Transference and countertransference in the analysis of a child with autistic nuclei

The author stresses the importance of using the countertransference when working with autistic and borderline children, in whom severe disorders of cognitive and emotional development have not permitted the establishment of an internal three-dimensional space whereby emotions can be contained, meaning can be assigned to those emotions and symbols can be formed. She argues that the transference will arise gradually in response to the analyst's countertransference. Great importance is attached to the setting in both its material and psychic aspects, the stability of the former being essential because of the patient's two-dimensional mode of functioning, in which he lacks any representation of space and time. After a review of the theoretical background to the treatment of autistic children with particular reference to the work of Houzel and Tustin and a brief discussion of general aspects of the transference in the light of the views of Freud, Klein and Bion, the author turns to the clinical material proper, presenting vignettes from a number of sessions in the analysis of an autistic boy. These show how she utilises her own emotions, sensations and associations to gain information about the patient's state and, by assigning meaning to these manifestations and communicating it to him, to impart motion to his frozen internal world. The author reports that, after several years of analysis, the patient has introjected a stable object that will lead to healthier development and a sense of security.