A Psychoanalytic Approach To Language Delay

JOURNAL OF CHILD PSYCHOTHERAPY
VOL. 28 NO 1 2002 73–93
A psychoanalytic approach to language

delay
When autistic isn’t necessarily autism
C ATHY U RWIN
London
Summary This paper describes family work with four children from different ethnic backgrounds
presenting with autistic features in the context of delayed or deviant language development and, in one
case, elective mutism. It begins by describing how psychoanalytic approaches to language development
have tended to see the process as underpinned by symbol formation as a compensation for loss of the object.
This is contrasted with an approach which, following Bion, emphasizes language development as an aspect
of a broad process concerned with enabling emotional experience to become thought. I also emphasize the
signi cance of the survival and development of the self in achieving separation. In the case studies,
the paper highlights the degree of trauma in the parents’ backgrounds, which had impeded them from
containing their children’s developmental anxieties. The parents’ telling their stories was both valuable
to them and enabled them to become more emotionally available to their children. In all cases the work
promoted language development and autistic features disappeared or waned considerably after relatively
brief intervention. The conclusions discuss the relevance of these ndings to the autistic child population,
and the value of child psychotherapy to differential diagnosis within the autistic spectrum.
Keywords Autistic spectrum; language development; language delay; multicultural; trauma.
This paper comes from a long-standing interest in language development as an

emotional process, and from a concern over the growing number of pre-school chil-
dren with autistic features referred to our clinics. How can child psychotherapists
contribute positively to the assessment and treatment of these children, where child
psychotherapy is not possible or appropriate?
I begin by contrasting different ways of conceiving language development psycho-
analytically, before describing family work with four children from different ethnic
backgrounds referred for severe language delay and autistic features, which disappeared
after relatively brief intervention. I emphasize the signi cance of traumatic aspects
of the parents’ backgrounds, and the rather active approach I took to reach parts of
each child that had gone missing. I conclude by discussing the relevance of this work
to the autistic child population as a whole.
Journal of Child Psychotherapy

ISSN 0075-417X print/ISSN 1469-9370 online © 2002 Association of Child Psychotherapists
http://www.tandf.co.uk/journals
DOI: 10.1080/00754170110114800
74 C. URWIN
Psychoanalysis and language

Language is central to psychoanalysis; it is after all the ‘talking cure’. Yet, surpris-
ingly, little attention has been given to how we acquire it. Most approaches stress
its signi cance in dealing with separation, absence and loss. For example, probably
the most extensive account is that of Lacan, for whom the acquisition of language
is part and parcel of the Oedipus complex. In identifying with the father, or accepting
the centrality of this position, the child takes on board the language of the commu-
nity as a cultural requirement, with repression as an inevitable cost (Lacan, 1966).
An earlier step in this process is illustrated by what Lacan called the ‘fort-da’, the
cotton-reel game, described by Freud (1920), as invented by an 18-month-old boy
child struggling to separate from his mother. The game consisted of throwing away
a cotton reel with a string attached, the child uttering ‘oo!’, recognized as a babyish
corruption of ‘fort!’ the German for ‘gone!’, before joyfully pulling it back, with ‘da!’,
the German for ‘there!’. While Freud gave many interpretations of this game, Lacan’s
account stresses not only a symbolic annihilation of the mother but also how the
symbolic substitution through the use of the words from the cultural register, ‘fort-
da’, cuts the child off from the object of his desire. For Lacan, language is created
around this ever-open gap, and contains this loss within it.
This emphasis on loss or cost involved in language development is also found in
Stern’s (1985) more recent account of the ‘verbal self’. Stern is well acquainted with
the pre-verbal communication research which demonstrates how gesture and pre-
verbal vocal communication, in the context of consistent parental interpretations,
provide the communicative matrix through which children learn to do things with
words (Bruner, 1983). For Stern, further development in putting oneself forward in
speech hinges on a capacity to reverse roles in interaction and to represent the self
or to take the self as an object. This is seen particularly clearly in symbolic play, as
children begin to represent themselves with dolls and other objects from the end of
the second year. Stern stresses the gains provided by language, but also the loss
of the intimacy provided by pre-verbal communication. As for Lacan, language brings
about a distancing in interpersonal experience.
It is probably generally accepted in psychoanalysis that language development is
an aspect of separation-individuation, and that there is something crucial about the
Oedipal situation, or the place of the father. Where a mother apparently anticipates
a baby’s needs too completely, for example, or where the baby merges with the
mother to a marked degree, there may be little incentive for the baby to learn to
talk. Most would also accept, with Lacan, that the presence of the father may not
just disrupt the exclusivity of the mother-child dyad but also provides another object
for identi cation through which self and other can be differentiated. But, as an
explanation for what motivates language development, the emphasis on loss in psycho-
analytic accounts smacks of what, in the 1970s, Bruner (personal communication)
used to call ‘get you out of trouble’ theories of language development, in which the
apparently unpleasant process of acquisition is somehow explained by an advanta-
geous end product, which the baby cannot know about in advance. For example, a
commonly stressed advantage of language is that it allows us to communicate about
events which are remote from us in time and space.
A PSYCHOANALYTIC APPROACH TO LANGUAGE DELAY 75
An alternative is to see language development as an intrinsically motivated system

in relation with other systems, in the manner in which Bion (1962) writes of the
development of thinking depending on thoughts nding a thinker, and indeed as an
aspect of the same emotionally driven process. In the rst instance the thinker is
typically the parent, who receives the infant’s primitive communications and other-
wise intolerable anxieties and works them over in her reverie, before returning them
in more manageable form. Eventually an identi cation with this containing function
gives rise to a notion of mental space in which thoughts come together in new rela-
tionships, contributing to the growth of mind and imagination. Repeated failures
in this process result in the installation in the mind of a structure actively hostile to
the communication of emotional experiences, which grossly distorts learning and
which Bion called a ‘nameless dread’ (Bion, 1967, 1970). Compatible with devel-
opmental psychology’s descriptions, it is possible to see infant communicative
intentions as being realized through the mental work going into the interactions and
the parents’ interpretations, in so far as this is rooted in their making sense of
emotional experience. Delays or dif culties in language development would then
emerge as part of a broader problem in thinking unthinkable thoughts and in repre-
senting emotional experience symbolically.
This puts the emphasis on the increasing fullness of mental life, which accrues
from becoming a language user, rather than on what is given up. Rather than language
development distancing us from internal objects, it is part of the process through
which we acquire them, and build an internal world.
This emphasis on both emotionality and fullness is expressed rather beautifully in
Meltzer’s (1986) concept of the ‘theatre of the mouth’, used to describe the young
baby’s lalling, or babbling, as she plays with the effects of the placing of the tongue
in the mouth, to recreate some of the pleasures of the relationship with the breast
while producing sounds. The lalling provides both continuity of emotional experi-
ence, rather than discontinuity, and the substitutability which symbol formation
requires, here across modalities, through touch to taste to sound in space.
A similar point about the importance of fullness, rather than emptiness, has been
made by Alvarez in her account of the cotton-reel game (1992: 165). Alvarez stresses
that the pleasure that the child gained in making the object return is fundamental.
Recognizing this becomes particularly important in working with severely deprived
children, or children with marked ego de cits, for whom achieving hope in the
object’s survival is a greater developmental priority than testing the strength of
destructive impulses. She stresses the active nature of the technique required of the
psychotherapist to support this transition, the need to provide previously unknown
containing functions, and to recognize the search for potency inside a child’s apparent
omnipotence. She has also noted that these children may have particular dif culties
with aggression, as a corollary of the lack of an object suf ciently resilient to with-
stand the anxiety arising from their angry attacks.
There is, however, a further corollary I wish to stress, implicitly recognized by Freud
in a footnote to his account of the cotton-reel game. On one occasion the mother had
been away for several hours. On her return the child greeted her with the words ‘baby
oooo!’ or ‘baby gone!’ In her absence the child had found a way of making himself
76 C. URWIN
disappear. By crouching down in front of a full-length mirror he discovered that he

