The Odd Patient: Relational Psychoanalysis Meets the

Asperger Patient

Ron Balamuth, Ph.D.

Case Presenter: Dr. Nancy Crown

4.0 NASW*/APA** Continuing Education Units

"Why is the pronghorn antelope, a prey, the fastest land animal, rather than the cheetah, a predator?" challenges a young patient who was diagnosed with Asperger. This young man is typical of a kind of patient that many of us have in our practices, to whom we casually refer as “odd” or “peculiar”. What strikes us as odd in these patients may vary. It may be the pedantic and over-precise use of language; perhaps the absence of inflection and prosody in their speech. With others it may be a single-minded obsession or a “specialty” similar to this young patient’s obsession with pronghorns. Often it is an oddity of body language, of movement, or of the way they use personal space that strikes us.

Regardless of the surface manifestations, it is the way we register in our gut their remoteness and inaccessibility, whether through lack of eye contact, flatness of affect, or lack of curiosity and interest in connecting with us that makes us consider an Asperger diagnosis. It is a particular lack of aliveness that is not a pervasive absence often associated with an autistic, psychotic or schizophrenic presentation. With Aspergers we are often struck by the contrast between areas of immense intellectual and often emotional investment, in the larger context of pervasive self-absorption and lack of inter-subjectivity. When we refer to these adult patients as “Aspergers”, we do it with a measure of tentativeness and uneasiness, perhaps aware that we are applying to adults a diagnosis that was originally applied to young children.

This workshop will provide us with an opportunity to study how we work developmentally and intersubjectively with these types of patients. We will spend the morning listening to a case presentation of analytic work with an adult Asperger patient. We will introduce and discuss the DIR (“floortime”) model developed by Dr. Stanley Greenspan for the treatment of young children with developmental challenges, and apply it to the work with adult Asperger patients.
In the afternoon we will expand our discussion and bring the DIR model with its developmental focus into a dialogue with relational psychoanalysis. We will discuss the inherent dialectic tension between developmental and intersubjective relational theories. Using participants’ and instructor’s case vignettes we will explore the strain of working intersubjectively with patients who have these kinds of significant sensory and processing challenges that limit their inter-subjective capacities.

Ron Balamuth, Ph.D. is a Clinical Psychologist and Psychoanalyst, graduate of the New York University Post Doctoral Program in Psychotherapy and Psychoanalysis. He is on the faculty and a supervisor at the William Alanson White Institute Child and Adolescent Training Program, the National Institute for the Psychotherapies, and Columbia University Teacher’s College Program in Clinical Psychology. Dr. Balamuth has been involved in the DIR and the Floortime method for over fi fteen years. He serves on the faculty of the DIR Institute, and conducts DIR workshops both nationally and internationally. Dr. Balamuth has written, presented and published numerous articles on topics ranging from Psychoanalytic approaches to the body, parenting, immigration, and the integration of spirituality and psychoanalysis. Dr. Balamuth is in private practice in New York City, where he consults with individuals, couples, families and children. He also leads study groups and case consultations for professionals.

www.nipinst.org

CEU's will be distributed at the end of the event, upon the completion of a brief workshop evaluation.

*This program has been approved for 4.0 hours of continuing education under the auspices of the National Association of Social Work.

** The National Institute for the Psychotherapies Training Institute (NIPTI) is approved by the American Psychological Association to sponsor continuing education for psychologists. NIPTI maintains responsibility for this program and its contents.