Anne Alvarez Replies

I was interested to learn of the views of Gerland and Sainsbury on Live Company. I was sorry, however, that they saw my book as representative of Bettelheim's view on aetiology, since I thought I had been careful to argue against a simplistic environmental aetiology. Also, I was sorry that they saw it as representative of a traditional psychoanalytic perspective: the book was an account of my struggle to understand precisely why certain traditional psychoanalytic ideas were inadequate in the treatment of people with autism of Robbie's type. I certainly did not write the book to show that psychoanalysis is the only way of understanding and treating autism. On the contrary, I was exploring why some of the traditional psychoanalytic theories and techniques were not helpful with Robbie's autism. I tried to show that a model of the mind which concentrates too much on the concepts of 1) defence against anxiety, 2) resistance and 3) withdrawal as intentionally motivated was often unhelpful for people who have deficits in the capacity for interpersonal relatedness and in symbolic functioning. I came to learn, for example, that Robbie was more undrawn than withdrawn. In the case of some of the non-autistic but nevertheless severely damaged children described in the second part of the book, I suggested that such a model was at times even harmful (at other moments, it was essential). So I am in many ways in considerable agreement with Gerland and Sainsbury.

However, in the book I did go on to point out that psychoanalysis itself has changed greatly in the last century, that modern ideas make much less use of a defence model – some American analysts, for example, insist that a concept of deficit must accompany the concept of defence (Kohut, 1985) and the work of Winnicott (1958) and Bion (1962) in the UK has led to much less emphasis on explanatory interpretations and more on slow careful description and containment – helping thoughts to become thinkable (what Alan Schore (1998;