The use of objects and footage in psychoanalytic treatment in a group of autistic children

Abstract

This article seeks to present the results of a research concerning the use of objects in the psychoanalytic treatment of autism, which involved attending a group of children diagnosed with Autism Spectrum Disorder at a public mental health institution. The audiovisual record of attendances proved to be an indispensable component of this approach, especially in meetings with parents and supervisors, inviting them to a reflection on their status. The issue of subjective constitution and the problem of diagnosis in childhood permeated the discussions proposed here.

Keywords:
autism; psychoanalysis; psychopathology; group psychotherapy; mental health

Resumo

Este artigo visa apresentar os resultados de uma pesquisa sobre o uso de objetos no tratamento psicanalítico do autismo, que envolveu a realização de um atendimento em grupo de crianças com diagnóstico de Transtorno do Espectro Autista em uma instituição pública de saúde mental. O registro audiovisual dos atendimentos mostrou-se um componente indispensável desta abordagem, em especial nas reuniões com os pais e nas supervisões, convidando a uma reflexão acerca de seu estatuto. A questão da constituição subjetiva e o problema do diagnóstico na infância permearam as discussões aqui propostas.

Palavras-chave:
autismo; psicanálise; psicopatologia; psicoterapia de grupo; saúde mental

Resumen

Este artículo tiene como objetivo presentar los resultados de una investigación sobre el uso de objetos en el tratamiento psicoanalítico del autismo, que se realizó en una atención grupal a niños con trastorno del espectro autista en una institución pública de salud mental. El registro audiovisual demostró ser un componente indispensable de este enfoque -especialmente en reuniones con los padres y en las supervisiones- invitando a la reflexión sobre su status. El tema de la constitución subjetiva y el problema del diagnóstico en la infancia permearon las discusiones aquí propuestas.

Palabras clave:
autismo; psicoanálisis; psicopatología; psicoterapia de grupo; salud mental

Résumé

Cet article présente les résultats d’une recherche sur l’usage d’objets dans le traitement psychanalytique de l’autisme. La recherche a compris un groupe d’enfants autistiques dans une institution publique de santé mentale. L’enregistrement audiovisuel des séances s’est avéré crucial dans cette approche - notamment dans les réunions avec les parents et dans les séances de contrôle -, invitant à une réflexion sur son statut. Les enjeux de la constitution subjective et du diagnostic pendant l’enfance se sont fait présentes tout au long de l’argumentation.

Mots-clés:
autisme; psychanalyse; psychopathologie; psychothérapie en groupe; santé mentale

Introduction

This article seeks to present the results of the research and extension project “The use of objects in the psychoanalytic treatment of autistic children: proposal for a partnership between the Universidade Federal do Espírito Santo (UFES) and the Child and Adolescent Psychosocial Care Centers (CAPSi) of Vitória - ES”. For research, scholarships from the Coordination for the Improvement of Higher Education Personnel (Capes) and support from the Espírito Santos Research and Innovation Support Foundation (Fapes) allowed the practice with autists in an institution during a post-doctoral internship at the Centre Médico-Psychologique Petite Enfance (CMP) of Hôpital Maison Blanche (Paris, France), under the supervision of psychoanalyst Dr. Marie-Christine Laznik. In the extension scope, the demand for public services through education and the ethical-political commitment of the Graduate Program in Institutional Psychology led to the possibility of intervening with children diagnosed with autism who attend CAPSi. Believing that a joint work between UFES and CAPSi could favor the expansion of care for these children and that the effects of this experience could be transmitted to other services, or inspire new research, a partnership was established via the Technical School and Professional Training of Health in Vitória (Etsus - Vitória). After the approval of the proposal by the Ethics Committee, group consultations started in June 2017. Weekly, for two hours, the meetings continued until July of the following year.

In this article we chose to address more specifically the status of the object and the use of footage in psychoanalytic treatment in a group of autistic children. However, the group itself, its functioning and the mutual effects among its members permeate the entire discussion - so that we do not rule out the possibility of dedicating an exclusive work to this theme in the future.

