Searching for a sliver of space: working psychotherapeutically with autistic states

Abstract

ABSTRACT This paper explores the emotional and mental barriers autistic children may face in the process of relating to other people as separate individuals. Clinical examples will illustrate these difficulties as they manifested in the therapeutic relationship and in the separation anxiety of two autistic patients. I will also explore the working through of the children’s separation difficulties in their relationship with the therapist. This work entailed both understanding the nature of the patients’ anxiety, as well as actively searching for a sliver of space for the therapist, which the children could tolerate. The work with one patient, who had more pronounced autistic symptoms and was non-verbal for many years, centred on forming bodily-physical separation. The work with the moderately symptomatic patient, who was verbally fluent, focused on tolerating ideational differentiation between him and the therapist. The children’s separation dread was understood by considering both psychoanalytic and neuro-cognitive models of autism. As these issues were worked through, the nature of the therapeutic relationship changed, from mainly consisting of an adhesive connection with the therapist, to more communicative, emotional and personal interactions. The discussion will address the way that the therapist’s use of her body and personality motivated the patients to relate with, rather than adhere to her.