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It's the Tortoise Race: Long-Term Psychodynamic Psychotherapy with a High-Functioning Autistic Adolescent

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The increasingly common knowledge that autism is a developmental disorder of neurologic origin has led to an abandoning of psychodynamic treatments in favor of behavioral methods that train and educate the child. Most autistic children, lacking the language and symbolic capacities requisite for traditional psychotherapies, have benefited from this enlightenment. This change for the better, however, may not apply equally to more mildly autistic boys and girls.

First described as "autistically psychopathic" (Gilberg, 1985, pp. 389-390), some autistic children function at higher levels. Though showing the classic symptoms of more severe autism (e.g., exquisite anxiety, social awkwardness, peculiar speech patterns, odd nonverbal gesturing, communication deficits, ritualistic preoccupations, intolerance for change, and eccentric interests), they are considerably more socially involved and intellectually adept. Oft times having been classified as schizophrenic, atypical, and pervasively developmentally delayed, such children are now seen as representing the upper end of the autistic continuum (Bosch, 1962; Schopler, 1985; Szatmari, 1989), their disorder, Asperger’s Syndrome, having recently been elected to diagnostic distinction (DSM-IV, American Psychiatric Association, 1994, p. 77). By showing how one such boy with Asperger’s Syndrome substantially profited from psychodynamic play and talk therapy, this paper attempts to remind that psychoanalytic theory bears relevance to the understanding and treatment of at least milder forms of autism. Through a focus on the adolescent phase of this 11-year, still ongoing treatment, the advanced years of the therapeutic relationship are examined at close range.
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Document Type: Research Article

Affiliations: Harvard Medical School

Publication date: December 15, 2000

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