could make his mirror image ‘gone’, bringing it back by standing up.
We can only speculate on the phantasies and functions behind this game, a version
of ‘Peek-a-boo’. These must surely include mastering the anxiety that, in separating
from the mother, the baby will lose his self, if he is without the object upon whom
he depends. Another interpretation hinges on the phantasies about what, in her
absence, the mother is engaged in, and with whom; in which case, the mirror game
might enable the baby to deal with his fear of being displaced. Indeed, it is prob-
ably only through discovering or rediscovering ourselves as interesting objects to
someone, which presupposes being able to identify with a position outside ourselves,
that we can deal with the fear of being wiped out entirely.
This child had managed the beginnings of self-representation emphasized by Stern
as a prerequisite for the emergence of the verbal self, indicated in his verbal expres-
sion, ‘baby oo!’ But, in this paper, I want to illustrate how it is the presence of a
containing object which makes possible the survival and development of the child’s
sense of self and its verbal evolution. The four children described were all under
5 years old at referral. The presenting concerns involved substantially delayed or
disordered language development with accompanying autistic features. These included
avoidance of eye contact, a lack of gesturing, intolerance of change, absence of peer
relations and perseverative rituals. A query about autism was explicit or implicit
in each referral. Here I illustrate the disabling impact of deprivation and traumatic
experiences in the parents’ backgrounds on their ability to provide the kind of
containing, interpreting and link-making functions Bion’s account implies. I also
illustrate the rather active steps I took to enable the children to reclaim lost or hidden
parts of themselves.
The families were seen in my consulting room, which contains a couch, a dolls’
house and two puppets, a dog and a cat. In addition to the usual toy cars, drawing
things, a ball, dolls representing the child’s family plus one for myself, domestic and
wild animals and bricks, the toys provided included a Galt pop-up peg toy (a wooden
box with four holes with springs at the bottom so that four pegs with faces painted
on them can be made to pop up and down), a yellow car with movable eyes and a
red nipple-like button on the top which makes a noise when pressed, a set of ‘Billy-
in-the-Barrel’ nesting barrels and a pot of bubble mixture.
Four cases
Daniel
The rst child of Scottish parents, Daniel was referred at 3 years simultaneously by
his speech therapist and the special educational needs coordinator (Senco) at his
nursery school. They were concerned about seriously delayed language and autistic
features. These included bizarre preoccupations like repetitively opening and shut-
ting doors.
I saw Daniel together with our specialist registrar. Though his mother was report-
edly very worried, the rst appointment was attended by the father, Daniel and his
7-month-old baby sister. I became aware of Daniel anxiously hovering at the end of
the corridor, apping his arms in autistic fashion. A very anxious and obviously
depressed father explained that the boy’s mother could not come. She had started a
new job as he had lost his own. In the meantime, Daniel had stared very deliber-
ately at me and rmly walked off in the wrong direction. Once redirected, he watched
my face furtively for clues, as if he believed he needed to know the way already. In
the room I noticed that Daniel had brought in a little green wooden engine with a
thread attached which he pressed against his tummy. He was wearing a green coat.
I drew Daniel’s attention to how Daniel’s coat and Daniel’s engine were both green.
Daniel smiled at this connection. I began to engage Daniel with the peg toys. He
was interested. I played ‘Where has it gone? There it is!’ I put the toy aside, giving
Daniel space.
In this intervention I had intuitively recognized that the little train represented
an aspect of Daniel. By drawing attention to the similarity between the toy and
his green coat, I underlined a connection with Daniel himself; Daniel felt I noticed
him. This was underlined by the play with the peg toy, a kind of peek-a-boo, which
interested him because it resonated with his emotional experience of being lost and
found.
Meanwhile, almost in tears, the father wanted to know, ‘Is Daniel ever going to
talk? Why is he like this?’ As far as he was aware, the pregnancy and delivery were
normal. Daniel was a ‘good’ baby, did not cry much and slept and fed well. He
walked at about 12 months and from then on was very active. He was also easy to
toilet train. However, from about 2 years he had had some food fads. He did not
like different foods to touch each other. For example, sausage should not touch beans
or chips. Also, Daniel did not go through a stage of using gestures to ask for or
point to things. Now, if he wanted things from the fridge, he would go and get
them himself.
This is signi cant because pre-verbal communication studies have shown that
normally children’s rst words used in communication are accompanied by previ-
ously established gestural patterns like pointing and reaching in demand (Bates
et al., 1975; Bruner, 1983). The absence of these gestures is now used as a diag-
nostic feature for autism in pre-school screening tests (see Baron-Cohen et al., 1992;
Lord et al., 1989).
As a matter of course, I asked about separations, losses and deaths in the family.
The father’s mother had died close to Daniel’s second birthday. It emerged that the
food fads came on soon after this. The father became visibly upset talking about
this. He was very close to his mother and it was a big shock for the whole family.
Daniel also became very anxious at this point, identifying with the father’s distress.
Attuned to his anxiety about loss of his self, I picked up the green theme again,
connecting Daniel’s green coat and his green train. To our delight Daniel imitated
‘green’. I drew his attention to the barrels, shaking them and saying, ‘What’s inside?’
Daniel was able to connect the noise with the idea that there must be something
inside. After one demonstration, he began to open the rst barrel and then move on
to the next. Particularly fortunately, this one happened to be green, which again he
imitated. Eventually, Daniel reached the Billy and tried to pull it out.
78 C. URWIN
The father was amazed and enchanted at Daniel’s persistence. ‘We never thought
to teach him his colours’, he said, as Daniel enjoyed matching up the colours on
the peg toy and imitating ‘blue’ and ‘red’. Shyly, Daniel showed me the face on one
of the pegs, and then pressed it down. I played, ‘Where’s it gone? There it is!’
Shortly afterwards, in a determined fashion, Daniel went to the door. The father
said weakly, ‘Don’t go out Daniel.’ Daniel went out nevertheless. I said, ‘Where’s
Daniel gone? Where has he gone?’ Daniel came in and gave me a stare and a tentative
smile. I said, ‘There he is!’ Daniel smiled more broadly and went out again. I repeated,
‘Where has Daniel gone?’ and, ‘There he is!’ as he returned. Daniel repeated going
out and coming in with great pleasure, registering and representing that now he
could be found and bring himself back.
Greatly heartened, the father was keen to accept another appointment. However,
the family failed the next appointment. Fortunately, the third was kept by the mother,
Daniel and the baby. We learned that the father was now back at work and was not
able to come. We also learned that Daniel was now talking. He was requesting,
imitating and repeating jargon. Particularly important diagnostically, he was also
drawing attention to things, indicating that he had grasped referential and declara-
tive functions of language, despite the early absence of pointing.
This time Daniel had brought his green engine plus another. I learned that these
were ‘Thomas’ and his ‘friend’. Daniel knew where to come but became anxious,
needing to be retrieved from the waiting room. I said perhaps Daniel was looking
for his father and he was going to the waiting room where he rst met me. Perhaps
he was trying to bring us all together. In fact, much of the session was spent in
recapping the previous work, while Daniel periodically opened the door, leaving the
room. I would follow to look for Daniel, saying, ‘Where’s Daniel?’ to see Daniel
standing at the far end of the corridor, where I had rst seen him. Daniel would
then grin broadly and run gloriously at full tilt along the entire length of the corridor
as if he was playing ‘Where’s Daniel? There he is!’ in his head. Another repetitive
game was ‘Poor Thomas’, dropping the engine on the oor and picking him up
again. At one point he went over to his baby sister, giving her a big hug and saying
