High-functioning autism: changes over fourteen years of psychoanalytic psychotherapy: part 1

Abstract

ABSTRACT This paper is both a follow-up and a lead-in. It follows up an earlier contribution [(Holloway, R. (2013). On emerging from autism and into the terror of relationships. Journal of Child Psychotherapy, 39(1), 39–58. https://doi.org/10.1080/0075417X.2012.761422)] to this Journal dealing with the author’s work with his patient Sam, who has high-functioning autism (HFA). This earlier contribution discussed Sam’s treatment from 2007 to 2012. The current paper revisits some aspects of the 2013 paper, but with a different thematic focus. It adds material from a more recent period in Sam’s therapy, from 2012 to 2021. The focus in this paper vis-a-vis the early part of Sam’s treatment is on the sadomasochistic aspects of his graphic novels, attempting to understand the origins of this sadomasochism. It also discusses recent aspects of Sam’s therapy, including a turning point in which Sam’s ability to use projective identification communicatively eventuates in an experience of emotional at-one-ment between us. This paper is also a lead-in to a pair of additional papers which will follow in future issues of the Journal. The two following papers are intended to further flesh out Sam’s clinical picture. The next two papers will thematise Sam’s psychosexual development up to the present time and the shifts in Sam’s defensive structures and functioning.