Surviving Black Holes and Finding the Third Dimension, with Alex

Abstract

This article discusses challenges in the treatment of a child, Alex, who is 11 years old when he begins treatment with the author. By the end of Alex’s first year of treatment, his sessions have become so deadening that his therapist often struggles to stay awake. Some days, she remains alert, but finds herself unable to feel or think. During a particularly grueling stretch, the author encounters Francis Tustin’s The Protective Shell, Tustin’s account of her psychoanalytic work with autistic children. Tustin’s ideas, when used by this author, have a transformative effect on Alex’s treatment. The author comes to understand that Alex employs autistic defenses, or protections—i.e., he is partially encapsulated. Tustin’s formulations regarding the etiology of autistic protections facilitate new possibilities for understanding and metabolizing Alex’s communications. In addition, the author grasps the importance of becoming a bolder and more active therapeutic presence with Alex.