Comparing a narcissistic and an autistic retreat: 'looking through or at the window'

In this paper I discuss two different forms of psychic retreats that I encountered in the treatment of a patient who suffered from two traumatic experiences: the loss of his mother when he was 2 years old and his 'near-death' experience when he was five. In the parasitic narcissistic retreat, using intensive projective identification enabled him to create an impasse in the form of a 'high tide - low tide' scenario in which alternating hope and disappointment kept the process going, yet paralyzed development. The autistic retreat, for its part, led to the collapse of projective identification mechanisms, dismantling and disrupting the transference/countertransference negotiations. The emerging state of non-communication and 'near death' seemed to act as a protection against the unbearable pain of abandonment and desolation.     

Controlling,Avoiding, or Protecting the Object: Three Reactions to the Breakdown of Psychic Retreats

In working psychoanalytically, it is common to encounter patients who need to carefully manage their immediate objects. This is evident in their stories about external life at home, at work, and with friends as well as in how it emerges within the transference. While a frequent theme in many analytic cases, the motives behind this need are varied.

Case material is used to show how these reactions emerge when psychic retreats fail. When unable to find refuge in pathological organizations or psychic retreats, patients are exposed to the worst of paranoid and depressive anxieties with only a fragile foxhole to withdraw into or defend from. In such a precarious psychological state, fantasies of unbearable self and object danger emerge, leading to various forms of acting out, overreliance on projective identification, and perverted images of giving and receiving. These fantasies result in the desire for idealized objects, the drive to resurrect fallen objects, and the need to avoid cruel and attacking objects that have taken over and replaced the sought out ideal.     

Mirroring,imitation, identification: the sense of self in relation to the mother's internal world

The phenomenon of neonatal imitation, and the use of mutual imitation by mother and baby in the service of attunement, are considered in relation to psychoanalytic theories of mirroring, imitation and identification. Material from infant observation and from the treatment of two children on the autistic spectrum is discussed in terms of the suggestion that developmental imitation implies a perceived position of balance between the external baby and the mother's supposed internal occupant. This is seen as making possible introjective identification and assimilation, with the enrichment of the sense of identity, in contrast to the kind of imitation involving mimicry, in which adhesive or projective identification may be operative.     

Autistic defenses in agoraphobic syndrome: "flat" objects and the retardation of projective identification

The function of autistic defenses in the generation of agoraphobic symptoms is explored in the case of a patient treated in psychoanalytic psychotherapy. The therapist's growing awareness of autistic modes of relating in the case facilitated various changes in the transference relationship. Although oedipal concerns are seen as important, a formulation is presented whereby autistic modes of generating experience are viewed as fundamental to an understanding of agoraphobic experience. Clinical findings in the transference-countertransference relationship led to the additional observation that the retardation of defensive forms of projective identification further contributed to the patient's agoraphobic difficulties. This formulation is tied theoretically to the idea that agoraphobic experience occurs when the dialectic between paranoid-schizoid and autistic-contiguous modes of generating experience collapses. The treatment implications of these observations are briefly explored.     

Murder: A psychotherapeutic investigation

This paper suggests that it is theoretically necessary and clinically useful to make a distinction between two types of psychic encapsulation within the broader literature. The proposed distinction, as it relates to these psychic structural manifestations, is illustrated here as applied to anorexia. The author suggests that psychic encapsulation is commonly encountered in work with anorexics, and that each type seems to imply a somewhat different therapeutic course. The distinction is made between anorexic patients who appear to display evidence of autistic/autistoid encapsulation as opposed to those who seem to manifest non-autistoid/later traumatic encapsulation – termed secondary adjunctive encapsulation in this paper. Defensive encapsulations are associated with pathological organisations of the personality – both within and beyond these structures, they exert an organising power over central mental processes. Psychic encapsulation and pathological organisations are defensive structural developments – the result of psychic trauma. Clinical material from three cases is presented to illustrate the arguments.     

