Contacting a 19 month-old mute autistic girl: a clinical narrative.

Conveying that psychoanalysis offers rich opportunities for the very early treatment of autistic spectrum disorders, this clinical communication unfolds the clinical process of a 19-month-old 'shell-type' encapsulated mute autistic girl. It details how, in a four-weekly-sessions schedule, infant Lila evolved within two years from being emotionally out-of-contact to the affective aliveness of oedipal involvement. Following Frances Tustin's emphasis on the analyst's 'quality of attention' and Justin Call's advice that in baby-mother interaction the infant is the initiator and the mother is the follower, it is described how the analyst must, amid excruciating non-response, even-mindedly sustain her attention in order to meet the child half-way at those infrequent points where flickers of initiative on her side are adumbrated. This helps attain evanescent 'moments of contact' which coalesce later into 'moments of sharing', eventually leading to acknowledgment of the analyst's humanness and a receptiveness for to-and-fro communication. Thus the 'primal dialogue' (Spitz) is reawakened and, by experiencing herself in the mirror of the analyst, the child's sense of I-ness is reinstated. As evinced by the literature, the mainstream stance rests on systematic early interpretation of the transference, which has in our view strongly deterred progress in the psychoanalytic treatment of autistic spectrum disorders.

From mimesis to agency: clinical steps in the work of psychic two-ness.

In this paper, through the study of the clinical process of a girl starting treatment at the age of 3 years 10 months, who was thought of as a 'dummy' by her family and who came for consultation when the assumed genetic aetiology was questioned, the authors build upon Tustin's contributions on the context of togetherness and the crisis of two-ness, and upon Eugenio and Renata Gaddini's on the precursor object. The mimetic phenomena enacted with an older brother and at the kindergarten are found to result from cumulative trauma at her contacting a loving but mind-blind mother. After an initial stage of transference autism, enactment in the session of the traumatic situation was the ?rst step in surmounting her autistic pseudo-stupidity. Mimetic transference dynamics took place principally at the level of the gaze, leading to the unfolding of the work of two-ness to a differentiation from the analyst as psychic breast, on the road to symbol formation and personal agency.

Clinical notes on a case of transvestism in a child.

This clinical presentation describes the therapeutic process of a 5-year-old male child presenting as a main symptom quasi-delusional feminine enactments starting at an early age, which persisted for most of his five-year treatment. This symptom was understood in terms of an attempt at restitution, itself the result of being confronted with an autistic structure stemming from a series of traumatic incidents during the oral phase: his mother's pregnancy, abortion, depression and subsequent three-month absence at the end of his first year of life. The clinical material, drawings included, illustrates the interplay of oral, anal and phallic levels, with enactment predominant in sessions. The oral traumatic situation initially led to anal-manic play, then to quasi-delusional female personifications in sessions, later surfacing as an annihilating 'black hole'. All the above issued into a broad enacted phallic-genital unfolding that dramatised an oral-genital primal scene, in the course of which he managed to structure his male identity. Near the end of the analytic process the analysand reworked the 'stages' of the link to the analyst. To end, based on the clinical material, the respective participation of the early and the late Oedipus complex is examined.