‘Poor baby’, turning to smile at us.
The mother con rmed much of the early history and acknowledged how worried
she had been and that the father had been ‘out of his head’ with anxiety. We also
learned that she had an older child by another relationship, who lived with the
mother’s previous partner in Scotland. She was conscious that Daniel had always
been slower and was not quite like this other child.
We did not hear anything more about the mother’s own background and what
were plainly previous losses. The next session was in fact the last. The mother was
satis ed with Daniel’s progress for the time being. They were able to increase special
needs support in school where he was doing relatively well.
Later we shared our thoughts with the speech therapist. The rapidity of Daniel’s
progress, his capacity for playfulness, his newly found empathy, the waning of ritu-
alistic behaviour and the uses to which he was now putting gesture and language all
argued against an autistic spectrum diagnosis. However, Daniel was clearly a very
anxious child, probably constitutionally vulnerable, who had attempted to by-pass
the normal pre-verbal communication through which the child relies on another’s
agency as a source of help. Daniel had apparently opted for a magical or omnipo-
tent solution in the search for potency, as described by Alvarez (1992). This involved
identifying with the father and taking his place so that he would not have to ask
for help at a time when his parents’ distress at the mother’s death may have made
it dif cult for them to contain the child’s anxieties and work together effectively.
Daniel had come to the rst appointment as if he had to know the way already.
Unfortunately, in this survival strategy the little boy Daniel disappeared. We believed
that the discovery that the little boy Daniel could be recognized and missed underlay
the delight in his running up and down the corridor. Further, losing himself and
picking himself up again may be what he was working through in his persistent play
with dropping and retrieving objects standing for his baby self, ‘Poor Thomas’ and
‘Poor baby’ and sometimes ‘Poor Daniel’.
Notably, it was dif cult to get both parents to come for appointments together.
This has been a feature in all four cases.
Memet
Memet was referred at 3 years 6 months with grossly disordered language develop-
ment by the speech therapist from the child development team. Memet’s other
problems included developmental delay and clumsiness. The speech therapist thought
that the bizarre content of Memet’s speech suggested autism and/or a thought disorder.
It might also have re ected events that he had witnessed. Memet’s mother is Cypriot
with Turkish as a rst language. She came to this country soon after an arranged
marriage that became violent. The violence continued until the parents separated
when Memet was 3 years old. The family did not attend at the time of the rst
referral. Nearly two years later Memet was referred again by his school. By this time
he was an aloof little boy, not relating to other children, though occasionally very
violent. He was also constantly preoccupied with holding two objects, two cars or
two action men, trying to force them together.
The mother attended a rst appointment with Memet and also a new Cypriot
husband and a baby daughter, mobile and talking. To my surprise, the husband was
told to stay in the waiting room while Memet somehow ended up leading the way
down the corridor.
Once in the room Memet started to bang the pegs, while his sister pulled things
off the table. Confused about what the appointment was for, the mother explained
that she was concerned that Memet was very slow and had been since birth. This
was not planned as she was on the pill. She did not know she was pregnant as she
continued to have what she took to be menstrual bleeding. She stopped taking the
pill in the seventh month. The mother told me reluctantly that her rst husband
had been violent towards her throughout the pregnancy and afterwards. But then
Memet was a baby and, she believed, would therefore not notice. As a baby, Memet
was always slow and a terrible feeder, constantly being sick. He would not take solids
properly until the fourth year, and even now he was very messy. ‘I have to feed him
like a baby’, she said with contempt.
80 C. URWIN
In the meantime an atmosphere of violence and chaos pervaded the session. The
little girl trampled across spilled animals and dolls’ house furniture while Memet had
taken charge of the dolls. A father doll was kicking the baby out and stamping on
the mother. It appeared that Memet’s mother was powerless to stop this aggressive
play. She wanted me to appreciate her dif culties.
I felt obliged to draw a rm line which, interestingly, both the mother and Memet
accepted. That was enough kicking of dolls, I said, and set him to draw a person.
Memet drew a boy, a mother, a father and a baby, tadpole like, but appropriately
ordered in terms of size. The mother was encouraged, but laughed at Memet’s efforts.
She wanted me to know how behind he was. With the barrels, at rst, when putting
them together, he left one out. However, he observed what I did, took them out of
his sister’s way and put them together correctly.
Memet was pleased with his achievement. I suggested to his mother that next time
she should bring him on his own. She agreed but cancelled the next two appoint-
ments. The Senco was disappointed. I agreed to try again.
On re ection I felt that the mess and chaos expressed the intolerable anxiety stirred
up by the talk about domestic violence. Perhaps my interest was felt as intrusive. I
also thought that the mother needed me to see Memet as the source of her prob-
lems because of the strength of her persecutory guilt, which she necessarily had to
project. The mother’s situation would have made it virtually impossible for her to
contain Memet’s anxieties as a baby, in the sense described by Bion (1962), who
refers speci cally to the containment of the infant’s fear of dying. I suspected that
this contributed to his subsequent communication dif culties. Nevertheless, some
success and recovery in the present would be essential before we could begin to think
about the past.
We began again with a minimal idea of success. I focused on enabling Memet to
nd lost objects. I explored what he thought happened to things that were ‘gone’,
and hoped to establish a context in which things, places and experiences could be
named consistently. On arrival, Memet shrank inside his coat, not sure whether to
recognize me in case he was in trouble. However, he went straight for the barrel toy
and with some pleasure repeated his previously successful performance. His mother’s
main concern remained that he was not learning and that he could not or would
not take things in. He still would not go and nd his shoes, even though they were
always in the bedroom. I suggested that the shoes be kept in a special place that
could be named so that he would know where to look. Memet’s mother apparently
did not grasp this; she would tell him and tell him, but he would not look.
I explored Memet’s ability to look for objects out of sight, using two barrel-halves
to hide a green pencil sharpener, shifting the barrel-halves around. Interestingly, from
a Piagetian perspective, he was able to deal with visible displacements, but gave
unusual reasons. He found the sharpener, for example, under the green barrel because
‘it’s green’ or ‘it’s sharp’.
I explained to the mother that I was doing this to explore what Memet thinks
happens to things when he does not see them. Do they disappear? Do they change
into something else? Do they get eaten up or turned into monsters? I was not, of
course, aiming to teach Memet ‘object permanence’ (Piaget, 1936). Rather, I hoped
to connect with his emotional experience, to build meaning that would enable him
to use his intelligence to exploit regularities in his environment. Fortunately, Memet
and his mother soon grasped this themselves.
At the next session, Memet greeted me more warmly. He had managed to nd
his shoes this week. His mother had now consistently placed them inside the door
where he could see them. He was pleased. His mother said things were a little better.
After enabling Memet to name his clothes and think about the things he puts on
in the morning, he asked me to ‘play that game again’. By this he meant hiding the
sharpener under the barrel shells, extending the hide-and-seek game to include other
objects. He gave me a boy doll to hide while he worked out whether it was in this
hand or in that. When it was not in one hand he would look in the other. Memet
was excited by his success at nding the object. I asked how he knew it was there.
‘Because I am thinking!’ he said touching his head and grinning. ‘Because I am
thinking. Cathy, you are magic!’
Memet attributed his pleasure in discovering that he had a mind to me. Suf ce
