Psychoanalytic Inquiry - Psychoanalytic Work With Patients Diagnosed With Asperger’s Syndrome

vendredi 2 décembre 2011

Dans son 3ème numéro de l’année 2011, Psychoanalytic Inquiry propose un numéro spécial sur le travail psychanalytique avec les personnes avec syndrome d’Asperger.

Les articles sont consultables sur le site de l’éditeur.

1. Cohler BJ, Weiner T. The Inner Fortress : Symptom and Meaning in Asperger’s Syndrome. Psychoanalytic Inquiry ;2011 (2011/05/01) ;31(3):208-221.

This article shows that psychodynamic perspectives are particularly relevant in working with people who have Asperger’s syndrome (AS). It is believed that a central problem among people with AS is difficulty in understanding their own mind and the mind of others. Recent discussion of factors involved in fostering change in psychoanalytic psychotherapy stresses the importance of a theory of mind, known as mentalization, that refers to the effort by the therapist to understand the patient’s mind. It is in this demonstration of the activity of coming to know the mind of another that psychodynamic perspectives may be particularly helpful in working with persons with AS to come to understand their own mind and to know the minds of others. Psychodynamic psychotherapy is also important in helping persons with AS to deal with difficulties and frustrations that they have encountered in their life.

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2. Gould K. Prologue. Psychoanalytic Inquiry ;2011 (2011/05/01) ;31(3):203-207.

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3. Gould K. Fantasy Play as the Conduit for Change in the Treatment of a Six-Year-Old Boy With Asperger’s Syndrome. Psychoanalytic Inquiry ;2011 (2011/05/01) ;31(3):240-251.

Using a psychoanalytic approach, I demonstrate how I was able to uncover the keen longing for attachment that lay underneath David’s unrelated and alienating behaviors ?behaviors that repelled his peers and made him an unmanageable puzzle for his parents and teachers. My clinical notes (from a two-and-a-half year treatment of once-a-week sessions), indicate the gradual process of guiding him into play by introducing first dialogue and then characters into his mechanized rituals until he begins to tell his own story. Over time, this experience of reciprocity enabled David to feel safe and empowered in the external world, where formerly he had been a helpless and angry outcast. An unplanned early termination first threatens to interrupt his progress but ultimately provokes an unexpected demonstration by David of what he had learned.

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5. Gould K. Epilogue. Psychoanalytic Inquiry ;2011 (2011/05/01) ;31(3):345-346.

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6. Rhode M. Asperger’s Syndrome : A Mixed Picture. Psychoanalytic Inquiry ;2011 (2011/05/01) ;31(3):288-302.

Diagnostic ambiguities surrounding Asperger’s syndrome are discussed in a historical context ; two main subtypes are distinguished according to whether coping mechanisms are predominantly obsessional or schizoid. A case is reported of a girl, later diagnosed with Asperger’s syndrome, who originally showed many characteristics of autism, including echolalia. In the later stages of her treatment, she resembled borderline children in her anxious outpouring of florid fantasy. The transition from the first stage to the second was marked by a fantasy of the bodily projection of her mouth into the therapist. Drawings from the beginning of treatment suggested that the schizoid fantasies characteristic of the second stage were already present, although in unelaborated form. The case is discussed in the context of object relations theory and of historical controversies concerning the relationship of autism to childhood psychosis. It is suggested that the intimate psychodynamic knowledge of a child acquired during therapy can make a contribution to diagnostic classification.

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7. Shaft JP. Finding the Pot of Gold : Using Psychotherapy to Assist the Emotional Development of a Four-Year-Old Girl Diagnosed With Asperger’s Disorder. Psychoanalytic Inquiry ;2011 (2011/05/01) ;31(3):276-287.

This article illustrates the development of a working alliance between a psychoanalytic psychotherapist and a four-year-old girl, Elsa, diagnosed with Asperger’s syndrome. From the beginning, intense anxiety related and reactive to Asperger’s was central to the treatment process. My nonimpinging presence and curiosity, and use of transference ?countertransference phenomena were central in the development and deepening of the therapeutic relationship. In the encouragement and safety of the three-times-weekly therapy schedule, Elsa began to play out her fantasies, which led to a process of active developmental growth. Over the course of the first three years of treatment, Elsa became more openly involved in the therapeutic relationship. Her anxiety diminished as she began to tolerate her own affective experience. She began to experience greater success and comfort in social interactions with her family and other people in her life.

