The autistic moment in psychotherapy

This is a report on the author's experience in treating four autistic children and their families. The importance of making available the therapist's own autism is stressed. The difficulty in doing this and reverting defensively to an administrative approach is described. A previous paper discussed the corrective autistic experience with a focus on the autistic person. This follow-up describes the autistic moment which is a relational experience between the therapist and both the autistic person and the autistic family. The family needs to have an experience of its own autism as a continuum of normal before it can relate to an autistic child. To the extent that the therapist can bring his own autism into the therapy can the family experience its own. The patients are the person, the relationships, the family, and the therapist.The author would like to thank Richard B. Anderson, MD, Lindy T. Barnett, MSW, David V. Keith, MD, JoEllen Barnett Smith, MA, and Orion Smith for their participation as cotherapists. The comments made on an earlier draft of this paper by the members of the Atlantic Psychiatric Clinic are warmly acknowledged. Valuable editorial assistance has been extended by Robert Garfield, MD, and Stuart Sugarman, MD. Lastly, the author would like to extend his appreciation to Robert R. Haubrich, PhD, for stimulating his interest in the field of comparative ethology.Presented at the Conference Honoring the Retirement of Carl A. Whitaker, MD, in Madison, Wisconsin, June 25, 1982.     

Forced migration and resettlement: Its impact on families and individuals

An increasing number of families are forced to migrate as a result of political turmoil, civil wars, and ethnic cleansing. This paper describes the impact of forced migration on individuals and their families. We suggest that forced migrants reject the new culture while their children are likely to embrace it. This discrepancy between the old values of the migrants and the values to the new culture espoused by their children is a frequent source of intrafamilial tension. We also describe a second acculturation process that takes place when forced migrants return to their country of origin. Families who migrate back to the country of origin realize, often to their surprise, that both they and their country of origin have changed significantly.     

The logic of delusion

Piagetian concepts explaining normal mental development are applied to delusion, a major psychiatric disorder of thought which can result in bizarre conduct. Piaget constructed problems in which the errors of six to eight year old children fit the standard textbook definition of delusion surprisingly well. When we examined cases of delusional individuals, we concluded that their apparent irrational and bizarre conduct could be explained as problem-solving errors like those of Piaget's young children. In contradistinction to existing theories, we define delusion as a regression under stress to the logic of children of a particular age range, and that what appears bizarre and irrational is the result of an adult attempting to filter experience through a child's logic.Under a different title this paper was presented at the Biennial Congress of the World Federation for Mental Health in Mexico City in August, 1991.     

A developmental perspective on the use of metaphors in family therapy

Because families generally consist of individuals at various developmental levels, family therapists require interventions that are effective regardless of an individual's developmental status. Although metaphor has proven particularly beneficial in therapy, it may be ineffective in families with preschool children who have yet developed sufficient cognitive capacities and knowledge for understanding metaphors. Previewing, a prospective technique derived from interaction between parent and infant, may be used for communicating metaphors about future change to individuals regardless of developmental level. Previewing provides knowledge about development and stimulates the cognitive skills necessary for viewing the present as a metaphor for the future.     

The child's participation in family therapy: A review and a model

A major gap in family therapy, the treatment of children and adults together, is addressed. The literature on the children's participation is reviewed and a model which systematizes their involvement is presented. The full participation of the child necessitates the use of play. To create a context of play without alienating the rest of the family, action-promoting methods are used. These methods are implemented through family activities and role playing, which are followed by discussion. The advantages, the indications, and the contraindications to the use of action in family therapy are presented.