The gaze, the mirror and representation of a self in the treatment of a young boy with pervasive developmental delay and marked autistic features

This paper explores the ways in which the ‘recognition of a self' aspect of mirroring, as epitomised by the mother's gaze of her newborn at the breast, served to set development in motion in the case of Adam, a little boy of four and a half, who was referred for psychotherapy after receiving a diagnosis of pervasive developmental delay with marked autistic features. The paper uses detailed clinical material to track Adam's development of a representation of his self and his object and his use of the mirror in this process. The author shows how Adam went from not recognising his reflection in the mirror to seeing the reflection of himself in the therapist's eyes and then using the mirror to support his exploration and internalisation of the permanence of his self and his objects as well as their physical and psychic characteristics and functions. The author also seeks to demonstrate ways in which Adam's use of the mirror facilitated emotional engagement and working through of painful aspects of the infantile transference: these included primitive anxieties related to being seen and taken into the mind by the object feelings of terror and loss inherent in experiencing the self and the object as separate and intense rivalry and envy of the other occupants of the object's mind. Lastly, the author seeks to show how Adam's work at the mirror linked to the emergence of verbal language and the development of symbolic thinking