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The main concern of this paper will be to study some factors which appear to have impeded or enhanced one particular boy's capacity for growth. Christopher, usually known as “Piffie”, commenced psychotherapy with me at the age of three and a quarter years. He attended four times weekly for the most part, until he was eight and a quarter when treatment was terminated. Two and a half years later his therapy was recommenced and, from eleven until thirteen (his age at the time of writing) he has attended once weekly.
For me the learning value of this work has been greatly assisted by Dr. Donald Meltzer with whom I have had many opportunities to discuss this material, together with a group of colleagues, in a study group on autism.
My earlier work with Piffie preceded the publication of Frances Tustin's contributions to the understanding of autism. But much of Piffie's material will have a familiar ring to those who have followed her illuminating and sensitive studies on this subject and may be understood as contributing further evidence in support of her findings.
It should be stressed however that the periods of psychotherapy to be discussed mainly concern the residual effects of an autistic state. Piffie was probably beginning to emerge from this state before he commenced psychotherapy and he shed its more blatant manifestations within the first year of therapy. Nevertheless traces of former autistic features may still be discerned and they continue to have a constricting effect upon his development.
Christopher is the youngest of three children. At the time of his birth, by Caesarian section, his mother was very anxious, having from her previous experiences reason to fear that he might die. In fact he was healthy, but a very passive baby, sleeping a great deal and never grasping the nipple or bottle teat sufficiently strongly to suck properly. Milk had to be practically poured into him.
At about two and a half a medical friend drew