• autistic states in adults;
  • Bion;
  • countertransference;
  • enactment;
  • Frances Tustin;
  • interpretation;
  • Klein;
  • motivation;
  • technique

The author suggests a number of technical extensions/clinical applications of Frances Tustin’s work with autistic children, which are applicable to the psychoanalysis of neurotic, borderline and psychotic adults. These are especially relevant to those individuals in whom early uncontained happenings (Bion) have been silently encapsulated through the use of secretive autosensual maneuvers related to autistic objects and shapes. Although such encapsulations may constitute obstacles to emotional and intellectual development, are consequential in both the relational and vocational spheres for many analysands and present unending challenges for their analysts, the author demonstrates ways in which it may be possible to detect and to modify these in a transference-centered analysis. A detailed process of differential diagnosis between autistic states and neurotic/narcissistic (object-related) states in adults is outlined, along with several clinical demonstrations of the handling of a variety of elemental terrors, including the ‘dread of dissolution.’ The idiosyncratic and perverse use of the analytic setting and of the analyst and issues of the analysand’s motivations are considered and illustrated. A new model related to ‘objects in the periphery’ is introduced as an alternative to the more classical Kleinian models regarding certain responses and/or non-responses to transference interpretation. Issues a propos the countertransference are also taken up throughout.