From Confusional Entanglement to Sense of Self: Aetiology, Thinking and Process in Work with an Autistic Boy

This paper arose from thinking about eighteen months of therapy with Dean, a latency autistic boy who, I felt, had begun to emerge as a clear personality from a muddled mass of confusion and autistic symptoms. As he issued from his state of psychic ‘confusional entanglement’ (Tustin, 1990), he could be seen to be developing an independent sense of himself and others.

In parallel, however, I found that I was less than clear about the concept of autism: somehow, the autistic disturbance is such that it is particularly difficult to conceptualize. Autistic children themselves seem to be in the grip of occurrences which appear to have little or no mental existence for them and in which their behaviour seems to carry no meaning at all. In my work with Dean this difficulty in thinking and in attributing meaning has been reflected both within the treatment itself and externally in the complex care network surrounding this child.

An additional factor has been the emotionally taxing nature of the