it to say, however, Cathy was not magic. His mother told me that the main language
spoken at home was Turkish, but that Memet was now more advanced in English
and trying to say more. However, in the session he produced some odd verbal asso-
ciations. These explained the initial concern about thought disorder and indicated
something of his internal chaos.
For example, I used the word, ‘understand’. ‘Stand?’ Memet asked. ‘Stand up?
Can’t stand? Can’t stand it?’ I referred to Memet having to deal with ‘all these
changes’ in his life. Memet started talking poignantly about different sets of clothes.
Furthermore, despite the success with nding his shoes, Memet’s mother had no
success in enabling him to get something from the kitchen. Memet would go in to
get his cup, stare straight at it and say it was not there. When I asked Memet what
things are in the kitchen, he said, ‘Batman’. Now it is possible that ‘Batman’ was a
reasonable answer as some toys were kept in the kitchen. Eventually he was able to
say ‘food in kitchen. A sharp knife.’ He raised his arms violently, and crashed about
the room like a monster before his mother got him to stop. She then talked again
about the terrible early feeding dif culties and how even now Memet cannot feed
himself without tipping everything down his front.
Subsequent sessions con rmed that Memet’s dif culties with nding things
re ected the persistence of the kind of process Bion (1962) described where the
young infant experiences the absent object not as something like a ‘good breast
missing’ but as a highly persecutory present monster. Imagery of sharp knives or
vicious teeth, for example, may re ect biting pangs of hunger, teething or weaning
and/or the young infant’s attacks on the combined object or parental intercourse.
For Memet, the terror arising from the violence of this primitive Oedipal phantasy
was exacerbated by the fact that the internal violence was horribly con rmed by the
domestic violence he witnessed.
The identi cation with a violent father, seen particularly in the rst session, allowed
Memet to escape the horror of his internal situation, but again at a terrible cost
to his small boy self. At the same time, Memet was more than usually motivated to
keep things apart, inhibiting things coming together meaningfully in perception and
82 C. URWIN
in language. By the same token the internal situation contributed to his rather manic
efforts to force things together, to stave off catastrophe, as in the ritualized play with
two objects.
Memet continued to attend for a further year. During this time, with sensitive
support at school, he made considerable progress in his use of language, his peer
relationships, his learning and his physical co-ordination. His mother did not always
nd it easy to recognize this progress and her part in it. In fact, it was only after
Memet’s feeding became less messy and a source of enjoyment that his mother felt
more con dent in her parenting capacities. Now that she could see that he was
getting better I began to hear more about the past. It became possible to think of
how to help Memet make sense of his grossly confusing experience.
Tunde
Primitive monsters were also a feature for Tunde, a small East African boy with
several elder brothers and sisters. He was referred by his speech therapist at 4 years
with severe language delay and autistic features. His school was particularly concerned
about explosive and violent temper tantrums. During these episodes Tunde appeared
to lose his mind completely. In addition, Tunde was terri ed of mirrors.
Tunde’s mother had already established a good relationship with the speech ther-
apist and, by the time of the rst appointment, Tunde had already started to use
words and eye contact had improved considerably. At the rst appointment, Tunde
headed along the corridor in front of us as if, like Daniel and Memet, he should
know the way already, suggesting an omnipotent identi cation. Indeed, once in the
room, he said ‘toys’ with great satisfaction as if he had magically produced them.
He named ‘cars’ and ‘bricks’ in a loud voice, rather arti cially. His mother explained
he had been for speech therapy this morning. She was keen to help him investigate
the toys but tended to instruct him as if he were a grown up. Tunde would repeat
the instruction without understanding. However, he was persistent with the barrel
toy, and was particularly delighted when he succeeded in nding the boy inside.
He was not able to order the dolls appropriately by size. He called the father doll
‘baby’, was muddled about the gender of the other dolls, and somehow the baby
doll ended up on the oor.
Tunde’s mother enjoyed this as playfulness and was now able to express some
distress about his language problems. The pregnancy and birth were unexceptional.
He was extremely quiet from the word go. He did not wake during the night, even
to be fed. This had worried her. The health visitor said to leave him. She breast-fed
him and supplemented this with bottles because she was concerned that he might
not be getting enough. Tunde’s mobility was extremely forward, and, like Daniel
and Memet, he had not used pointing or reaching in demand gestures. If he could
not get things for himself, he would push his mother to get things for him, moving
her arms bodily. His mother also worried about his tantrums. When he could not
have what he wanted, he could ruin everything for the whole family.
Tunde’s mother was keen to come for the next appointment, for which her husband
joined us part way through. She was pleased to report that Tunde was now talking
more, and trying to co-operate with his brothers and sisters. However, tantrums were
still occurring at school, mostly when he could not have something or something
was taken away. Anything ‘gone’ was gone for good.
As I had not asked before, I asked about bereavements in the family. The paternal
grandmother had died the year before in East Africa, but she had been living with
them before that, very involved with the family. Why did I ask? I explained how
children react to losses. Shortly afterwards the father arrived, apologizing. The mother
began a conversation in their language. She told him, she said, what I had said about
children being affected by losses. Tunde’s father was plainly shocked. He himself did
not think Tunde was affected by the death of the grandmother because he hardly
knew her. But he had been very affected when the family moved house shortly after
she had left. Tunde had cried and cried at night after that, not wanting to be left.
Now Tunde keeps talking about a monster. The father has to go upstairs with him.
‘Monster’, Tunde whispered, and leant up against him.
One effect of this intervention was that the family failed the next two appoint-
ments. However, I subsequently learned that another was that the father had arranged
for the mother to return to their country of origin for a holiday in the interim. She
had not been back since her marriage. When I asked how she got on with her own
family, with a wry grin she said, ‘It is a long, long story’, indicating a painful and
dif cult past.
I never heard the details of this, or of what family members had been visited,
or mourning rituals completed. However, the visit clearly had a galvanizing effect.
The father had looked after the children when the mother was away. Interestingly,
initially Tunde showed no reaction. Then suddenly, in the second week, he asked
‘Where Mummy?’, becoming very distressed, panicking and running a temperature.
The family agreed that at rst Tunde did not notice, but then, when he did notice,
he got very worried. He had been very clinging and attentive to his mother since.
While grandmother’s disappearance may have had more of an effect on Tunde
than his parents had thought, Tunde’s panic states were part of a broader problem
in regulating emotional states. Tunde and his mother regularly presented with broad
smiles and apparently buoyant cheerfulness. But Tunde’s drawings began to indicate
a wider range of facial expressions, culminating in a drawing of Mummy with a very
wobbly mouth. I asked what Mummy was feeling. ‘Happy’, Tunde said, ‘Mummy
happy’, unconcerned but unconvincing. This depiction of a very sad internal object
supported my sense that Tunde’s reluctance to feed at night as a baby already repre-
sented his sparing a depressed or preoccupied mother. Another consequence of this
was that he kept parts of himself hidden, as he showed me by secretively covering
up the boy in the barrel,
Quite why became clearer when I began to understand more about the night-time
monsters by seeing Tunde himself in a monster state of mind, when father was away
over two sessions on a training course. At the rst, while I was talking to his mother,
Tunde began to overturn the dolls’ house, bellowing like a bull on a rampage, as if
