The role of the self-object experience in the therapy of an autistic child: From lying flat to launching a 'spaceship'

In this paper, I describe the first part of a seven-year period of once weekly therapy with an autistic boy aged 4 at the start of treatment. By careful attunement to his affect and internal state, the therapist was able to engage him, allowing him eventually to come out of withdrawal. During this process, the self-object experiences between the patient and the therapist played a remarkable role. I was helped in my thinking by Tustin's (1981) view of the traumatized autistic child and by Meltzer's (1975) work regarding dimensionality in mental function. The patient was a child with cumulative psychic trauma arising from the mother-child relationship. At the start of therapy he was absent-minded and vacant. In the safe, protected therapeutic space, he was able to experience, perhaps for the first time, affective attunement with another. After a year of therapy, communication became possible when the therapist could contain the child's projective identification. He established a more robust skin-ego as he started to play out fantasies and stories symbolizing separation and reunion.