Co-Construction of a Common Language: From Shared Silence to Psychoanalytic Dialogue With a Patient on the Autism Spectrum

This paper explores the challenge of constructing a common language between the analyst and a patient on the autistic spectrum. It describes the difficulties the patient encounters using words and exemplifies the process that leads to shared ways of communicating. It relies on clinical fragments from the work with a patient, now 18, who has been in psychoanalysis four times a week since age two and a half. At the beginning, there was no verbal communication or eye contact and no representation of space between self/other and between the patient’s sounds, which were long, apparently meaningless sequences, sought for the sensation they provided. Crossing the space between inside and outside triggered the anxiety of falling. Communication began with elementary forms of attunement. Shared experiences within the setting’s rhythmicity helped to transform the patient’s sense of intolerable emptiness into a representation of space within oneself and between oneself and the other. Out of a two-dimensional/adhesive situation, patient and analyst were able to create forms of mediation to cross space and adventure into the intangible dimension of imagination, granting at least partial access to abstract conceptions. The way the analyst listened to and addressed the patient as a subject as well as the patient’s role as a promoter was important in this transformation. The patient’s active role in co-constructing a common language led to a more cohesive self and the capacity to reflect on his own experience.