Bisagni, Francesco. ‘The sound-hand’.  J. Amer. Acad. Child Psychiat., 2009,  35, 3, pp.  229-49.

This clinical article focuses on the four times a week analysis of a severely autistic child named Daniel. It provides a rich description of a child analyst's sensitive use of imaginative processes in his therapeutic work that proved to be ultimately quite helpful for this autistic child's mental growth and development. The most fascinating part of the article is a description of, as well as reflections upon, the rhythm of sounds that create safe spaces within the interactions between analyst and analysand during the analytic work. The sounds that the analyst provides, and which are responses to Daniel's sounds, creates a kind of primary skin in which the analytic work can safely unfold and take place. Rhythmic sounds are distinguished from stereotypical and meaningless sounds produced by the analysand, and their function of activating representations and amplifications in the child analyst's mind are explored in the stage of treatment when the child does not yet speak. The article views the analytic work from the perspectives of post-Jungian (Fordham) and post-Kleinian (Bion, Alvarez, Tustin and Maiello) analytic thought. It also explores some neuroscience research contributions to a possible understanding of dialogue, empathy and rhythm.

Bisagni, like Fordham, views autism as linked to a weak capacity of the self to undergo the sequences of de-integration and re-integration. This he believes could lead to a fracture in the rhythmic subject-object interplay. My own understanding—obtained through infant observations of babies who later develop autistic symptomatology—is that the infant and the caregiver/attachment figure are often caught in an awkward dance in which rhythm, tempo and the interplay of sensuous contact which are predominant features of the interpersonal and intersubjective interchange are not in synch and the infant/caregiver couple are in a sense out of step with each other. For the