Method

At the French public institution (CMP), the so-called Groupe Relais is composed of three special educators (specific training in mental health in France), three autistic children, a psychology intern (graduated and undergoing psychoanalytic training) and a supervisor. The educators take turns¹ caring for children, seeking to facilitate interaction between them; the intern oversees filming the sessions and editing the videos for supervision; and the supervisor listens and guides the work of educators and interns. For two hours, the children are free to choose their games without a goal being set before each consultation. There was no proposal for a necessary collective activity in the group, except in the final thirty minutes, when the team sought to gather the children around the table for a snack. Although no conceptual elaboration on this experience has been formalized, the analysis of the videos confirmed what we had observed in relation to the subjective changes in each of the children. When we reproduce this model in Brazil, we can offer some interpretation keys for French teams that use methods that are not rigidly structured to treat autism.

In an attempt to get closer to the French model, the group had three children diagnosed as autistic (CAPSi users), three psychologists and two psychology students, all undergoing psychoanalytic training. The two hours of duration were kept, reserving the final thirty minutes for a snack, as well as the designation of an adult for each child, without these “pairs” being previously established, under the assumption that the children themselves could manifest something from a subjective position in the choice of the intervener² with whom to interact. In severe child psychopathologies, as Vorcaro (1999) points out, it is necessary to suppose a subject, in an act of anticipation, before there is one. Unlike Groupe Relais, in our project we had an extra intervenor, acting both for support in the most difficult moments and for recording images of the sessions. Furthermore, it was not the interns who edited the videos, but the professionals; thus, whoever filmed was not the same person who reviewed the scenes, and the psychologist who took care of the cuts was the one who should conduct the supervision. The footage was our first report and, it is worth mentioning, it already brought the perspective of the one who filmed it. Sometimes, the function of the footage agent was alternated between the interveners; what always stood out, however, was the fact that not everything was filmed: there was only one camera, moved from the choices made by those who took care of it during the sessions. Involved in the scene, whoever filmed, and the other team members needed to endure being filmed/seen (by others during the sessions), seeing themselves (in supervision) and also dealing with the fact that not everything was recorded - something was always lost. The camera never had the role of guaranteeing objectivity, neutrality, so that posteriori was used as a guarantee of the facts’ veracity that occurred in the group. With Lacan (1973/2003) we learned that the truth can only be “half said” and, if the filming enabled a return to what happened or the capture of certain subtleties, unnoticed at the moment, this only makes sense for what it caused in each member of the team at the time of supervision, in which the statement also brought a new perspective at the editing of the videos.

In order to convey the experience of this work, we will prioritize two interconnected axes: the use of objects in the clinic in children with severe psychopathologies and the specific use of the camera as an object that provides us images to be worked with the team and the family. Such meetings, held every two months, were also a differential of the work developed in Brazil and played such a relevant role in the treatment that we can consider them indispensable for the adoption of this methodology. On this point, it is worth mentioning that we present here some reasons why we understand that this work responds to the conditions of intervention supported by psychoanalysis: starting from the child’s interest, respecting the defenses that they have already built (Lucero & Vorcaro, 2017a) - which implies not to see their symptoms as dysfunctional -, to consider the child’s place in the parents’ discourse (Lacan, 1969/2003) and, mainly, not to treat the concept of group as something closed and static. That is, our group did not intend, beforehand, for the existence of an interaction or a collective production between the children - which does not mean to say that there was no desire for the social bond on the part of the interveners, even though attentive to the fact that that this demand could not come directly from the team or as a treatment objective, even if it was a possible effect.

Through this article, we shall see a discourse crossed by psychoanalysis, even if we do not delve into the theoretical apparatus that supports the proposal here reported. Nor will we be able to dwell in detail on the clinical cases monitored, which shall certainly be subject to other publications. For now, we remember the extreme mutability that characterizes childhood and the danger of adopting a definite diagnosis at this stage of life. Trusting the possibility of changes in the subjective constitution and even the inscription of certain traits that allow such a conformation, let us move on to our first point of discussion.