identi ed with a very angry, bellowing parent. This identi cation was con rmed in
the next session, when his mother told me that the night-time monster had been
around in earnest. I asked about the bedtime routine. She explained the sleeping
84 C. URWIN
arrangements. In a two-bedroom at, all the elder children sleep in one bedroom.
As the baby, Tunde sleeps with her.
At 4 years of age Tunde was almost certainly caught up in an intense Oedipal
situation. He both wished to usurp his father and was also terri ed of taking his
place. In his rages Tunde appeared to be becoming the monster father in intercourse
because of his fear of retaliation. Some con rmation of this kind of process occurred
later in the session. While I was talking to the mother, Tunde became very disturbed,
as if the night-time fears were taking over. ‘Tunde stop it, we are going now’, the
mother said. She did not know what made Tunde angry sometimes, as Tunde crashed
about. I commented that Tunde needed help to manage his angry feelings. Tunde
got the puppets down, made them ght each other and then gave one to me. His
fought mine, then he turned them around so that my puppet was to attack his. I
commented on how Tunde was afraid that he would have made me angry and turned
Cathy into the big, horrible, cross monster. Tunde was pleased with this, and wanted
me to blow bubbles for him.
Despite the intense persecutory phantasies, and possibly facilitating their expres-
sion, there were a number of positive developments going on concurrently. For the
rst time, Tunde pointed to the white woman doll, called it ‘Cathy’, hid it, and
played my own game back at me. ‘Where’s Cathy? There she is!’ Tunde thought
this was extremely funny. A month later, Tunde gave more evidence of grasping the
idea that when people are out of sight they may retain their good qualities. The
parents were pleased to report that when father was away Tunde had told people
that he would be coming back ‘at the weekend’. Tunde was delighted to see his
father, giving him glasses of water and asking if he was all right.
Tunde played with the peg toy for the rst time at this session, deliberately making
the mouths on the faces disappear and showing me this. He also drew attention to
the eyes. ‘Oh dear, boo hoo’, pointing to the eyes when he dropped them to show
they were crying because they were dropped, showing a clearer understanding of links
between object relations and emotional states.
As for the monster, the parents believed that it had gone for good. In fact it
re-emerged in a different form as, in the next session, Tunde produced phantasies
about a new pregnancy, playing out his anxiety as to whether this was something he
could bear. Pushing the yellow bubble car with big eyes slowly and threateningly
towards us, Tunde played that this was a monster baby who could consume every-
thing. At home Tunde played at being a monster. His siblings indulged him because
he is ‘the baby’. His mother was not too worried now about Tunde’s dif culties.
She believed he would grow out of them. She thought Tunde was as he was because
he was the last child.
In fact, even without another pregnancy in the family Tunde was moving out
psychologically. He tried to put the Tunde doll into a little drawer in the chest of
drawers in the dolls’ house. ‘Baby? Oh oh,’ he shook his head, ‘too big.’ Tunde
understood more, asked more questions and wanted to explain more. He would take
turns on the computer, and allow his father to change television channels to watch
the news. Ten months after we began the parents reported that Tunde still needed
someone to take him upstairs to bed sometimes, but he would now say ‘I don’t do
tempers. I don’t do roll-about on the oor. Oh no. Babies do that.’ There was some
wish to be more grown up.
At this session, Tunde wanted to blow bubbles. For the rst time he became fasci-
nated at looking at his re ection. He blinked when the bubble burst. He looked up
close to my eye, I believe at his re ection, as if he was not sure whether he would
disappear and be swallowed up by my blink. Tunde could now bear this anxiety,
knowing that I was able to retain a memory in my mind that was separable from
the mirror image of him, and that it would not disappear. But neither this image
nor the memory is the ‘real Tunde’. Where is he? Tolerating this uncertainty means
tolerating profound existential anxiety. At this point I think Tunde’s fascination with
the re ection was an outcome of stronger internal cohesion or a more robust object,
and that this containment underpinned a stronger sense of self.
Foyzal
Dealing with mirrors was also problematic for the fourth child, Foyzal. At 4 years,
Foyzal presented as electively mute at school. He was referred for additional concerns
about autism. He has learning dif culties, as does his father, who speaks English and
came to this country from the Indian sub-continent when he was 10 years old. His
mother does not speak English. Foyzal has two younger brothers, developing normally.
I saw this family with a male interpreter. In this case a major aspect of the work
involved releasing the inhibition contributing to the elective mutism. This became
possible after enabling the parents to see their achievements in a positive light and
to talk through their traumatic experiences.
At their rst appointment, unlike the other three children I have described, Foyzal
made no assumptions about knowing the way, but padded along beside me like an
overgrown baby. In the room he went immediately for the car with eyes and pressed
the red button to try to make them disappear. He gave the impression of wanting
us to disappear as well.
The parents’ concern was that he did not speak at school, though he spoke at
home. For example, he would say what he ate for dinner at school. He now ate rice
and other things, but as a baby he had been very dif cult to feed. The father gloomily
said that Foyzal was the same as him. He had been to a special school. It had not
done him any good. I said that it was very good that Foyzal was now eating solid
foods. At this positive comment, Foyzal came to the table and obligingly gently
removed the crocodile from the animal box.
Shortly afterwards Foyzal found the barrel toy. He watched me begin to open it,
rapidly got the idea, and smiled appreciatively at the end when I emphasized, ‘It’s
a boy!’ He tended to leave out a cup when putting it back together again, but
persisted until he got it right. However he walked off limply when little brother
muscled in.
I attracted Foyzal’s attention with a doll and asked him to ‘put the doll in the
dolls’ house’, pointing. He did this. I asked him to give the doll a bath and then to
put the doll to bed. He did this appropriately. His mother insisted that he under-
stood things perfectly. But she was plainly very pleased to have this demonstration.
86 C. URWIN
The family was keen to come again but in the event failed the next two appoint-
ments, the father coming alone with Foyzal for the one after that, apologizing gloomily.
Foyzal looked at me directly, disarmingly silent. However, he was keen to get the
barrel toy open and pulled hard at the Billy inside. My intuition was that this was
an expression of castration anxiety, related to observing me talking to his father. I
attempted to interest him in the peg toy, but he turned the faces away. He began
to draw long shapes like caterpillars.
Meanwhile the father complained again that he and Foyzal were just the same. I
wondered if he thought that Foyzal had the same reasons for not talking as he might
have had. The father brightened and said he thought it might be for different reasons.
Perhaps Foyzal is shy.
I recalled that Foyzal had been very dif cult to feed as a baby. Foyzal had been
born in their country of origin, the father explained. He himself was not able to be
there. It was some time before he could get his wife over to the United Kingdom.
His wife’s mother had died soon after Foyzal was born. His wife had had no parents
to support her. But he had to come back to be in this country with his own family.
At this point Foyzal silently interrupted me to show me that there were ies on
the front of the Billy in the barrel’s trousers. I said this was very de nitely a boy!
Foyzal’s coming forward in this way was, I think, closely connected to his father’s
telling his story and feeling strengthened by it. The father told us that he sometimes
takes Foyzal to the local airport to watch the planes, which he loved, although he
had not been on a plane since he was very small. I drew a plane, Foyzal added some
appendages, then covered them up.
At the end of the session I showed Foyzal the bubbles. He was interested but
could not or would not blow, shrinking away. Like Tunde he became alarmed when
he saw his own re ection in the bubbles, and when he saw me looking at him in
