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Citation |
O'Neill S. Br. J. Psychother. 2020; 36(4): 548-562. |
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Copyright |
(Copyright © 2020, John Wiley and Sons) |
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DOI |
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PMID |
unavailable |
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Abstract |
This paper discusses the psychotherapy of a patient with autistic features and rigid resistance to free association. The patient often presented his experience as merely physical sensations. The paper juxtaposes two theories that illuminate the clinical picture. Tustin's theory of autistic objects identifies a defensive manoeuvre whereby sensation is actively substituted for the primary maternal object. Green's concept of the central phobic position describes a peculiarly rigid phobia of free association that functions to defend against awareness that a murder is felt to have taken place in the psyche. The author proposes that, in this patient, Tustin's substitution of sensation for the mother is Green's psychic murder. A therapeutic impasse that arose during the treatment was resolved following some working through in the countertransference. The patient's inability to free associate was subsequently ameliorated, and his previous inability to acknowledge oedipal reality shifted. He could then acknowledge, appreciate and identify with a paternal authority figure. This illustrates, the author considers, Scariati's observation that in the treatment of patients with impaired capacity for symbolization, countertransferential working through precedes the patient's acquiring a capacity for working through in the transference. Indeed, it facilitates this capacity. |
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Keywords |
AUTISTIC; COUNTERTRANSFERENCE; FREE ASSOCIATION; PHOBIC; PSYCHIC CHANGE; THERAPEUTIC IMPASSE; WORKING THROUGH |