The use of objects in treatment

Since the first descriptions of autism in the field of child psychopathology, Kanner (1943) had already highlighted a particular type of relation between autism and objects “that do not change in appearance and position, that retain their sameness and never threaten to interfere in the child’s loneliness...They [the autistic children] have a good relationship with objects; if they are interested in them, they can play with them for hours at a time”. In psychoanalysis, Francis Tustin (1975) coined the term “autistic objects” to designate certain objects that serve to maintain the isolation of autistic children, who feel comfortable and satisfied when they are with their objects. In his conception, these objects would be pathological, as they would result from an autoeroticism that went astray and became perverse. For Tustin (1984), the excessive use of objects impedes the development of symbolic capacity, excluding a transitional and communicative use of them. Thus, one of the ways for treating autism is the removal of the child’s autistic objects, leaving them without this defense against the outside world - which would, therefore, make them more permeable to its influence.

Seeking to regain the importance of objects in the autism clinic, Maleval (2009) organized a collection of articles entitled The autist, their double and their objects, whose objective was to reflect on the solutions that autists find to deal with their difficulties to go to outside. Instead of conceiving the object as something that closes the autistic person in his world, or the double as a persecutor - as we have the report in some cases of paranoid delirium, as well as in the literature interpreted by Otto Rank (2013), who analyzes from the short story commented on by Freud (1919/2006), “The sandman”, by E. T. A. Hoffmann, up to “The double”, by Dostoiévski -, the authors strive to show how the double and objects can be sources of “libidinal animation” for the subject, as long as they are managed clinically.

Starting from the premise that “the main orientation for psychoanalytic care for autistic patients is to assert, in the treatment, the defenses that the subject was able to structure, as this is the subject itself, which is more unique” (Lucero & Vorcaro, 2017a, p. 95), we were interested in specifically addressing the use of objects by autistic children and questioning the best way to insert them in the context of treatment. On this, let us see Maleval’s considerations (2017):

on the horizon of all educational approaches - it urges us to consider evidence that, in order to help the autistic person, it is advisable to “treat [their] inadequate attachment to objects or [their] inflexible adherence to daily routines” (Hemsley et al., 1978, p. 479). An approach guided by psychoanalysis leads to distrust of these assumptions - not only for ethical reasons, but also because they do not consider the work of protection against ongoing anguish in these conducts. (p. 297)

With the assumption that a direct analyst-child relationship can often be uncomfortable for the autist, we bet on the mediating power of the object. The use of these would enable an exchange ratio through play, to then make it viable for the child to let go of the object, let an intervener manipulate it and allow its insertion in the exchange circuit, or its “pulsion circuit”, such as psychoanalysis allows us to name it³. In fact, for Orrado and Vivès (2016), the objects of mediation must allow a possible opening to the other and a relaunch of the pulsion expression - that is, the directing of the subject’s interests to the outside, contrary to what we observed in the cases of autism. In his seminar The anguish, Lacan (1962-1963/2005) speaks of an autistic enjoyment to refer to any type of relationship between the subject and the object of their desire that does not pass through the field of the big “Other”; that is, that disregards the symbolic universe, the world of language and words.

It is important to note that satisfaction, in autism, is mainly sought in the body itself, without, however, this constituting autoeroticism, as suggested by Tustin (1984). We remember that Bleuler (cited by Hochmann, 2009) coined the term autism precisely by removing eros - libido or life - from autoeroticism. Without this component, which for Freud (1920/2006) would link human beings to each other, autistic people may have their pulsion activity limited to concrete objects, which do not require the libidinal investment of other people.

Making concrete objects mediation objects is a simple and usual guideline in the institutional context (Orrado & Vivès, 2016). Taking into account the specificity of our patients with regard to adherence to routines, before each attendance we organized the room in the same way: we covered the floor with large EVA sheets, on which children’s tables and chairs were placed, and we spread out through the four corners of the room story books, cars, plastic or plush animals, drawing materials, modeling clay, among other toys - always making sure that something familiar in the arrangement of the objects was (re)discovered by the children. From this, each child established a specific relationship with the objects/toys available in the environment, including, with the video camera, an important element in the sessions.

At the beginning of the group visits, Estela removed and placed balls of clay in a truck; Paulo burst balloons, shouting “pow”; and Alberto organized letters in alphabetical order⁴: three children between 3 and 4 years old diagnosed as autistic, but with very different psychological and verbal developments. While Estela did not speak, at most making a few sounds (especially those referring to music), Paulo screamed a lot and made some significant sounds, often in a holophrastic way, like the “grroito” to talk about the cookie, or other words that always seemed cut in half. Alberto, on the other hand, was able to speak clearly, but he often repeated the words and phrases he heard, without appearing in the first person as the subject of the enunciation.

