Calibrating the Interpretive Stages Towards Symbolic Engagement: An Examination of Changes in the Therapeutic Dynamic

Psychotherapists working with autistic children adapt interpretations to the child’s emotional, social, and cognitive capacities and to the nature of the child’s psychopathology. This study examined the vocal utterances of a Child and Adolescent Psychotherapist during four years of therapy with a young child with severe autism. Earlier research had shown improvements in the child’s emotional and interpersonal functioning. Here, the therapist’s interventions were analyzed using Alvarez’s three interpretive levels: vitalizing and bringing meaning to access feeling, amplifying meaning, and enriching meaning. During the first two years, utterances aimed at vitalizing and creating meaning predominated, whereas during the final two years interventions that amplified meaning became more frequent. There was little evidence of interpretations designed to enrich meaning. Findings from this single case study support a developmental sequence in psychoanalytic work with severely autistic children in which access to feeling through the therapeutic relationship precedes reflection on feeling and emotional states.