ABSTRACT

This paper is the third of a triptych of papers. The word ‘triptych’ refers to traditional religious paintings, where three panels are joined with hinges. Each of the three papers in this triptych outlines certain aspects of my patient Sam’s fourteen year psychotherapy. When these papers are read together, they provide a detailed exploration of the most noteworthy changes I have observed in Sam over the fourteen years of our therapeutic relationship. This third and final part deals with the way that Sam’s defensive structures have developed and shifted over fourteen years. It integrates material from all three papers, and makes a foray into theorising about some possible aetiological sources of ASD, emphasising psychodynamic aspects. Taken together, the three papers are my effort to map out the important psychodynamic changes in Sam’s functioning across fourteen years of treatment.

摘要

这篇论文是三联论文中的第三篇。“三联画”一词指的是传统的宗教绘画，其中三个面板用铰链连接。这幅三联画中的三篇论文中的每一篇都概述了我的病人山姆十四年心理治疗的某些方面。当这些论文一起阅读时，它们详细探讨了我在我们治疗关系的 14 年中在 Sam 身上观察到的最值得注意的变化。第三部分也是最后一部分涉及山姆的防御结构在 14 年中发展和转变的方式。它整合了所有三篇论文的材料，并尝试对 ASD 的一些可能的病因学来源进行理论化，强调心理动力学方面。综合起来，