This scenario configured our first impression of the children and, in other words, it turned into a relatively quick time. Looking back and with the help of filming, we see how the group, the presence of other children and the various intervenors was important for this change. The simple fact of seeing a colleague playing something else really caught the eye of Estela, who, among the three children, was the most opposed to interventions. On the second day of the group, for example, she gets interested and approaches the letters that Alberto played with. Always discreetly, looking out of the corner of her eye, Estela was attentive to what was going on around her, the camera, the music. Alberto, in a similar way, was always attentive to what Paul was doing. If, on the one hand, Paulo seemed messy and disorganized by his standards, we saw, on the other, that he was able to play an important role in his subjective constitution, since he carried an excitement that was attractive to Alberto; in fact, even though Paulo seemed inattentive, dropped things on the floor and passed over the toys of others, he surprised us in his ability to perceive what is going on around him. That was how he moved from the role of the one who disturbed and hindered to the role of the child who offered some libidinal excitement to others. If we had any doubts about their acceptance in the group - would it be a case of autism? - the suspension of the diagnosis proved to be of extreme relevance for us. After all, if from the psychiatric perspective of the DSM-5 (American Psychiatric Association, 2014) all of our patients can be included in the autistic spectrum, from the point of view of psychoanalysis, we opted for the undecided of the serious childhood psychopathologies - which include the cases of autism, psychosis and weakness (Vorcaro, 1999) - in the assumption that a clinical intervention in this period would allow subjective inscriptions that would broaden the possibilities of establishing the social bond, being, therefore, constitutive.

Despite the controversial diagnosis received, it is worth noting that Paulo was the child who came closest to establishing an autistic relationship with objects, in the sense given by Tustin (1975, 1984) of closure to the relationship with the Other. Thus, a first clinical direction was to offer objects that could replace the balloons, keeping some metonymic relationship with them: for example, the inflatable punching bag (difficult to burst) and the blowouts (which can be blown). We thought of offering something that could favor the duration of the game or with which he could engage his body more easily, after all, the blowouts require less effort to blow than the balloon. However, Paulo had already chosen his object and the clinical work was unfolded from the introduction of new elements that could favor and stretch playing with balloons: games of filling and emptying, throwing the balloon to the other, scoring baskets, goals etc.

Paulo’s agitation, which we here call libidinal excitement, increasingly attracted the attention of Alberto, who insisted on denouncing his “inappropriate” behavior in lines such as: “look, he is eating clay”; “Paulo knocked down”. We also noticed that Alberto’s accusations were filled with admiration or will, and when we asked him if he wanted to rip a sheet of paper, just like Paulo had just done, his bodily fragility was evident: Alberto was unable to tear a sheet, as well as he barely took the clay in his hands - preferring that we model it for him - nor was he able to knock down a tower of wooden blocks.

The conflicts between Alberto and Paulo were sometimes motivated by Alberto’s refusal to play or share his toys, sometimes linked to the envy of Paulo. For Lefort and Lefort (1990), envy is characterized by addressing something that one does not want; what arouses this feeling is an image of the other’s completeness, as if that other had achieved full satisfaction with what the Other brings him. Whenever Paulo interfered in Alberto’s play, we had the impression that he did not want any of that, but he was bothered to see Alberto receiving the attention of the interveners or showing some pleasure with the objects. Unlike Paulo, Alberto could spend an entire session playing with just one intervener, staying in the same activity for a long time.

When he was abruptly questioned by Paulo, Alberto even got confused with him, apologizing when he was attacked. We recall, here, the article “The stranger”, in which Freud (1919/2006b) addresses the double with reference to the subject who identifies with the other to the point of being in doubt about who he is, or, still, substitutes his own self for a stranger. Once when he constantly beat the inflatable punching bag, emitting his screams, Paulo is called “monster” by Alberto: “the double stranger needs to disturb ‘all the hours of sweet interaction’” (Rank, 2013, p. 15). As in the examples of literature - in which the double appears as the reverse of the hero who, in trying to prevent his alter ego from proceeding with actions of which he disagrees, ends up eliminating itself by attempting against its image - Alberto seemed to affect himself even when Paul’s aggression retaliated, showing more suffering in those moments than in those he was targeted. He did not recognize himself as the perpetrator of the violent action, accusing his colleague of having committed it. In fact, Alberto, similar to the writer James Joyce, in the reading made by Lacan (1975-1976/2007), seemed to have no affection for the suffered bodily violence, as in the times when he exposed his own body, unprotecting himself to maintain the objects of his play intact. For Alberto, the objects guaranteed a certain stability and were used as instruments to mobilize his body: it was important to touch them, feel them, knead and cut the clay, knock down the wooden blocks.

