroline Polmear, Sally Weintrobe, Eric Rhode, Julie Kitchener and Catherine Lemberger.

Notes

1. Rosenfeld (1971) describes a paralysis that is brought about through the operation of the kind of projective identification first described by Klein (1946), in which parts of the self are split off and evacuated into another person so that they can be disowned, or lodged in another person in order to control them. He particularly stresses the extreme paralysis that is caused by an aggressive form of parasitism, mediated by projective identification. This is obviously different from the communicative, ‘evocatory’ projective identification with which I am concerned in this paper.

2. The striking regression reported by Jacky’s parents suggests that a deficit in establishing links in the first place (Alvarez, 1998) is likely to have been a less important factor for him than it can be for other children on the autistic spectrum.

3. I am grateful to the two therapists for their generous permission to refer to their work.

4. Many children with autism, from Klein’s patient Dick onwards, are fascinated by doors and door handles.

5. Similarly, Klein’s Dick bit the father doll’s head, saying, ‘Tea Daddy’, which Klein understood as ‘eat Daddy’.