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8. Sherkow SP. The Dyadic Psychoanalytic Treatment of a Toddler With Autism Spectrum Disorder. Psychoanalytic Inquiry ;2011 (2011/05/01) ;31(3):252-275.

This article describes a psychoanalytically informed dyadic approach to treatment of children with autism spectrum disorder that both engages the child on a psychodynamic level and works toward addressing the impact on the mother and the mother ?child relationship resulting from the child’s diagnosis and developmental differences. The treatment of Johnny, a 2.5- to 6-year-old boy on the autism spectrum, is used to illustrate the methodology implemented in this approach and explores and elucidates the developmental themes as they unfold in the course of treatment.

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9. Sugarman A. Psychoanalyzing a Vulcan : The Importance of Mental Organization in Treating Asperger’s Patients. Psychoanalytic Inquiry ;2011 (2011/05/01) ;31(3):222-239.

The opinion that psychoanalysis is of little value in treating patients suffering from Asperger’s syndrome is a relatively common one, even among fellow psychoanalysts. Several reasons have been suggested to account for this including the discrediting of psychoanalytic treatment for patients in the autistic spectrum because of Bettelheim’s (1967) mistaken blaming of the condition on poor parenting or the assumption that a biochemically based disorder cannot benefit from a psychologically oriented treatment. This article suggests that a third reason has to do with the underlying model of mutative action used by many current day psychoanalysts. Implicit in most modern day Freudian work is a model of mutative action that prioritizes verbal interpretation and emphasizes the gaining of insight into unconscious mental content. Viewing the psychoanalytic task as deciphering the unconscious meaning of the patient’s verbalizations ignores the problem that Asperger’s patients have with mentalizing or developing a theory of mind. This article suggests that psychoanalysts shift their emphasis to promoting a process of insightfulness defined as the equivalent of mentalization as it occurs in the psychoanalytic situation. Insightfulness is similar to the Kleinian emphasis on promoting higher order symbolic thinking. The psychoanalytic treatment of a patient suffering from Asperger’s syndrome is described to illustrate how the psychoanalyst works to promote insightfulness and how this approach differs from trying to uncover the hidden, unconscious content presumed to lie at the depths of the psyche. The patient described also illustrates the higher end of the Asperger’s spectrum and the need not to let the character defenses that develop to cope with such a debilitating disorder not obscure the essential constitutional basis of the patient’s difficulties even though, of course such limitations will become components of compromise formations.

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10. Topel E-M, Lachmann FM. Connecting With Two Asperger’s Syndrome Patients—With the Help of Some Ants. Psychoanalytic Inquiry ;2011 (2011/05/01) ;31(3):303-319.

In this article, we expand a prevailing emphasis on behavioural ?educational treatments, by presenting an approach that focuses on psychodynamic factors, nonverbal communication, and animal-assisted psychotherapy. We describe interactions between patients and therapists on a procedural, verbal, and nonverbal level that further the therapeutic process with increasing affect. The treatments of an adult and a child both presenting Asperger’s syndrome illustrate the bridging from their nonhuman world to the world of feelings and people.

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11. Volkmar FR. Asperger’s Disorder : Implications for Psychoanalysis. Psychoanalytic Inquiry ;2011 (2011/05/01) ;31(3):334-344.

Although described only one year after Kanner’s (1943) classic description of autism, Asperger’s account of the condition that now carries his name (Asperger, 1944) has, until recently, received much less attention. Psychoanalytic attention has focused largely on infantile autism. and early work was concerned with the idea that experiential factors might be involved in pathogenesis. During the 1970s, a large body of work questioned this view noting, for example, the strong genetic and brain basis of autism (Volkmar, 2000). Work from other fields began to question some early theoretical notions, e.g., the normative existence of an autistic phase, but important questions that autism raised for understanding early ego development and capacities for self-object differentiation continue to be a concern of some theoretical and clinical interest (Volkmar, 2000). This article provides a summary of Asperger’s as a diagnostic concept in terms of the history of the concept, aspects of clinical expression and co-morbidity as well as implications or intervention. The final section of the article focuses on implications that the condition may have for theory and practice.

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