Contacting a 19 month-old mute autistic girl: a clinical narrative

Conveying that psychoanalysis offers rich opportunities for the very early treatment of autistic spectrum disorders, this clinical communication unfolds the clinical process of a 19-month-old 'shell-type' encapsulated mute autistic girl. It details how, in a four-weekly-sessions schedule, infant Lila evolved within two years from being emotionally out-of-contact to the affective aliveness of oedipal involvement. Following Frances Tustin's emphasis on the analyst's 'quality of attention' and Justin Call's advice that in baby-mother interaction the infant is the initiator and the mother is the follower, it is described how the analyst must, amid excruciating non-response, even-mindedly sustain her attention in order to meet the child half-way at those infrequent points where flickers of initiative on her side are adumbrated. This helps attain evanescent 'moments of contact' which coalesce later into 'moments of sharing', eventually leading to acknowledgment of the analyst's humanness and a receptiveness for to-and-fro communication. Thus the 'primal dialogue' (Spitz) is reawakened and, by experiencing herself in the mirror of the analyst, the child's sense of I-ness is reinstated. As evinced by the literature, the mainstream stance rests on systematic early interpretation of the transference, which has in our view strongly deterred progress in the psychoanalytic treatment of autistic spectrum disorders.