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Chapter Ten - In the Clearing of Being: The Difficult Discovery of Shared Meanings in the Process of Weaning from Therapy in a Patient Suffering from Pervasive Developmental Disorder

Bertolini, Roberto Karnac Books ePub

Foreword

In this final chapter of the book I would like to consider the concepts of “treatment” and “cure” in psychotherapeutic and psychoanalytic work with children and adolescents suffering from pervasive developmental disorders. I shall do this by focusing my attention mainly on those aspects of their personality, stemming from their mental functioning, when they recover from being autistic or psychotic.

The importance of this study is linked to the fact that even after years of therapy, we must acknowledge that there is something irreducibly peculiar about their mode of being. We find above all in their character a mixture of immaturity and obsessional traits (Hoxter, 1975), which is difficult to interpret on a developmental basis. As such, we are eager to learn how much of it represents an overcoming of the initial condition or simply a sophisticated transformation.

As a basis for my discussion, I have selected the written notes of five sessions of the last year of Al's therapy, the adolescent patient suffering from Asperger's, whom we have already met in Chapter Three, when I talked about the countertransference phenomenon of the “negative contagion”, which occurred during our discussion of the immortality of the soul.

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Chapter Four - What can be Done if the Mind does not Develop? Encountering Bi-Dimensionality and Absence of Meaning While Working with Child and Adolescent Psychotics

Bertolini, Roberto Karnac Books ePub

Introduction

In the course of our work as psychoanalysts of children and adolescents, we have found that in recent years there has been a steady increase in the number of psychotic patients suffering from serious delay in the structuring of their personality, with peculiar character traits and social and intellectual limitations mainly due to a failure to enter a three-dimensional world in their mental life rather than with a state of confusion in their sense of identity. Their internal world was flat, populated with few fragmented and degraded objects with no emotional light. Their relationship with others and with the emotions they give rise to was based mainly on automatic mechanisms of consent or dissent, or on mechanisms of avoidance and closure of an autistic type.

By automatic consent we mean all adhesive ways of relating to others (adhesive identification, adhesive behaviour, adhesive learning); by automatic dissent we mean all negativistic ways of relating to others (negative identification, behaving in the opposite way to that expected such as by laughing when crying or being frightened is expected, or spitting out when drinking is in order, or by saying words with their syllables reversed).

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Chapter Two - An Example of Psychoanalytic Consultation with Children: The Clinical Case of Carlotta (C)

Bertolini, Roberto Karnac Books ePub

At this point I would like to illustrate what I said earlier with the help of the notes of the first consultation session with C, a five-year-old girl. My purpose in discussing this piece of clinical work here is to show how a particular receptive and listening attitude adopted by an experienced, sensitive adult, in the context of a setting that is well structured and sufficiently free from external interferences, allows, in just a few sequences, the child to reveal some deep aspects of her relations and emotional life. This, in turn, facilitates the therapist's understanding, and my own as a supervisor, of the main characteristics of the little girl's personality structure so to formulate a few interpretative hypotheses about her symptoms, which will be investigated later in the following sessions and finally shared with her parents.

C is a five-year-old girl attending a private nursery. She has a sister who is two years her senior. Her parents want a consultation because for a few months, before going to kindergarten, C has started vomiting (despite having an empty stomach, since she never eats her breakfast), or panicking as a consequence of a simple reprimand, saying that she has heartache and that she cannot breathe. C never shows her anger or rebellion, and she often shows—both at home and at the kindergarten—an excessively complacent attitude, despite being often in the grip of feelings of anxiety when faced with something that was not programmed by her, or anything unpredictable.

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Appendices A to K - Areas of Conceptual and Methodological Development

Bertolini, Roberto Karnac Books ePub

In the following section I will try to offer a clearer definition of the conceptual tools, which I applied to the clinical notes in the book while interpreting the behaviour of my patients. In doing so I hope to help people who are not familiar with the observational method of child psychoanalysis to share my way of looking at the developing mind in children and at the same time to allow those colleagues or other professionals who are already accustomed to it to test its usefulness in future research and therapeutic work.

Appendix A: the alpha-function

The alpha-function is a fundamental concept in W. R. Bion's “theory of thinking”, according to which, in order to “learn from experience”, the individual must transform the sense impressions of early emotional experiences (beta elements) into psychic elements (alpha elements). The notion of alpha-function was first introduced in Learning from Experience (1962) on the notion that any knowledge of the human mind, even the most abstract one, is largely metaphorical, and that the earliest metaphors used are those that can date back to sensorial experience and to the perceptions of our sensory-motor apparatus. In this sense, any theory on the birth and development of the mind must be seen as a hypothesis, whose validity lies in its capacity to enhance the quality of our observations of clinical phenomena; therefore it has the significance of a model that, when no longer useful to its purpose, must be abandoned.

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Chapter Five - Is it Possible to Interpret Autistic Material in the Way we Interpret Dreams?

Bertolini, Roberto Karnac Books ePub

Autism is a variant of thought and its development, which is based on alpha function reversal and on projective identification on the level of the part-object. By applying these two principles in an imaginative way, it could therefore be possible to interpret autistic material in the same way that we interpret dreams (Meltzer, in: Associazione Culturale Racker Venezia, 2002).

In the previous chapters on observation and the psychoanalytic method, I have shown how difficult it is, even in a specific context, such as the analytical one, to understand the behaviours of children or adolescents who suffer from pervasive developmental disorder. We saw, in my meeting with the autistic child in the ward at the Gemelli General Hospital (in the prologue), how everything that in normal personal and social relationships creates contiguity, reciprocity, arouses interest, or courtship, at first glance appears in these patients extraneous to communicative intentionality, enclosed within an unfathomable solipsism. I showed above all, with the help of Alessio's clinical data, how our difficulty in getting in contact with their way of being is not simply linked to their personal isolation, to their inability to form relations (an objective solipsism), but also to a fairly high degree of alienation from objective reality (in a pseudo-scientific manner).

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