The relationship that Estela established with objects is also remarkably interesting. Many balls made of clay were repeatedly placed and removed from containers and holes of other toys while she emphatically refused our intrusion, either by moving places in the room, or by pushing the hand of the intervener who tried to play with her. Our first strategy was to take advantage of her interest in music to transpose certain elements to clay; that is, model the “yellow little chick” and the “butterfly in the kitchen”, changing the song lyrics for situation settings. That was how, in the movement of filling the truck with clay balls, we sang that the “chick was very afraid of the truck”, and not “of the hawk”, as in the original song. This change triggered an immediate action by Estela to pick up the chick and put it in the truck, contrary to what she had been doing repeatedly with all our attempts to join her play.

Small displacements allowed the replacement of the balls by the hydrographic pens from the moment that Estela started to circulate more easily in the room and, in our eyes, perhaps in an anticipatory hallucination, to address the other: with a very mischievous aspect, she tried scribble the walls, to which we reacted by setting limits. Estela seemed to ignore us, and we could have taken more severe measures if we had not been warned about the mechanism of denial (Lucero & Vorcaro, 2017b), already used in the “chick” scene. We understood, then, the adjective that her mother used to describe her: “headstrong”. In response, we also continue to insist on our interventions.

New objects joined the play. With the pens and then with colored glues that Estela clung to, we tried to insert new elements - modeled by the clay or drawn with the glues - that had some relationship with whatever it was, at some point (in the sessions, at home, at school), aroused their attention and interest. Thus, if a nursery rhyme like “I threw a stick at the cat”, sung in a game by Paulo, attracted the eye, even if fleeting, of Estela, that was enough for a kitten to be drawn on paper. Some success came from our many advances, with stars made from clay (“Twinkle, twinkle, little star”), or else transforming the colored glues into very cheerful and bouncy children (“Jump popcorn”), in a tireless creativity. In fact, we won, at these moments, some response, demonstrating the necessary desiring implication of those who occupy this role with children with severe psychopathologies.

We saw the accessible time for the other being extended in the countless birthday parties created for dolls, stuffed animals and even for colored glue friends. In one of the sessions, during the song “Happy birthday to you”, Estela vocalizes all the time. She gives in with her voice, accompanying the music, and she gives in with her eyes, directing it to everyone present, and then pretending to eat a cake (delicious in our eyes) made of clay by one of the intervenors. From then on, not without surprise, Estela accompanies one of the intervenors in a fun dance for both.

The contact with Estela was, in fact, facilitated by an indirect approach and by the mediation of music. So, sometimes, the intervenors played with each other, but precisely with those elements that were supposed to attract the girl, sometimes transforming the sound objects of her favorite songs into concrete objects made of clay, drawings and toys, sometimes using songs to give meaning and excite Estela’s repetitive (dull for us) movements.

In fact, music was present in the group, in general, whenever circle games arose. If at first Estela seemed touched by the excitement of the other children when they made a circle, we observed that it was also very difficult for her to participate in the scene. It took some time for Estela to accept entering the circle, like someone who does not care about her, extending a hand without even looking at us, and then running to the others, holding their hands, rotating to the rhythm of the music, crouching in the final verse and, smiling, applaud. It is important to say that, in this most enthusiastic episode, the presence of the camera was essential, since Estela puts herself behind the lens to support looking at the circle before running there. Did the camera act as a screen, allowing some mediation in the relationship between Estela and the other participants in the group? What other functions could we assign to this object? This is what we will talk about next.

The use of the camera and the function of the images

In order to address the function of the camera in attendances and, in particular, in the treatment of autistic children, it is essential to consider the gaze object, which is so important for subjective constitution.