the mirror. I wondered silently whether Foyzal was alarmed at seeing two of me, or
me in the wrong place, or whether he was afraid I would get right inside him and
devour him with my eyes. While I was thinking this, he went to the animal box
and took out the crocodile and the lion, feeling their teeth. As I commented to the
father how much Foyzal understood, and how much he was trying to communicate,
Foyzal picked up the mother pig and a baby pig, and had the mother feed the baby.
This con rmation that I understood Foyzal’s emotional experience was very moving.
Unsurprisingly, Foyzal found it hard to separate at the end of the session. I said that
Foyzal was angry at having to go, but we would play with these things again next
time. Foyzal watched my face and touched his own teeth.
This was the rst direct indication that inhibition of aggression was affecting what
Foyzal allowed in and out of his mouth. At the next session he was much occupied
with watching my face, drawing faces with mouths with teeth, which he did not
scrub out afterwards.
More substantial changes in expressed emotion came after the next session, attended
by both parents. Through the interpreter I asked the mother more about the early
history. The mother had been living with her mother and sisters when she was preg-
nant. Her mother became seriously ill unexpectedly. It was a big shock when she
died soon after Foyzal’s birth. The labour was straightforward and he was a good
weight. But he would not feed from the breast. The mother started crying. Foyzal
looked up sharply, alarmed, watching her face.
After this I engaged Foyzal’s attention with the peg toy. He looked at the little
faces, and followed my lining them up until his little brother intervened. Foyzal
surreptitiously took animals and dolls to the dolls’ house. The crocodile savagely
attacked and fought the baby.
This play suggested the degree to which rivalry with his baby brothers, and anxiety
about the consequences of his aggression, may have been inhibiting him. But it is
also possible that Foyzal was already inhibited within the early feeding relationship,
like Tunde, dealing with the internal world of a depressed and preoccupied mother.
The mother attended the next appointment with Foyzal and a younger brother,
without the father. The mother complained that Foyzal was ‘the same’ but it soon
emerged that by ‘the same’ she meant that Foyzal was becoming more dif cult. In
the session, one of the most striking changes was in the exuberance of the play
between the two boys. Now Foyzal would not give way when his brother took things
from him. There was a good deal of more or less playful ghting between them and
between the dolls, some of it plainly mirroring sexual intercourse.
At the end of the session Foyzal requested the bubbles, which he now enjoyed
though he could not blow them. Before nishing, the mother asked if I could help
with their housing situation. We learned that all ve of them were living in one
room in her father-in-law’s house, inhabited by other members of the extended family.
Embarrassed, she said that her husband was reluctant to move because he did not
want to leave his family.
I was shocked by the overcrowding. I wondered if they could move to another
at somewhere nearby. I said I would write a letter, adding that, from the play, she
had two growing boys here and they were getting too big to be in the same room
as their parents. The interpreter looked extremely worried at the task of interpreting
this but said he would do his best. An animated conversation ensued, into which I
was eventually included. The interpreter explained that he had said what I said in a
‘polite way’. The mother had said she knew exactly what I meant and she quite
agreed. Please would I have a go telling her husband!
At this point I felt a sharp pull on my arm. Foyzal had got hold of the bubbles
and had pulled the lid off. ‘Phew! Phew Phew!’ No longer afraid, Foyzal was blowing
glorious strings of bubbles across the room. At the door Foyzal wanted to give me
a kiss. ‘Bye bye’, he said, ‘Bye, bye, bye.’
There are many reasons why this was a pivotal moment for Foyzal. The adults
took responsibility for saying something unsayable, referring to the parents’ sexual
relationship and the father’s separation dif culties. The work done by the interpreter
was considerable. He was broaching a cultural divide that interestingly mirrored
Foyzal’s elective mutism. Foyzal was avoiding going public in the language of the
dominant culture outside the home, spoken by the father but not the mother.
Over the following weeks the changes in Foyzal were neither rapid nor dramatic. He
continued to say ‘Bye’ at the end of sessions, to become more outgoing and to enjoy the
bubbles. He also enjoyed looking at himself in the mirror. The father did agree to apply
to the housing department, in the meantime getting bunk beds for the two elder boys.
88 C. URWIN
For various reasons, after the family had been attending for about six months, we
decided to have a break in the work and to review again in six months time. The
review was held early in 2000 and attended by Foyzal and his father. Foyzal wrote
the date and the year, 2000. I wondered if he had seen the reworks celebrating
the Millennium. He nodded, and began a funny little drawing like an upturned
spider with spiders’ legs. I turned to talk to the father. They were quite pleased with
Foyzal. He was working hard and doing homework. Foyzal interrupted, to produce
his rst statement in a session, ‘I have seen the Millennium Dome! We went on the
Docklands Railway.’ Then followed a quiet but articulate discussion of the millen-
nium celebrations. With encouragement he drew a picture of the Docklands train
with passengers and a driver. Though immature, this was a substantial advance over
previous drawings.
I saw Foyzal for review subsequently. At that time he was a good looking,
caring boy with very powerful eyes and a passionate relationship with his mother.
He remained a quiet boy at school, but was no longer isolated and actively
related to peers. Particularly encouraging, there had been some changes in measured
intelligence.
Discussion
At the beginning of this paper I described some different approaches to language
development within psychoanalysis and developmental psychology. Each offers
complementary explanations of language delay, focusing on different aspects of the
acquisition process.
I began with Lacan, whose views on language were in uenced by the work of de
Saussure, a linguist whose major contribution was to argue for the notion of signif-
icant difference as the basis of meaning in language. To understand how, for example,
the word ‘tree’ comes to signify vegetation with a trunk, branches and leaves, one
has to understand the relation between this word and other words in the language
which denote things that a ‘tree’ is not.
Though the link between words and things is arbitrary, something must ensure
some relative stability. Lacan’s originality lay in relating the acquisition of language
to the growth of the psyche as described in psychoanalysis such that the growth of
language is part of the growth of mind, with culture implicated within it.
For Lacan it is through what he calls the Law of the Father, prohibiting the
child’s access to the mother through the universal incest taboo, that the position of
the phallus gains centrality in the relative xedness of the meanings in a language.
Thus the ‘difference that makes the difference’ in language is underpinned by the
castration complex and the Oedipal situation. As Lacan puts it, sooner or later
we all have to decide whether to line up with the ladies or the gentlemen (Lacan,
1966). This emphasis also means that language is necessarily gendered, and language
delay or disorder may re ect dif culties in negotiating the Oedipal situation or
its precursors.
More recently, developmental psychology has understood the problem of what
unites words and things in terms of the problem of reference, or what allows speaker
and hearer to identify for each other the same object or event in the world, real or
imagined. The roots of this are now thought to be pre-verbal. Thus, the kind of
turn-taking games and reciprocal interactions described by Bruner (1983), Stern
(1985) and others for ensuring the mutual regulation of attention and intention
underlie the primacy of pragmatics in language, that is, devices for interlacing perspec-
tives between speaker and hearer. They are also thought to pave the way for referential
communication. Particular attention has been given to communicative pointing, as
indicating the skills involved in drawing another’s attention to a particular object in
the world (Bruner, 1983). Hobson (1993) has seen the clinical signi cance of this
in his work on understanding autistic children. For them the dif culty with, or
absence of, communicative pointing is but one aspect of a more global problem in