Projection and projective identification: developmental and clinical aspects

Projective identification and projection are defined, described, and contrasted. Projective identification is seen as an early or primitive defensive operation, and projection as later or more advanced and derivative in nature. The developmental origins and adaptive functions of projective identification are examined with an emphasis on the cognitive preconditions for the operation of this defense. The varying functions of both defensive operations are described within the context of psychotic, borderline, and neurotic personality organization. Case material is presented to illustrate the diagnostic approach to and the clinical functions of projective identification, particularly its importance in contributing to complementary identification in the countertransference. Also illustrated is the technical management of severe transference regression under the impact of projective identification. Finally, alternative approaches to the diagnosis and interpretation of projective identification are discussed.     

ACQUISITION OF SIGN LANGUAGE BY AUTISTIC CHILDREN. I: EXPRESSIVE LABELLING

There has been growing interest in teaching sign language to autistic children who have failed to develop speech. However, controlled experimentation in this area is nonexistent. In the present study, four nonverbal autistic children were taught expressive sign labels for common objects, using a training procedure that consisted of prompting, fading, and stimulus rotation. The efficacy of the procedure was demonstrated in a multiple-baseline design across objects. The results were reliable, replicable across children, and generalizable across therapists. A stimulus control analysis demonstrated that, for three of the children, correct signing was controlled solely by the visual cues associated with the presentation of a given object and was independent of the auditory cues related to the same object. These latter results are discussed with respect to the known perceptual and linguistic deficits of autistic children.     

On psychic elements in a case of autistoid perversion

The paper explores the formation of psychic elements from an epistemological point of view, drawing on the work of Bion to examine a clinical case of autistoid perversion. Distinguishing the qualification of psychic elements from the realization of pre‐conceptions, the paper argues that psychical elements are constituted through a mutually shared experience of presence, and so they should be understood in a paradoxical way – through being‐O and transformations into K. These ideas are explored via a clinical case concerning a patient with an autistoid–perverse organization. The patient had been denied any bodily contact with her parents during her first year of life due to an infection; in later life she exhibited an autistoid coprophilic perversion. During the course of her treatment, as it became possible to break down the autistoid organization, the nameless contents surfaced in a mutually shared experience of presence. The analyst was able to hold on to their meaning, which was unavailable to the patient. The absent analyst, however, turned into the mother who ‘put the child down’ and was experienced by the patient as a suicidal threat. In being‐O, the analyst was able to endure the paradox of being the one who ‘put her down’ in order not to put her down; the paradox of being‐O functioned as a container for the destructive objectal dimension of the state of ‘being put down’.     

From pilot fish to analyst: Finding a path between symbiotic and autistic defences

This paper presents the clinical case of a patient with autistic features. One of the main difficulties in his treatment was the particular rapid rhythm of his projections, introjections and re‐projections that constrained the analyst's capacity for reverie and hindered the use of effective projective identification processes. These alternating defensive constellations lead either to an expelling autistic barrier or to an engulfing symbiotic fusion. Their combination can be seen as the expression of a defence against an unintegrated and undifferentiated early experience of self that was in this way kept at bay to prevent it from invading his whole personality. Maintaining the symbiotic link, in which I kept included by staying partially fused to what was being projected and using my analytic function in a reduced way, helped to relate to what was in the patient's inside. Leaving this symbiotic link let my interpretations appear to ‘force’ their way through the autistic barrier. Yet as the process developed they allowed to show the patient how he ejected me and what was happening in his inside, behind his autistic barrier. So I found myself on the one hand accepting the symbiotic immobilization and on the other hand interpreting in a way that seemed forced to the patient, because it implied a breaking of the symbiotic position. The inordinate speed of projections and introjections could thus be interrupted, creating a space for awareness, reflection and transformation, and allowed the emergence of a connection between the patient's inside and outside. In the course of treatment I realized that this kind of dual defence system has been described by the late Argentinian analyst José Bleger. He assumes the existence of an early “agglutinated nucleus” that is held together by a psychic structure he calls the “glischro‐caric” position, in which projective identification cannot take place because there is no self/object differentiation. I have considered the rapid and fugitive use of projection and re‐introjection I met in my patient to be a manifestation of the dual defence system Bleger describes. Although he does not specifically mention this particular vicissitude of operative defences he does give hints about a rhythm in the patients’ projections and introjections.     

