ABSTRACT

This paper is the second of three, outlining different aspects of my patient Sam’s fourteen years of psychotherapy. This second paper focuses on two aspects in the work. The major issue involves Sam’s psychosexual development from eleven to twenty-four years of age, emphasising the autistic level of the Oedipus complex. The second issue is the decline and eventual disappearance of Sam’s autistic rituals, which he had used in his treatment. The discussion of his psychosexual development includes the perverse and sadomasochistic aspects tied into his sexuality, along with powerful castration anxieties, which were also tied into annihilation anxieties. More recently, Sam has been consciously concerned with behaving ‘appropriately’ with women, but with unconscious fears of his own sexual impulses regarding being bullying and aggressive. Autistic rituals were not uncommon in the early part of Sam’s treatment. I outline in detail the last autistic ritual he showed me, during his sixteenth and seventeenth years. No further rituals have been observed from Sam’s eighteenth year onward. I conclude with some observations on how Sam responded to the sudden switch from in person to online psychotherapy in March 2020.

摘要

这篇论文是三篇论文中的第二篇，概述了我的病人 Sam 十四年心理治疗的不同方面。第二篇论文主要关注工作中的两个方面。主要问题涉及山姆从 11 岁到 24 岁的性心理发展，强调俄狄浦斯情结的自闭症水平。第二个问题是山姆在治疗中使用的自闭症仪式的衰退和最终消失。关于他的性心理发展的讨论包括与他的性取向有关的反常和施虐受虐方面，以及强烈的阉割焦虑，这些焦虑也与毁灭焦虑有关。最近，Sam 一直有意识地关注对女性的“适当”行为，但无意识地担心自己的性冲动会受到欺凌和攻击性的影响。在山姆治疗的早期阶段，自闭症仪式并不少见。我详细概述了他在 16 岁和 17 岁时向我展示的最后一次自闭症仪式。从山姆 18 岁起就没有再进行过任何仪式。最后，我总结了 Sam 对 2020 年 3 月突然从面对面心理治疗转变为在线心理治疗的反应。