identifying with another person’s point of view. Insofar as this requires being able
to represent the position of the other, this position is broadly compatible with that
of Stern (1985), for whom the representation of the self–other relation is integral to
the emergence of the verbal self.
Another set of possibilities, however, follows from the work of Bion, for whom
language development begins at a more primitive level concerned with the commu-
nication of emotional experience. For Bion, what connects signs and their referents
or signi cates depends ultimately on a relation with a thing in itself, which, following
Kant, is essentially unknowable. However, it also depends crucially on the develop-
ment of what he calls alpha function, the capacity to sustain thinking about emotional
experience. This carries with it its own momentum, as a link-making, self-generating
process.
Like Lacan and the developmental psychologists, Bion would need to account for
how or why children are eventually motivated to adhere to the particular language
system used around them. For Bion, this socialization would be underpinned by
the move into the depressive position, and with it the pre-genital Oedipal situation.
As this is a psychoanalytic account, this entails coming to terms with separation and
loss. However, in the depressive position or the pre-genital Oedipal situation, the
pressure of internal reality creates the phantasy of displacement that makes commu-
nicative effectiveness in the outside world highly desirable. As Burhouse (2001) has
argued, it is likely that the growth of deliberate pointing in the outside world is
linked to this internal shift. Put simply, ordinarily babies’ use of language to gain
and direct attention to themselves and the world means they are less likely to feel
left out.
Moreover, from the argument developed here, it is not just the signi cance of loss
inherent in the depressive position that drives language development, but its gener-
ativity, the unstoppable coming together of things in new relationships. Though
designed for another purpose, Bion’s diagram (Figure 1) illustrates how the obser-
vation of many examples of symbolic relations may create a pressure on the psyche
to create new structures to encompass developing concepts, although what ultimately
links them may be unknowable. Here, for example, Daniel’s discovery that the word
‘green’ could link his coat, his train and himself led on to his need for more words
to name other colours, as he grasped the relation between colour as a concept and
words in the language.
90 C. URWIN
Music Religion Sculpture Poetry Painting
Instrument God Stone Language Paint
Root
Source: Bion (1992: 323)
Figure 1
For Bion, where there have been repeated impediments in the communication and
modi cation of emotional experience, the development of a link-making function
will be impaired. Implicated in the breast–mouth link initially, this will eventually
manifest itself in the link between the parental couple on which, symbolically, the
generativity of the depressive position is based.
Where would one place the children described in this paper? Though there are
many differences between them, the four children are all developing against a back-
ground of deprivation and trauma in families dislocated from their countries of origin.
In consequence, as is common in families where there are children with communi-
cation dif culties, more work than usual was necessary in liaising with external agencies
and in enabling the families to attend. It was often hard for both parents to attend
the appointments simultaneously. I have suggested how the parents’ own tragedies
had impeded their ability to contain their children’s anxieties, cutting across link
making and contributing, quite literally, to a ‘nameless dread’ as described by Bion,
manifested in delayed or inhibited use of speech. All the children showed distur-
bances in feeding and anxiety about taking in through the mouth. This anxiety may
have had implications for early symbol formation, at the level described in the concept
of the ‘theatre of the mouth’, which Meltzer (1986) derived from Bion’s notion of
creative links between mouth, nipple and breast. However, it is also clear that, in
the case of at least three of the children, their anxiety and inhibition was exacerbated
by an infantile view of parental intercourse as violent and terrifying. Containing
the anxiety associated with these universal phantasies is especially dif cult for young
children frequently caught up in domestic violence. It is also particularly dif cult in
cases where constitutionally vulnerable children have repeatedly been witness to sexual
intercourse. In both situations the external reality then matches the internal situa-
tion too closely. Rather than reaching the generativity of the depressive position, a
child locked in this kind of internal scenario, inside the primal scene, may be driven
to break links, to keep things apart. Here, the consequences included disordered
thought, a retreat into mindlessness and an identi cation with violent internal gures,
as well as delays in language development.
Enabling the parents to begin to talk about their own situations contributed to
their capacity to respond to their children as children, and to the withdrawal of some
of their own projections. But I have also highlighted the active steps I took to reclaim
and bring forward hidden parts of each child, after rst identifying and modifying
in the countertransference the nature of the object with which he was partially iden-
ti ed, whether absent, dead, collapsed or highly persecutory. For each child it was a
big step when he could show that he knew that I knew that there was a little boy
inside the barrel, and that it was a pleasure to bring him out. This coincided with
developing a sense of the generations, a clearer gender identity, a capacity to use
language with a new authenticity and a waning of autistic features.
The interventions lasted from four months to one year. At the end, all the chil-
dren still have special educational needs, and two have full Statements of Special
Educational Needs. This entitles them to gain extra help in school. Nevertheless, the
relatively brief and non-intensive work led to a substantial waning or disappearance
of autistic features. Did the work stave something off, cure something or was the
concern about autism inappropriate?
This work did not cure autism. The initial concern, though, was completely appro-
priate. The interventions had a huge impact in mobilizing the potential in the children
and parents, opening new developmental pathways. The increasing incidence of chil-
dren being given a psychiatric diagnosis of autism or autistic spectrum disorder
encompasses a wide range of different presentations and degrees of severity. Psychiatric
diagnosis does not necessarily correspond with what we may think of as signi cant
psychodynamically. Psychiatric diagnosis depends largely on the presence or absence
of de ning characteristics. This can mask signi cant differences between children and
fail to do justice to their developmental strengths.
A psychodynamic viewpoint can complement psychiatric diagnosis by describing
the nature of the child’s object or part-object relations that contribute to the symp-
tomatology, the ego de cits and their implications. It may also be able to describe
the personality characteristics of children who overcome some of their dif culties as
opposed to those who do not. Psychotherapy with autistic children has now given
us considerable insight into the phenomenology of autism, providing valuable descrip-
tions of different kinds of internal situations contributing to different presentations.
These include Tustin’s (1981) original distinction between ‘encapsulated autism’ and
‘schizophrenic type autism’, where the object is more persecutory and fragmenting,
and Alvarez’s (1999) more recent distinction between ‘undrawn’ as opposed to ‘with-
drawn’ autistic children, with the emphasis on the nature of the de cit in the object’s
containing capacity and the child’s response to it. Most of this work has depended
crucially on Meltzer and his colleagues’ careful analyses and descriptions of how
fundamental problems of containment impact on the development of mental space,
contributing to the two dimensionality and stuck-on quality of autistic children’s
thinking and relating (Meltzer et al., 1975).
From this point of view, what was striking about these children was that they
actively sought containment, and were not overly dominated by two-dimensional
thinking. They were positively interested in what was inside the barrels. Moreover, with
the possible exception of Tunde, none of them ‘dismantled’ the sensori-perceptual
92 C. URWIN
apparatus under the pressure of emotional experience, as described by Meltzer (1975).