Breakdown of Intimacy. Insights into the world of a depressive lock-in

Breakdowns are states in which the continuity of being was destroyed. A breakdown has happened but could not be experienced. It is not possible to observe these states because they are beyond our intuition. We have to paraphrase them as ‘shadow’, ‘non-existence’, or ‘black hole’. In these dynamics, the development of a Super-Ego precedes the development of the ego. Under such a Super-Ego, the unthinkable turns into omniscience – no intimacy is left.

This process is demonstrated using the example of a treatment in which a patient regresses into a severe autistoid depression (major depression). In a depressive lock-in, all mental life collapsed and intrapsychic and interpsychic communication was not possible, neither of the depression nor of the panic. The ‘me’ is threatened with dissolution, the ‘not-me’ is flattened into a two-dimensional non-existence. For the analyst, it is nearly impossible to understand anything, to build up any empathy, i.e., to grasp the depression intuitively. Finally, intimacy gets lost – until it is possible to communicate this agony (e.g., by projective identification).     

Projective identification and the therapist's use of self

This article addresses how therapists can recognize and therapeutically utilize client projective identification in therapy. Splitting and projective identification are conceptualized as occurring in sequence. Transference, countertransference, and projective identification are discussed as interrelated phenomena, which underlie the therapist's effective use of self as an instrument in therapy. A three phase intervention process, which emphasizes the importance of the timing of interventions, is introduced.     

The use of stories as autistic objects

This paper reviews Frances Tustin's concept of the 'autistic object' and its development over the course of her writings. Clinical material from work with a 4-year-old boy is brought to suggest that the concept can usefully be extended to include such cultural artefacts as stories as well as the physical objects emphasized by Tustin. It is also emphasized that the awareness of reality which autistic objects are used to defend against refers both to internal as well as external reality. The paper argues that it is the function to which the object is put that is critical in determining whether or not it should be viewed as an autistic object.     

Notes on the Superego

The idea of the superego emerged late in Freud's conception of countercathexis or counterwill. It was preceded by censorship and the ego ideal, the latter of which later became associated with the newfound superego. Freud believed that the superego emerged as the resolution of the Oedipus complex. Klein, though agreeing with Freud, also uncovered the origin of the archaic superego in the early oral stage owing to projective identification of aspects of the infant into its image of the mother, which is then introjected and installed within the infant's internal world. The epigenesis of the superego, from the Kleinian point of view, enters into a transformation from a harsh, punitive, and retaliatory superego in the paranoid-schizoid position to a more forgiving and helpful one in the depressive position. The author suggests that there is such a thing as a “triune superego,” much like the Christian trinity, in which there are representations of the infant, the mother, and the father. Pathologic retreats constitute a default superego that vies with a normal superego.     

Group therapy with sexually abused boys: leadership, projective identification, and countertransference issues

Group therapy is an essential component of the treatment of sexually abused children. Since the painful effects associated with the abuse are often dissociated or acted out, the group leaders learn of the affective experience of the abuse through the process of projective identification. The leaders must be aware of this process, set limits on the abusive acting out in the group, and help moderate, label, and empathize with the affect. It is through this difficult process that the children have a chance to reintegrate and work through their abuse experiences so they no longer feel compelled to act them out through repetitive abusive relationships. Specific leadership, countertransference, and projective identification issues in group therapy with sexually abused boys are discussed.     

