Beginning Treatment of an Autistic Child from An Intersubjective Perspective

This paper describes the first few months in the psychoanalytically oriented psychotherapy of an autistic girl.1 As such, this report is preliminary, designed to provide an example of the kind of treatment possible using an intersubjective perspective. The focus is on the process of beginning treatment, in particular on the evolving intersubjective field, and on the special difficulties and demands which come up for the therapist in working in this way with an autistic child. Attention is given to establishing a self-self object relationship which makes possible the beginnings of transformation in the tie and the ensuing changes in the child's subjective experience of the world.2

Before beginning the case study, a brief outline of the theoretical foundation upon which the therapist based her understanding of the treatment as it unfolded is given. A more complete discussion of this theory is provided elsewhere (Roser & Buchholz, 1996). Using Stolorow et al.'s conceptualization of the intersubjective field (At-wood & Stolorow, 1984; Stolorow & Atwood, 1992), it is postulated that at the center of normal development is the creation of a mutually regulatory system between infant and caregiver which “provides the infant with a consistent experience of being cared for and responded to. This system is the foundation for the establishment of a sense of self based on a ‘self-with-other’ experience” (Roser & Buchholz, 1996, pp. 307-308). This regulatory experience begins in the “rich network of constancies” (Sander, 1975, p. 139) established between caregiver and infant. From this network of constancies, an