In consequence they seldom showed evidence of going into autistic states of mind
proper. Rather, these children were getting by on hugely omnipotent solutions.
Apparently in mammoth projective identi cation with variously depressed, ineffectual
or aggressive fathers, these solutions re ected a search for potency, in the sense
described by Alvarez, as the children made the best of their psychically deprived cir-
cumstances. As Maria Rhode (personal communication) has suggested, this implies
that they had managed something of the developmental shift from mother to father.
This itself argues for some three dimensionality and is in contrast to children who
identify more or less completely with a collapsed or highly damaged primary object.
In my view, this factor, along with the availability of alpha function, differenti-
ates these children from children who are clearly autistic. However, there are some
interesting similarities between these children and accounts of children in the liter-
ature for whom a diagnosis of autism is unequivocal. This gives this work general
relevance. For example, Rhode’s (1999) recent work on language development in
autistic children describes how she has come to focus on enabling the child to nd
his or her authentic voice. This depends on the child becoming reunited with hidden
parts of the self, possible only once the tolerance of emotional experience has increased.
Similarly, it is also striking how often, within the collection of papers edited by
Alvarez and Reid (1999), ‘Peek-a-boo’ emerges as the children begin to recover. This
is illustrated in Reid’s (1999) vivid account of an assessment in which, after an
unpromising beginning, a little girl becomes able to represent her self and to play
‘Peek-a-boo’, making herself appear and disappear. Reid describes how cheered she
was by this. I would go so far as to say that ‘Peek-a-boo’ is a hallmark of the emer-
gence of the non-autistic personality, and it is to support such a process that the
I-me-you-it games of infancy are so important, and a justi ed aspect of psychother-
apeutic technique.
Flat 1
18 Alexandra Grove
London N4 2LF, UK
e-mail: cathy.urwin@ukgateway.net
Acknowledgement
I should particularly like to thank Linda Dawson, Andy Cohen and Nural Huque
for their invaluable help in this work and in writing this paper.
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A Psychoanalytic Approach To Language Delay

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JOURNAL OF CHILD PSYCHOTHERAPY

VOL. 28 NO 1 2002 73–93

A psychoanalytic approach to language

Keywords Autistic spectrum; language development; language delay; multicultural; trauma.

This paper comes from a long-standing interest in language development as an

Journal of Child Psychotherapy

Psychoanalysis and language

An alternative is to see language development as an intrinsically motivated system

disappear. By crouching down in front of a full-length mirror he discovered that he

Music Religion Sculpture Poetry Painting

Instrument God Stone Language Paint

Source: Bion (1992: 323)

apparatus under the pressure of emotional experience, as described by Meltzer (1975).

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