Estela’s gaze through the camera is an important step for those who vehemently refused to direct their gaze to the Other. In many moments, her gaze reminded us of Rosine Lefort’s report of Marie-Françoise: “it is its gaze that wandered in the void, lost; it is dead and gave the impression of a wall” (Lefort & Lefort, 1990, p. 177); not only when she does not give in, but also when she looks at those who care for her, including her mother. At the beginning of the attendances, Estela seemed to ignore that she was being filmed, as long as the intern responsible for the filming did not speak to her. Reviewing the records, we noticed that the voice behind the camera attracted Estela’s gaze and seemed to provoke a strangeness that was too attractive and irresistible to maintain in her autistic defense of refusal. We do not know if it were the initial silence that allowed such an accessibility or if denial would again be at stake, making the person who should least intervene in the group the person with whom Estela would be most willing to interact. The fact is that the cameraman was captured by Estela and the group had to start taking turns also in this role, which, at first, was the only one assigned to a specific person.

Alberto, on the other hand, did not look directly at anyone, he called all adults “aunt” or “aunty”, making no distinction between the intervenors when he asked for them; he seemed to look at everyone and no one at the same time. In contrast, since the first group, he looked at the camera, which made us wonder if it would represent an anonymous look, or if it also functioned as a screen and, therefore, the eyes of those who filmed it were less intrusive. At various times, Alberto summoned those who filmed to show him a toy or what they were doing.

With regard specifically to what he was looking at, we could see, albeit only later, with the help of the footage, Alberto’s gaze on Paulo, who seemed to function there as his double - that is, how he carried an apparently difficult excitement and liveliness for Alberto. Often, watching Paulo’s playing was the only possibility for him, refusing to participate when he was invited. What caught our attention was the day when Alberto picked one of Paulo’s privileged objects/toys: the children’s story books. He tried to tell the story in his own way and requested that his colleague be present, to come and listen to his story, despite having the eyes of three of the five adults present at the attendance. This attitude made us question how the pulsion circuit was established for Alberto, who oscillated between being seen passively and a gaze that seemed to waive with the pleasure of the Other, serving only his autistic enjoyment.

Freud (1915/2017) describes the pulsion path in three stages: an active one, in which the baby seeks the external object; a reflexive one, marked by the return of the pulsion to the body in an autoerotic way; and, finally, a passive one, necessary for the pulsion shot and the moment when the child becomes the object of a new subject. Reread by Lacan (1964/1979), the pulsion path gains new contours by valuing the place of this new subject. From there, for the pulsion, it is no longer a matter of going towards an object of need to satisfy itself, but rather of finding an object that causes it - that is, that it returns to itself and allows it to go through all the times necessary for its shot countless times (Laznik, 2004, p. 79); which is different from simply making a pulsion shuttle that puts only the body and its satisfaction at stake.

With the help of the camera, Alberto can repeat these reciprocating movements, either by looking at the group through this screen, or by looking at himself (turning the camera viewfinder to himself). Alberto sees himself up close and says: “now I’m big”; he moves the camera away and concludes: “small”. Between big and small, near and far, find the angle to pose and ask them to take a picture of him. Like a mirror, the camera seems to confer a body on Alberto, who still has a lot of difficulty making himself seen. When Alberto shows his objects, he camouflages himself behind them; when he tells a story, he needs his double to appear. On the day that he decides himself to make a film, Alberto emphasizes that he should stay out of the scene: it is not to film him, but his characters. We have the impression that making yourself seen is a point to be worked on with Alberto, corroborating the hypothesis of Laznik (2004, 2011) that there would be a failure in the establishment of this third period of the pulsion circuit in cases of autism. These children would have difficulty making themselves the object of the pulsion to another: they do not offer their bodies to the other, they do not show their feet for the other to bite or they do not raise their arms to get tickled. Our guess is that, with the construction of the body image, Alberto can include the Other more in his exchange circuit, without feeling invaded or threatened.

Finally, Paulo, who in the preliminary interviews presented a gaze directed at those who addressed him, in many moments corresponded with an empty look, which crossed the interlocutor. In the group, Paulo almost never looked at Alberto, only showed his aggressiveness. He could ignore his colleague’s plays or hit him by surprise, without his gaze revealing any intentionality. But with Estela, he could look into the depths of her eyes, involving her with his body, as if requesting an answer.

