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Preface

Both the Tavistock Autism Team and its Workshop are based in the Child and Family Department at the Tavistock Clinic. The members of the Team are privileged to work in a National Health Service setting to which a wide range of patients with autism is referred - from the mild, high-functioning Asperger's children and young people, to those who are severely handicapped by their condition. We treat not only those who are sufficiently young and responsive to be helped back onto the path of normal development, but also those at the other end of the spectrum, in terms both of the severity of their autism and of its chronicity. In the latter cases it may be impossible to effect a major reversal of the process, but it is possible to have a significant impact on the quality of the autistic person's life and that of the family. Chronicity brings problems in its own right, and this has important implications for early detection and treatment. Indeed, our work with the very handicapped children informs and illuminates the work with the less damaged children. The study of the more chronic conditions throws much light on the course of the autism, and so, by definition, on its nature.

Some of the cases described in the book have been treated by members of the Tavistock Team: the rest have been treated by other members of the Workshop, who work elsewhere in the UK in a variety of National Health Service settings. The Workshop was founded by Sue Reid in 1986 in order to give clinical support to child psychotherapists working with these puzzling children. The Workshop is now a multidisciplinary forum with several research projects in progress. Anne Alvarez joined as Co-convener in 1990, after several colleagues drew our attention to the similarities in our views regarding the urgent need to rethink and revise psychoanalytic technique with these mysterious children. This volume is the fruit of our collaboration. It presents our ideas about the importance of personality for the developmental course of the illness, and the implications for psychotherapeutic technique. (Anne Alvarez's book, Live Company [1992], published by Routledge, discussed some of the problems of chronicity, and also the need to revise psychotherapeutic technique and theory in the light of developmental thinking.)

Our clinical work over the years has made it impossible to ignore the existence of sub-groups in the autistic spectrum. This has had far-reaching