What does psychoanalysis have to offer models of intervention? There are several features of psychoanalytic theory and technique that can benefit the treatment of ASD children and their parents.
First, the training and experience of psychoanalysts is unique in that it involves developing an intimate, dependent relationship with a person in need, with the focus of attention on that individual’s inner world and also in the interaction between the two analytic partners. This attention to what is going on in the relationship, in the moment, contributed to by both partners, and understood at a deep level – both symbolically and in the implicit and nonverbal – allows for a different kind of co-creative meaning making. I would consider this to be a unique competence of the psychoanalyst.
Second, psychoanalytic training and experience includes a high degree of “pattern recognition”, for example, an ability to recognize symbolic representations of strong emotions within relationships, and combinations and sequences of emotion and psychological efforts at self-protection or defense. Illustrations of these patterns might include a child’s remark about a tornado followed by an association to the child’s younger brother. Another example might be a child’s attempt to protect him or herself from threatening aggression coming from within by turning away from what is provoking the sense of threat or by retaliating against an imaginary external threat. Refined pattern recognition allows the psychoanalytic clinician to take a less linear approach to the treatment of ASD children in that partial or relatively incoherent symbolic representations are easier to spot and to use in understanding the child’s experience and communicated to the child. This often can be helpful even if the child is not considered to be at a level capable of apprehending such a communication according to other models.
Third, psychoanalytic training and experience requires learning a great deal about yourself, that is, about the clinician him or herself. This self-knowledge might include the clinician’s personal organizing fantasies, for example, to rescue a suffering child. It might include the stressors that challenge the clinician’s sense of him or herself, such as making a mistake or causing pain in another person. It might also include the individual’s particular reactions to emotional challenges and the characteristic means he or she uses to deal with intense affect – to withdraw, for example, or to try to undo some perceived injury.
Psychoanalytic training also allows for a deeper and more comprehensive understanding of parents – how adults cope with stress, how they transmit early relational patterns from one generation to the other, how they grow. Psychoanalysts learn how to tolerate anguished attacks without taking them personally, how to help a suffering person move from the perception of being a victim to that of taking an active role in recovery, and how to move into a collaborative role with another in the context of threat.
Psychoanalysis “off the couch” is valuable not only to the psychoanalytically trained clinician, but to the team that treats these children. I believe that a team that includes specialists in psychoanalysis or psychodynamic psychotherapy, occupational therapy, speech, and education should treat all children with autistic spectrum disorders. Pediatricians or pediatric specialties are also sometimes needed. It is very challenging to organize a team into a collaborative partnership in which roles are clear and compatible and in which there is adequate communication, but it is possible. It is also challenging – though I also believe possible – to plan such a treatment that is affordable and not an unbearable burden for parents.
Photograph by Ginger Gregory