Clinical material

Background

Lizzie was diagnosed with autism at age two and a half and referred for psychotherapy by an independent specialist child psychotherapist following an intensive intervention with her and her family when she was just three. During their own fortnightly sessions with a psychotherapist, Lizzie’s parents regularly returned to the traumatic experience of having watched powerless as Lizzie, having met all her developmental milestones at 18 months, then began to ‘lose’ sociability, humour, interest and eye contact for reasons that remain uncertain. Whilst their other daughter Jane, four years older, went from strength to strength both cognitively and socially, Lizzie, aged three and a half at the start of treatment, had no words, no signs, could not bear to see anyone eat or to sit at a table with food and could not be potty-trained. More painfully still, she no longer seemed to recognise or enjoy her parents except for the functions they could perform for her, pulling their hand towards the fridge if she wanted a drink or towards the door if she wanted to leave. Significantly Lizzie appears to have an ongoing digestive problem that causes stomach or bowel pain, which she feels severely, plus serious allergic skin reactions to certain foods, so that both parents and professionals have wondered whether overwhelming pain associated with the mouth and ‘insides’ is implicated in generating her autism. Lizzie is a thin, blonde girl with a dreamy, slightly pained resting expression.

First month of on-going treatment, Lizzie aged three years, six months

When I come to the waiting room, Dad sees me and calls to Lizzie, who at once starts running the other way. Dad quickly catches up with her and easily turns her back to face me. I crouch down and say, “Hi” to Lizzie, who does not acknowledge or look at me, but runs straight past.

Dad gives Lizzie her soft toy ‘Barbar’, picks her up and carries her down the hallway towards our room. I say to Lizzie, “You’ve brought Barbar”; s