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The psychoanalysis of infantile autism

Starting from Frances Tustin's description of failure of the containing function in autistic children due to a splitting between the masculine and feminine aspects of the containing object, the author suggests that the first stage in the psychoanalytic treatment of an autistic child consists in restoring that function by working through what he calls the transference on to the container. His description of container bisexuality differs slightly from that given by Tustin. In the author's description, the masculine elements of the container do not penetrate the female ones, but rather strengthen them in the same way as buttresses strengthen a building. Once the transference on to the container is sufficiently worked through, the child can begin to trust the containing capacities of the object. Thereafter, an infantile transference, as defined by Melanie Klein, begins to develop. That transference tends to have a special intensity in autistic children, with the emergence of a fantasy that Tustin called the ‘nest of babies’ fantasy. A clinical illustration of that fantasy is given. The infantile transference represents the second stage in the psychoanalytic treatment of an autistic child. The third stage consists in working through the transference neurosis as described by Freud. An autistic child who reaches this degree of psychic organization may look like an ordinary child, but this level of mental functioning will remain very unstable for some time. The end of the treatment can be envisaged when the child continues to make progress mentally even during breaks in the analysis. Clinical material illustrates the three stages described in the paper.