The psychoanalytic psychotherapy of a mentally retarded man

In this paper, the author discusses the psychoanalytically informed treatment of a 25-year-old patient, who at the beginning of treatment was severely developmentally retarded. The patient showed repetitive behaviours (tapping his fingers, tying and retying his shoelaces); visual and auditory hallucinations, delusions, vague to absent ego boundaries; inability to do simple maths, tell the time, read or write; and angry vulgar outbursts accompanied by occasional throwing of objects. He was bewildering and unresponsive to various psychological and physical treatments that had been performed since his infancy. The patient had been examined by a variety of medical and psychological specialists, but he seemed to belong in no particular place in the system of health-care providers. All courses of drugs that were tried proved ineffective. This author presents clinical material from a psychoanalytic psychotherapy that resulted in remarkable improvement in the patient's capacity for self-reflective thought as well as in his capacities for more mature object relationships and work. More specifically, the author discusses aspects of the treatment he thinks were most pivotal: (1) the interpretation of sensation (autistic) states; (2) the use of countertransference derived understandings of the patient's intra- and intersubjective experiences to guide his interventions; (3) the use of sensation-based communication in a verbal form of play.