In relation to the camera, when he began to notice his presence and that he was being filmed, he started to position himself behind the equipment, experiencing the difference between what he saw through the camera and what he saw without this instrument. He seemed to be embarrassed by this: what was real about the image? Would he seek to find that difference? In order to see himself through the camera’s viewfinder, as a mirror, Paulo often attached himself to the body of the intern who was filming, taking the object from his hand and trying to manipulate it himself. In addition, he liked to look at his mouth through the viewfinder, opening and closing it, moving his tongue in and out, covering his mouth with his fingers, with clay or with a loaf of bread (if it was snack time). There was a need for Paulo to fill the oral hole (either with objects or with screams) so that it was difficult to understand his words the few times he tried to speak. His expressions were also enigmatic: was his smile of joy or a sadness? Was he crying or laughing? When he bit us, did he show anger or affection? And with colleagues? What provoked Paulo’s aggression (against Alberto) or compassion (with Estela)?

If for the children (as a screen or mirror) and for the intervenors (in the only-after allowed by the supervisors) the use of filming was important, the possibility of reviewing the images of the sessions proved to be equally interesting in the meetings with the family. There, our objective was also to take this singularized perspective, revealing characteristics of their children that go beyond a diagnosis and that point to their own subjectivity, built from their experiences and possible to be transformed into new contexts and relationships. Even the defenses built by each child were shown as singular productions, as possible inventions. This direction presupposes, therefore, that the subject’s inventions can be accepted without being subjected to a supposed knowledge of the stages of a typical development (Maleval, 2017, p. 299). For Maleval (2017), the child’s uniqueness even challenges knowledge about clinical theory, so that the psychoanalyst can only “position themselves in a certain bias: in a certain failure (a). To the general case known to the experts, they must respond with the particular case. To the universal that the institution aims at, they must respond with the singular of the patient’s discourse” (Stevens, 2005, p. 29). We tried, in meetings with family members, to remain faithful to the ethics of psychoanalysis - that is why we were not interested in focusing on the difficulties of the children, of which the parents were well aware, since they faced them daily (either in the meeting with schools, whether in other health services or other spaces which they circulated).

We sought, with the visual resource, to enable parents to take another look at their children, subjects of their own stories. By reviving the parents’ discourse, it might be possible to cultivate other relationships between parents and children, new ways of being together. The choice to focus on the children’s potential marks an ethical direction that aims to raise, in parents, the surprise and pleasure of being with their children (Laznik, 2011). In these situations, pleasure is commonly replaced by concern, while surprise tends to be avoided - which is, in fact, justified by the impact of the diagnosis - with the search for knowledge about each manifestation of the child. There is no room for the unpredictable and, here, it is worth remembering that structuring the routine of these children, so as not to leave room for the lack, as suggested by some treatment techniques, only increases, in our view, the distance between parents and children.

In this sense, another point that differentiates our orientation from other therapies is that we bet and maintain that knowledge is on the side of each child and their parents, and not on the side of the intervenors in the position of analysts. Therefore, we called on parents in a position to transmit what they knew and thought from the view they had of their children. What is it like to be a parent of that child diagnosed as autistic? How do you feel when you see your children playing with things they have never seen before, or interacting with people, colleagues and intervenors differently than usual? We were incredibly careful about the transfer on these occasions, because sometimes parents can feel the changes in therapy as failures on their part - which is not true and never came up as an issue in our meetings. Perhaps because, as Lacanian-oriented professionals, we knew that directing treatment does not mean directing the patient. Attentive to the place we must occupy in the transference play, we were better placed in our lack-to-being than in our being, marking a fundamental divergence between the exercise of psychoanalysis and conduct guided by re-education. We knew that it was only because of their own desire that it became possible for the analyst to occupy this place, which is said to be empty, and which supports the emergence of the subject.

