title: From pilot fish to analyst: Finding a path between symbiotic and autistic defences.
abstract: This paper presents the clinical case of a patient with autistic features. One of the main difficulties in his treatment was the particular rapid rhythm of his projections, introjections and re-projections that constrained the analyst's capacity for reverie and hindered the use of effective projective identification processes. These alternating defensive constellations lead either to an expelling autistic barrier or to an engulfing symbiotic fusion. Their combination can be seen as the expression of a defence against an unintegrated and undifferentiated early experience of self that was in this way kept at bay to prevent it from invading his whole personality. Maintaining the symbiotic link, in which I kept included by staying partially fused to what was being projected and using my analytic function in a reduced way, helped to relate to what was in the patient's inside. Leaving this symbiotic link let my interpretations appear to 'force' their way through the autistic barrier. Yet as the process developed they allowed to show the patient how he ejected me and what was happening in his inside, behind his autistic barrier. So I found myself on the one hand accepting the symbiotic immobilization and on the other hand interpreting in a way that seemed forced to the patient, because it implied a breaking of the symbiotic position. The inordinate speed of projections and introjections could thus be interrupted, creating a space for awareness, reflection and transformation, and allowed the emergence of a connection between the patient's inside and outside. In the course of treatment I realized that this kind of dual defence system has been described by the late Argentinian analyst José Bleger. He assumes the existence of an early "agglutinated nucleus" that is held together by a psychic structure he calls the "glischro-caric" position, in which projective identification cannot take place because there is no self/object differentiation. I have considered the rapid and fugitive use of projection and re-introjection I met in my patient to be a manifestation of the dual defence system Bleger describes. Although he does not specifically mention this particular vicissitude of operative defences he does give hints about a rhythm in the patients' projections and introjections.
authors.affiliation: Graf-Recke Str. 18, 40239 Düsseldorf, Germany.
authors.forename: L Viviana
authors.initials: LV
authors.lastname: Strauss
mesh_terms: D000328:Adult; D001321:Autistic Disorder / Q000523:psychology*; D003674:Defense Mechanisms; D006801:Humans; D008297:Male; D011369:Professional-Patient Relations; D011575:Psychoanalytic Therapy / Q000379:methods*
keywords: autistic barrier; introjection; projection; rythm; symbiosis