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Experiences of psychological connection between analyst and patient have an inexorably curative impact in child and adolescent psychotherapy. Ionas Sapountzis highlights play therapy techniques during shared moments of attunement with markedly unrelated children who are depicted as retreating from bad internal objects and persecutory family realities. Rather than dissociating in the face of trauma, these children often become increasingly isolated and difficult to engage as they withdraw from peers and family members, and from play itself. Following the work of Klein, Bion, Winnicott, and Ogden, Sapountzis carefully documents the use of drawings with a withdrawn 11-year-old girl whose mother died, and the construction of Lego airplanes and fantasies about planes with a withdrawn 11-year-old boy who suffered from intense fears and sleep disturbance. These vignettes sensitively illustrate how shared moments in sessions foster the withdrawn child's involvement in therapy and enhanced sense of identity and self-efficacy. By facilitating severely withdrawn children's play, the therapist allows for an emotional engagement that circumvents the degree of withdrawal that Steiner (1993) categorizes as a protective, psychic retreat and Tustin (1972, 1980, 1986) classifies as an autistic defense against both paranoid-schizoid and depressive anxieties.
As a commentary on this paper's discussion, I would like to make two brief points about withdrawal and the use of the term autistic to describe defensive processes. First, children's reliance on withdrawal reflects a spectrum of psychopathology and defenses against interpersonal and environmental trauma, as well as internal states of overexcitation. Second, the use of withdrawal can be understood according to a continuum of psychopathology