Table Of ContentLIVE COMPANY
Children whose minds as well as bodies have been damaged by the
intrusions of sexual abuse, violence or neglect, and others, quite
different, who are handicapped by their own mysterious sensitivities
to more minor deprivations, may experience a type of black despair
and cynicism that require long-term treatment and test the stamina
of the psychotherapist to the utmost.
In Live Company Anne Alvarez reflects on thirty years' experi-
ence of treating autistic, psychotic and borderline children and
adolescents by the methods of psychoanalytic psychotherapy. Cen-
tral to the book is the moving story of an autistic child's long
struggle between sanity and madness, in which the author describes
the arduous journey that she as therapist and he as patient made
together towards new understanding and his partial recovery.
Modern developments in psychoanalytic theory and technique
mean that such children can be treated with some success. In the
book the author outlines and discusses these developments, and also
describes some of the areas of convergence and divergence between
organicist and psychodynamicist theories of autism. Particularly
important is her integration of psychoanalytic theory with the
new findings in infant development and infant psychiatry. This
has enabled her to formulate some new and exciting ideas relevant
to working with very disturbed children and to speculate on the
need for some additions to established theory.
Anne Alvarez has produced a professionally powerful and
enlightening book. drawn from her extensive experience as a
child psychotherapist at the Tavistock Clinic, which will be of
interest to all professionals involved with children and adolescents
as well as anyone interested in madness and the growth of the
mind.
LIVE COMPANY
LIVE COMPANY
Psychoanalytic psychotherapy with
autistic, borderline, deprived and
abused children
Anne Alvarez
Routledge
Taylor &Francis Cmup
LONDON AND NEW YORK
First publishcd 1992 by Routlcdgc
27 Church Road Hovc Cast Susscx BN3 2FA
Simultancously publishcd in thc USA and Canada by Routlcdgc
270 Madison Avcnuc Ncw York NY 100 16
Rcprintcd 1993, 1996, 1998, 1999,2002, 2003 and 2006
'liansfcrrcd to digital printing 201 1
(C) 1992 Anne Alvarez
Typeset in 10 on 12 point (iaramond by
Falcon Typographic Art Ltd, Fife, Scotland
Printed and bound in Great Britain by
'I:] I Digital, l'ads tow, (Cornx~ii~ll
All rights reserved. No part of this book (nay be reprinted or
reproduced or ~~tilireind any for111o r by any electronic,
~iieclianical,o r other means, now known or hereafter
invented, including photocopying and recording. or in any
information storage or retrieval system, without perniission in
writing fi-0111t he publishers.
Bi.ili,slz Li111,at:v( 'ulaloguit~git z P~~111ic1~lDion1lztr
Alvarez, Anne
Live company: psychoanalytic psychotherapy with
autistic, borderline. deprived and abused children
I. Title
6 18.9289 14
Lihraq*o /'C'otlgrc.s.s( blaloguitzg in Pzlhlic.a/iotz Dnltr
Alvarez. Anne 1936-
Live company: psychoanalytic psychotherapy with autistic,
borderline, deprived and abused cliildren /Anne Alvarez.
p. cm.
1. Autism Treatment. 2. Schizophrenia in cliildren Treatment.
- -
3. Schizophrenia in adolescence- Treatment. 4. Borderline
personality disorder in children Treatment. 5. Borderline
personality disorder in adolescence Treatment. 6. Autism
- -
Treatment- Case studies. 7. Child analysis. 8. Adolescent
analysis. I. Title.
[DNLM: 1. Autism, Infi~ntilet herapy. 2. Child Abuse psychology.
-
3. Psychoanalytic Therapy in infi~ncya nd childhood. 4. Psychotic
-
Disorders in infi~ncya nd childhood. 5. Psychotic Disorders therapy.
- -
WS 350.2 A473Ll
RS506.A9A58 1992
61 8.92'8982065 1 dc20
-
DNLMJDLC
for Library of Congress 9140447 C'lP
ISBN 978-0-415-06097-4(pbk)
How, physically, could the infant mind identify persons? What
features of their behaviour are diagnostic of them? Intentional
behaviour has a number of features that are not shared with
inanimate things, and so an intentional agent may be equipped
. .
to respond to others like itself.. Inanimate movement runs
downhill, oscillates in simple ways, bounces, but it does not surge in
self-generative impulses. Anything that tends to make unprovoked
bursts of rhythm, like a spot of reflected sunlight, seems alive. This
rhythmical vitality of movement is the first identification of live
company.
(Colwyn Trevarthen 1978)
I have no doubt whatever of the need for something in the person-
ality to make contact with psychic quality.
(Wilfred Bion 1962)
CONTENTS
Preface ix
.. .
Acknowledgements xu1
Introduction: modern developments in psychoanalysis 1
1 The long fall 12
2 Vegetable life and awakenings 26
3 Becoming vertebrate 42
4 Growth of a mind: the function of
reclamation
5 Reclamation and live company:
normal counterparts in the
caretaker-infant relationship
6 Making the thought thinkable:
perspective on introjection and
projection
7 The problem of the new idea:
thought disorder and behaviour
disturbance as forms of cognitive
deficit
8 A developmental view of 'defence':
borderline patients
LIVE COMPANY
9 The necessary angel: idealization
as a development
10 Clinical depression and despair:
defences and recoveries
11 Some precursors of reparation in
the hardened destructive child
12 Child sexual abuse: the need to
remember and the need to forget
13 Beyond the unpleasure principle:
play and symbolism
14 Wildest dreams and lies: aspiration
and identification in depressed
children
15 Autism: the controversies
16 Rites and rituals in autism: the
use of the counter-transference.
Robbie at 30
Appendix 1
Appendix 2
Bibliography
Name index
Subject index
PREFACE
This book is a record of my reflections on the experience of
treating autistic, psychotic and borderline children by the meth-
ods of psychoanalytic psychotherapy. Some of the children and
adolescents I shall describe are psychotic patients who begin to
get better, some are borderline psychotics who have been hovering
on the brink; all, I hope, give an idea of the two worlds of
sanity and madness, the fragility of the one and the ugly and
seductive power of the other. Such patients can be helped by
psychoanalytic methods, but the treatment is long, arduous, and
almost always places considerable strain on the therapist. Yet
there is growing consensus that this strain and burden is in
some way central to the treatment. Children whose minds as
well as bodies have been damaged by the intrusions of sexual
abuse, violence or neglect and others, quite different, who are
handicapped by their own mysterious sensitivities to more minor
deprivations, may experience a type of black despair and cynicism
far beyond that felt by neurotic patients. A therapist suffering from
too large a dose of therapeutic zeal or of passionate belief in the
therapeutic power of psychoanalytic explanation, may experience
great disappointment when the child doesn't seem to feel helped
by her remarkable revelations, and doesn't seem to change. I have
had many such disappointments myself. The patient's terrors may
be too overwhelming to be easily named, let alone explained; or his
destructiveness or self-destructiveness may have developed, after
perhaps years of practice, into high art. The psychotherapist has
to be capable of being disturbed enough to feel for the patient, and
at the same time sane enough to think with him, until the patient's
own ego, his thinking self, grows enough to be able to do it for
himself.
Description:Children whose minds as well as bodies have been damaged by the intrusions of sexual abuse, violence or neglect, and others, quite different, who are handicapped by their own mysterious sensitivities to more minor deprivations, may experience a type of black despair and cynicism that require long-te