Discussion

The recognition of the defenses built by each subject and, therefore, of their unique inventions, served as an important clinical direction. This is what was always at stake when we started reflecting on the use of objects in the direction of the psychoanalytic treatment of autistic children. Therefore, our initial guess was focused on the possible elaboration of each child, regardless of the effects that one could have on the other. It is clear that, since Groupe Relais, we are faced with situations in which one child triggered emotions (Lucero & Laznik, 2018) or unexpected behaviors in the other. The fact, however, that we have a group of typically autistic children with little interaction between them, did not prepare us for the therapeutic effects that interactions between children could have.

In the article “What can one child do for another? About children’s therapeutic groups”, Kupfer, Voltolini and Pinto (2010) emphasize the importance of heterogeneous groups for the treatment of autistic and/or psychotic children, pointing to the importance of neurotic children in this composition. The authors mention the “provocations” that make children circulate in different subjective positions, which could be “more in the direction of the educational act than the psychoanalytic act” (p. 108).

In the CAPSi care group, we saw how certain “provocations” arose among the children, how they took care of each other and, in addition to a diagnosis, with all its singularities, caused mutual effects, allowing displacements to occur. In this way, a child was able to provoke in the other psychic rearrangements that were put at the service of the subjective constitution. In addition, the intervenors were able to learn to make use of the loopholes that children produced - in themselves and in others. We thus understand that, in addition to the object, essential in the psychoanalytic treatment of the autistic child, the group enabled an experience with the similar ones that favored the libidinal excitement both in relation to the objects and with the double, regardless of the psychopathological classification of the children. This assumption on childhood as a time of subjective constitution, a possibility of becoming, which moves our work and our interventions, not letting us get discouraged in the face of serious psychopathologies.

If, when it comes to the clinic with the child - especially the autistic one - it is up to the analyst to take responsibility for the authorization they give to respond to a demand for help, which always comes from someone else (be it the parents, be it the school), we are interested in thinking about what the desire of analysts is involved, when working together in an institution, so that, in the exercise of their function, they contemplate the ethical requirements of psychoanalytic practice.

Di Ciaccia (2005) states that multi-professional work in an institution has the condition that each professional knows how to behave

in their own name, with their own style, with their own abilities, knowing how to put at stake their own image, their own presence and their own absence, their own interests, their own theatrical relationship with life, with the body and with the desire. (p. 47)

Putting oneself at stake, Di Ciaccia will say, it means taking responsibility in the first-person for the invention of ways of becoming the child’s partner, in order to enable “the invention of the chaining of a work already initiated by the autistic child, based on the manipulations they make with their own body and with the objects that complete them, elevating them to the dignity of signifiers” (p. 45).

The relationship between the intervenors and the support that one can give both to the other and to children, in some situations, deserves an analysis that would not fall within the scope of this article. Each professional, also in possession of their uniqueness, provided unique interventions and unexpected encounters, which were always resumed in the supervisions with surprise and pleasure. The use of the footage is also an important element here, since, in addition to the contributions already mentioned in the observation of children, supervision and meetings with parents, the records were consulted to make these theoretical considerations. All of this allowed us to gather here some contributions from psychoanalysis related to the use of objects in group treatment of children diagnosed as autistic, to the implications of this use in the subjective constitution and the possibility of developing new clinical strategies that increasingly distance themselves from prefabricated therapeutic prescriptions and that value care that considers the time and place of the word.

Referências

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• 1
  The name of the group was given due to this possibility of the professionals to take turns (if relayer) in caring for children, being able to support each other as a true team.
• 2
  As the three psychologists and the two psychology students carry out their psychoanalytical training in different institutions and in different ways, we will adopt the term intervener to refer to any adult in the group, as we do not consider it necessary to discern the interns’ professionals.
• 3
  It is in his Seminar 11 that Lacan (1964/1979) develops the pulsation circuit, moving away from the theory of Freudian support and relating it to the presence of the Other - hence it involves a fundamentally symbolic “exchange”. Vladimir Safatle (2007) highlights that the “Other” with a capital “o” is the structural system of symbolic laws that previously organize the way in which the empirical “other” can appear to the subject. However, as the Other can be represented by an empirical figure, Lacan will speak, for example, of the maternal Other.
• 4
  The children’s names are fictitious.

Publication Dates

• Publication in this collection
  25 June 2021
• Date of issue
  2021

History

• Received
  19 Nov 2018
• Reviewed
  02 Aug 2020
• Accepted
  08 Mar 2021