The Psychotherapeutic Treatment of a Psychotic Child with Marked Autistic Features

This is an account of psychotherapy with a psychotic boy for whom the diagnostic prognostications had been very gloomy. For one thing, a previous analysis had broken down due to difficulties with the parents; for another, the child was nine years of age, and his psychosis was so severe and long-standing as to seem intractable. The author found that the main difficulty in working with this child was the autism associated with his psychotic pathology. The core feature of all autism is the disturbance in the primary relationship with the suckling mother. For this difficulty to be explored within the infantile transference of psychoanalytic psychotherapy, an orderly setting had first to be established.

The usual psychoanalytic child guidance methods were somewhat modified in order to cope with the exigencies presented by this case. For example, as the result of the parents' clashes with the colleagues working with them, the child's therapist worked directly with the parents so that they began to take an interest in their child, and also to take responsibility for the regularity and continuance of his attendance for psychotherapy. There were also continuous adaptations of the usual psychoanalytic methods of psychotherapy, the need for which becomes clear as the paper proceeds. It is demonstrated how, by patience, perseverence and willingness to adapt to and learn from them, a therapist can help some seemingly hopeless psychotic children to function relatively normally.