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The paper focuses on psychic states, in which living and bearing one’s vitality have become hindered or totally obstructed. I relate especially to patients who have been severely traumatized and built withdrawal encapsulations with schizoid/autistic-like features, that create complex challenges in therapy. The lecture will weave clinical cases with theoretical understandings and with a discussion of the Kurdish movie ‘Turtles Can Fly’, in which many orphan Kurdish refugee children try to survive emotionally the traumatic life they have been going through. I discuss the complex states of mind of some of these orphans who are sentenced to life, having lost all their hope and ability to live, due to extreme traumas. The dilemmas enlivened by this movie echo major clinical questions that in my understanding are not frequently addressed in our clinical dialogue: How do we work with patients who cannot stand their own vitality and less so ours? What is the impact of our saving fantasies as therapists and of our own vitality on these patients, who, most often as a result of trauma, have lost their ability to feel hope or be in touch with their vital potential and creative parts? I sustain that sometimes our vitality and the therapeutic encounter itself can create a toxemia of therapy which poses major clinical challenges. Various scenes from the movie will be screened as part of the lecture.

In the paper the author describes the coexistence of two parts of the adult patient’s personality: one part which is encapsulated, unmentalized and nameless and another part which communicates with the analyst more directly.

The author presents two sessions when the analyst wasn’t able to grasp and to be in contact with the patient’s elusive feeling, what equalled the experience as if the skin embracing them cracked (Anzieu, 1986/1990, Werbart, 2018) .

Further she describes the space of the supervision and the circumstances created by the supervisor and the analyst to help the feelings to evolve and to be named, firstly in the analyst. The transformation which took place in the space between the supervisor and the supervisee and in the analyst’s herself was later further developed and worked through in the relationship between the patient and the analyst. Probably the analyst and the patient were in one (Bion, 1984) with these feelings and with the struggle to avoid them. The author emphasizes the importance of the presence of the other mind who is an ally for the non – autistic part, both of the analyst and of the patient, and helps to meet with the truth of the patient’s feelings.

The author refers to the literature („Little Prince”) as an illustration of a dialogue between unemotional and emotional part in a human being, which makes us more open and sensitive for subtle feelings and different sides of human experiences.

In this presentation I will describe 10 years in the five-sessions-per-week Psychoanalysis of an ASD 22-year-old  young man. I shall consider the varying use the young man made, from early childhood on, of autistic withdrawals and autisto-psychotic pathological organizations – in everyday life and in his analysis.

A special place will be given to the question  of the changing uses of analytic technique throughout the patient’s development as well as to the internal positioning of the analyst within the total transference situation. The analyst had to make use of his own withdrawals and autistic enclaves in order to facilitate a benign “ object implant”.

The final analytic sessions regarding autistic problematics differ as a function of each particular case and of the frame of each treatment. With adults with autistic enclaves, the last sessions may bring up Oedipal and primal scene issues provided the preceding elaboration of separation anxieties has been effective.

The same development may also be observed in certain analytic processes with autistic children. In contrast, those children who had not been treated in a mother-child setting from the beginning of life, separation anxieties render the treatment interminable, at times into adulthood (over 50 years of age).

Nevertheless, the final session may yield surprises with regard to the capacity for empathy. Countertransference is at issue, at times through dreams in all the clinical cases discussed in this presentation.

The author explores the meaning of the earliest experiences of rhythmic elements of reality for the psychic development of the infant. Rhythm permeates all that is living and represents a structuring element of the experience of time and relatedness.

In autistic states, any uncontrollable movement represents a threat to survival. As a consequence, the very basis of living life and human relationships is blocked. Natural primary rhythmicity is frozen and replaced by solipsistic repetitive stereotypies.

The psychoanalytic process of working with a severely autistic little girl shows the gradual discovery and tolerance of rhythmic elements, which over time led to basic existential psycho-physical experiences, from which further exploration of external/internal reality became possible and brought about genuine learning. In the process, rhythmic elements of human relatedness and reciprocity could not only be explored and experienced, but shared, and ultimately became the source of moments of joyful emotion.

With clinical vignettes illustrating developments from autistic withdrawals to relational nuances within child psychoanalysis, we will present our PRISMA (Protocol for Psychoanalytic Investigation of Signs Mapping Changes in Autism). Autism nowadays has been surrounded by polemics where psychoanalysis has been losing space as a useful treatment when compared with behavioral alternatives. Prisma is a psychoanalytic instrument, emphasizing psychic change and subtle nuances that may not always be noticed, but that contribute as a basis for genuine and longstanding structural transformations in autistic children’s and their families’ lives. This instrument helps professionals to be attentive to psychic structural aspects and can help psychoanalysis to demonstrate its potential as a modality for comprehension of mental life and for the treatment of autism. It favours, therefore, our attention to our own countertransferential responses – with conscious but mainly massively primitive and unconscious processes triggering the analyst, as we move along the contact with the patient and with our own primitive states. Within this autistic dimension, we work with the building up of psychic functioning, fostering the capacity for representation and attribution of meaning to experience, rather than the withdrawal from the intensity or fragility of relational links. Our protocol highlights the following areas of development:sense of interest in people or objects, shared interaction, sensory integration, constitution of internal space, symbolic capacity and transferential field.

Parasitism has a malignant ring and has been thought of mostly in an intrapsychic way. While this is not without its justification, this perspective could be seen as paranoid from other “vertices” (Bion 1965, pp 90). Bearing in mind the discourse of natural sciences, the paper sees more primitive aspects of what drives parasitism in a “bipersonal field” (Baranger and Baranger, 2008) and attempts a “binocular” (Bion 1962, pp. 86)  reading towards that. It is suggested that the womb-foetus link may be used paradigmatically to map parasitic relations which could be emerging from an encounter of autistic parts of the patient and analyst. But fundamentally it is about recognising the still “encapsulated” (Tustin 1986; Bergstein, 2009) parts of our mind that collaborate in the formation of autistic islands, that can confront the parasitic nature of the link.

This workshop will present a therapeutic process of a three year old child on the autistic spectrum. It will offer an integrative view into the complex therapeutic process in our multi-professional psychoanalytically-oriented day care unit for young Autistic Spectrum Disorder children. Clinical observations from the therapeutic-educational environment will be presented by Orly Shalev. This part will briefly present a multi-dimensional picture of the child in the context of our psychoanalytic-developmental working model. It will be followed by clinical material from a psychoanalytically oriented psychotherapy, presented by Gal Meisels. A short theoretical discussion, reflecting on the presented clinical materials will be presented by Dr. Tami Pollak.

This paper will exemplify one possible application of Tustin’s concept in clinical work with adult patients. Some adult patients experience repetitive, fixed states of auto-sensory stimulation that are lacking, to a large extent, a symbolic representation. This results in severe difficulties in attempts to think or to speak about such states. In these circumstances the crucial task of psychotherapy is not developing an awareness of relational patterns, achieved by means of work in transference, so much as supporting the ability to represent or mentalize experience of one’s body. I will refer to Frances Tustin’s formulations as a conceptual foundation allowing to understand the protective function of auto-sensory mechanisms, and then I will present Riccardo Lombardi’s clinical perspective, focused on supporting the fluent flow between body and mind and on clothing sensations in thoughts. An attempt to bridge these two perspectives will be illustrated by an example from the clinical work with an adult patient suffering from addiction to a destructive and largely unmentalized auto-sensory mechanism.

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