Interpersonal conflict in group therapy: An object relations perspective

The aim of this paper is to demonstrate how object relations theory can be used to understand and regulate interpersonal conflict in group psychotherapy. Such concepts as projective identification, intersubjectivity and the analytic third are used to describe how conflict emerges in group psychotherapy and how it can be worked through. Case material is also provided to illustrate concepts and techniques in promoting a group's transition from a paranoid/schizoid to a depressive position. Positive aspects of the concept of projective identification are discussed including its use as a form of communication, a method of reducing anxiety and reintegrating previously dangerous and threatening aspects of the self.The paper was funded by Evan F. Lilly Memorial Trust Grant PV 13,067.     

THE TRAINING AND GENERALIZATION OF SOCIAL INTERACTION SKILLS WITH AUTISTIC YOUTH

Two experiments were conducted to increase the initiations and duration of social interactions between autistic and nonhandicapped youths. Experiment 1 taught two autistic youths to initiate and elaborate social interactions with three age-appropriate and commonly used leisure objects; a radio, a video game, and gum. The students were first taught to use the objects and subsequently instructed in the related social skills. The youths generalized these social responses to other nonhandicapped peers in the same leisure setting. A second experiment trained a third autistic youth to emit similar social leisure skills. The use of the leisure objects and the related social skills were taught at the same time. The autistic youth learned these skills and generalized them to other handicapped peers in the same leisure setting. The importance of teaching generalized social responding in particular subenvironments was emphasized.     

Favourite objects of autistic children

Favourite objects (FOs) of autistic children were compared with the FOs of healthy preschool and school children as well as mentally handicapped children. Three clusters of objects were obtained for normal children (comprising primary transitional objects and their forerunners, secondary transitional objects, and non-cuddly toys). When autistic children and mentally handicapped children were included, a fourth cluster of deviant objects was found. Frequency distributions of the two handicapped groups in the clusters were similar. Similarities between the two handicapped groups were also found within each cluster. The occurrence of secondary transitional objects was rare in the handicapped groups. The characteristics of "autistic" FOs reported in earlier case studies (e.g. being hard, often having an exciting effect, not being used in their adequate functions) were typical only of objects in the fourth cluster.     

Towards the logic of projective identification

This paper is devoted to the ‘logic of the unconscious’ and its application to the analysis of projective intentionality in psychoanalysis.Subjective assumptions concerning the existence and identity of intentional objects are often unconscious. They result from personal experience through its assimilation and transformation in further psychological (e.g. defensive) processes. Formal aspects of these subjective assumptions and their influence on our judgment and action have been studied by a number of psychoanalytic authors, in particular by Silvano Arieti, Ignacio Matte-Blanco and their followers who tried to develop ‘logic of the unconscious’. My project consists in the reformulation, clarification and elaboration of the logic of the unconscious using contemporary modal and relevant logics, in particular Graham Priest's logic of intentionality. An important advantage of this logic is that it allows for truth indeterminacy and paraconsistency of the propositional content of intentional states. In this article I explore the logic of projective identification, which I assume plays the central role in the logic of the unconscious.Special attention is given to the logical analysis of the notion of an internal object, and to a logical reconstruction of the fantasy of projective identification.     

INCREASING SPONTANEOUS VERBAL RESPONDING IN AUTUSTIC CHILDREN USING A TIME DELAY PROCEDURE

One oft-cited problem with teaching speech skills to autistic children isthe failure of the speech to be spontaneous. That is, the children's speech often remains underthe control of the verbal behavior of others rather than underthe control of other nonverbal referents inthe environment. We investigatedthe effectiveness of a time delay procedure to increasethe spontaneous speech of seven autistic children. Initially, the experimenter presented a desired object (e.g., cookie) and immediately modeledthe appropriate response “I want (cookie).” Gradually, asthe child imitatedthe vocalization, the experimenter increasedthe time between presentation of the object andthe modeled vocalization in an attempt to transfer stimulus control of the child's vocalization fromthe experimenter's model tothe object. Results indicated that allthe children learned to request items spontaneously and generalized this behavior across settings, people, situations, and to objects which had not been taught. These results are discussed in relation tothe literature on spontaneous speech, prompting, and generalization.