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Tristan at nineteen months

At the beginning of the second home treatment session with Tristan, a nineteen-month-old autistic boy, mother welcomes the therapist, saying: "It's not a good time to come! Tristan is still asleep. I'll have to wake him up ..." The therapist replies that she needn't wake him up right away, they can have a talk first. They agree on a different time schedule for future sessions, then go into the sitting-room and settle into armchairs. Tristan's mother has a lot to say, "Yesterday, he didn't have his nap at all, he didn't wake up until 10:15 in the morning. When the weather's bad like that, we can't go into the garden."

The therapist asks mother how she is managing to put up with the weather in this part of the country—the family has recently moved from the south of France to Brittany.

"The weather's not great", says mother. "But the countryside is much nicer and the beaches are prettier. We haven't yet gone back to our lovely home city. My husband and I have explained the problem with Tristan to our parents. My parents are very understanding and they have faith in the treatment that's being done here, but not my parents-in-law. They want us to consult specialists in Paris and follow their advice. They don't feel that we're doing the right thing to help Tristan here in Brittany. It doesn't help when they question everything we are trying to do. My husband went to Paris recently—they're pressurising him to have Tristan treated in Paris. We're not sure what to do yet."

In this example, we see that mother is overwhelmed and upset by so many things that come both from inside her mind, and from the outside world. She has a real need to talk to the therapist about all this, and the therapist has to give all her friendly attention in spite of that fact that mother is, inter alia, criticising the treatment. In fact, as the session goes on, mother's complaints diminish little by little and she ends up trusting the therapist, and enjoying observing her baby in the company of this new person. My contention is that, through her apparent complaints over the schedule, the weather and the attitude of her parents-in-law, she was projecting into the therapist her own uncertainty and distress.

ii. Reinforcing parental competence

Very frequently, parents of mentally disturbed children are trapped in a "fantasy of incompetence". I have encountered this fantasy particularly in mothers of autistic children: it is as though such mothers have no sense of their own competency to deal with their child and find correct responses to his different needs. Indeed, they induce others to judge them as inadequate mothers: either they respond to their child as if they really were inadequate or they ask for advice in such a way that they give the impression of being unable to find their own solutions. This is a trap frequently set for the unwary therapist. Giving advice to the mother—or even replacing her in caring for the child—only increases the mother's feelings of inadequacy and reinforces her "fantasy of incompetence". On the other hand, avoiding identification with the incompetent aspect projected into the therapist will help the mother to break free from this terrible vicious circle of incompetence. When therapists succeed in this, we see mothers become able to discover their own authentic responses to their infant's needs.

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