High-functioning autism: changes over fourteen years of psychoanalytic psychotherapy: part three

ABSTRACT This paper is the third of a triptych of papers. The word ‘triptych’ refers to traditional religious paintings, where three panels are joined with hinges. Each of the three papers in this triptych outlines certain aspects of my patient Sam’s fourteen year psychotherapy. When these papers are read together, they provide a detailed exploration of the most noteworthy changes I have observed in Sam over the fourteen years of our therapeutic relationship. This third and final part deals with the way that Sam’s defensive structures have developed and shifted over fourteen years. It integrates material from all three papers, and makes a foray into theorising about some possible aetiological sources of ASD, emphasising psychodynamic aspects. Taken together, the three papers are my effort to map out the important psychodynamic changes in Sam’s functioning across fourteen years of treatment.