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

Abstract

ABSTRACT This paper is the second of three, outlining different aspects of my patient Sam’s fourteen years of psychotherapy. This second paper focuses on two aspects in the work. The major issue involves Sam’s psychosexual development from eleven to twenty-four years of age, emphasising the autistic level of the Oedipus complex. The second issue is the decline and eventual disappearance of Sam’s autistic rituals, which he had used in his treatment. The discussion of his psychosexual development includes the perverse and sadomasochistic aspects tied into his sexuality, along with powerful castration anxieties, which were also tied into annihilation anxieties. More recently, Sam has been consciously concerned with behaving ‘appropriately’ with women, but with unconscious fears of his own sexual impulses regarding being bullying and aggressive. Autistic rituals were not uncommon in the early part of Sam’s treatment. I outline in detail the last autistic ritual he showed me, during his sixteenth and seventeenth years. No further rituals have been observed from Sam’s eighteenth year onward. I conclude with some observations on how Sam responded to the sudden switch from in person to online psychotherapy in March 2020.