From chaos to Caravaggio: technical considerations in the psychoanalysis of autisto-psychotic states in relation to sensory-perceptual fragmentation

ABSTRACT

In this article, I describe the psychoanalysis of a girl on the Autisto-Psychotic Spectrum and her struggle to emerge out of a severe autistic pathological organisation. At the beginning of her analysis, the girl was in a state of autistic confusion, which was manifested as a sensorial lack of colour differentiation. Following interpretative working-through of her deep anxieties-of-being, she established a sensorial-emotional ‘wall’, leading to a consolidation of a previously precarious primary splitting. This, in turn, led to a better capacity for emotional perception and differentiation. Further interpretation of her paranoid-schizoid anxieties enabled a gradual emergence of relatedness, communication, concern, and some integration and reparation. Moreover, as the girl’s linking functions, psychic space, object relations and integration improved, her sensory, perceptual and motor skills and integrative capacities improved as well. She eventually emerged into the emotional and sensorial ‘land of colours’. Thus, psychoanalytic psychotherapy, with its linking and mantling functions, proved to be indispensable for both her development, as well as for structural changes in her sensory-perceptual experience.

KEYWORDS:

• Autism
• psychosis
• sensory integration
• autisto-psychotic spectrum
• child psychoanalysis
• transference

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No potential conflict of interest was reported by the author.

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Joshua Durban

Joshua Durban is a training and supervising child and adult psychoanalyst at the Israeli Psychoanalytic Society and Institute, Jerusalem and Tel Aviv (IPA) where he also teaches. He is on the faculty of the Sackler School of Medicine, Tel-Aviv University, The Psychotherapy Program, Post-Graduate Kleinian Studies. He is a member of the IPA inter-committee for the prevention of child abuse. He has a private practice in Tel-Aviv and specializes in the psychoanalysis of ASD and psychotic children, adolescents and adults.