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This paper will describe work in progress with a boy who was 3-4 years old at the time of referral. At this time he had no speech and there were a number of marked autistic features in his presentation, although no formal diagnosis had been made. He had suffered the trauma of a life-threatening illness requiring major medical interventions at the age of 5 months and again at 18 months, which may have been the precipitating factor for his disturbance. He is from an intact family with an older sister and a younger brother and no apparent significant family pathology.
During the course of his treatment—which has now been ongoing for nearly three years—he has acquired a capacity for play and has become very talkative. Using extensive clinical material, the paper will explore the factors which may have contributed to his improvement, especially the modifications in technique introduced by the therapist in order to make contact with this little boy. Special attention will be given to the role of playfulness, as introduced by the therapist, with particular reference to the way in which this may facilitate the emergence and expression of aggressive feelings and phantasies. The links with the development of the capacity for speech will be explored.