ARGENTINE PSYCHOSOCIAL CENTER

LOBOS HEADQUARTERS.

FINAL WORK: Monograph

TOPIC: AUTISM

MEMBERS: Victoria Brandan.

Daiana Lucero.
Ana Moya.
Veronica Roldan.
Valeria Berdini.

Delivery date: 06 /09/2014.

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Topic: Autism

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 Hypothesis:
What is autism?

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 Introduction:
We decided to choose this topic because it seemed to us to be of greater interest and it is the
one that had more relevance throughout the course of Therapeutic Accompaniment.

You propose to investigate the deficits, failures, shortcomings, discover the resources,
strengths, skills and competencies that each of the people diagnosed with Autism Spectrum
Disorders (ASD) have, but we will focus mostly on children in the early years of the school
stage.

Etymologically the term autistic has its origin in Greek, the root is the Greek word auto which
means "Self, Self", the meaning of the word, then, would be to get into oneself. The word
autism was first used by the Swiss psychiatrist Paul Eugen Bleuler (1857-1939) in 1912 and he
used it to refer to a disorder, typical of schizophrenia, which implied a detachment from
external reality. The medical classification of autism did not occur until 1943, when Austrian
psychiatrist Leo Kanner (1896-1981) studied a group of eleven children and introduced the
characterization of early infantile autism. Those children presented difficulties in social
reciprocal actions and in adapting to changes in routines, good memory, sensitivity to stimuli,
echolalia and problems in performing spontaneous activities. This is how Kanner took the term
autism to refer to the inability of a group of children to establish social relationships, among
other characteristics already mentioned.

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 Development:
The term "pervasive developmental disorders", better known as PDD, was first used in the
DSM III (APA-1980) to describe disorders characterized by developmental disturbances in
multiple basic psychological functions involved in the development of social skills and
language, such as attention, perception, awareness of reality and motor movements. What
the DSM III did was to definitively differentiate autism from psychotic disorders. The current
autism spectrum disorders (ASD) are also known as pervasive developmental disorders (PDD),
and so they were mentioned in the international diagnostic classifications (DSM IV-TR and ICD
10), comprising the following entities:

 Autistic disorder.
 Asperger's Disorder
 Childhood disintegrative disorder.
 Rett's Disorder
 Pervasive developmental disorder not otherwise specified.

Since the late 1980s, autism has been referred to as a continuum. Psychologist Angel Riviere
(1949-2000) further elaborated the concept of autism spectrum and the consideration of
autism as a continuum of different dimensions, and not as a single category. Autism is a
continuum (spectrum) that causes people with autism to have different strengths and
weaknesses. The DSM V (2013) already speaks of a single category: autism spectrum disorder.
Among the advantages of the new manual, we find a better identification of affected persons,
the possibility of making a diagnosis before the age of 3 years and a better identification
system also for adults. It is more flexible and recognizes that people with autism may also
present other additional pathologies, such as depression, anxiety, cognitive deficits, attention
deficit, seizures, etc.

The term autism is generally used, both in the media and in professional and institutional
settings, to synthetically define all the disorders included from Kanner to the DSMIV under the
denomination of pervasive developmental disorders, currently in the DSMV, under the title of
autism spectrum disorder. TGD affects three areas of development:

 Areas of communication: verbal and non-verbal

 Areas of socialization.
 Areas of imagination, creativity and play, resulting in restricted interests and/or
stereotyped behaviors.

Therefore, autism is characterized, for the DSM IV, by delay or abnormal functioning
before the age of three in one or more of the following areas:

 Social interaction.
 Communication.
 Restricted, repetitive and stereotyped patterns of behaviors, interests and activities.

One of the fundamental characteristics of autism is that it is a very heterogeneous disorder,

encompassing different degrees of severity and different levels, which gives rise to what is

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known as the autism spectrum, a concept developed by Lorna Wing and Judith Gould in a
study carried out in 1979.

Symptoms:

 Absence of social smile.

 Lack of eye contact: avoids looking and contact with others.
 Absence of babbling.
 Stop at the entrance in verbal and nonverbal language.
 Tendency to isolation.
 Absence of demands (e.g., does not stretch arms).
 Repetition of syllables or words - isolated or out-of-context phrases.
 Repetition of fragments heard somewhere.
 Appearance of distress in apparently normal situations.
 Difficulty accepting changes in routines.
 Stereotyped manipulations of objects and exclusive fixation on specific objects,
rather than playing with them or using them in a functional way.
 Stereotypies and excessive rituals.
 Aggression to self or others.

In 1997, Angel Riviere expanded to twelve the dimensions that can appear within the autism
spectrum:

 Qualitative disorders of the social relationship.

 Disorders of congenital referral abilities (joint action, attention and concern).
 Disorders of intersubjective and mentalistic abilities.
 Disorders of communicative functions.
 Qualitative disorders of expressive language.
 Qualitative disorders of comprehensive language.
 Disorders of anticipatory skills.
 Mental and behavioral flexibility disorders.
 Disordered sense of self-activity.
 Disorders of imagination and fictional abilities.
 Imitation disorders.
 Disorders of suspension (the ability to elaborate signifiers).

Angel Riviere factors:

 The association or not of autism with mental retardation, more or less severe (or, in
other words, of the intellectual or cognitive level).
 The severity of the presenting disorder.
 Age (the evolutionary moment of the person with autism).
 Gender: autistic disorder affects women less frequently than men, but with a greater
degree of alteration.
 The adequacy and efficiency of the treatments used and of the learning experiences.
 The commitment and support of the family.

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Symptoms and severity vary in each of the affected areas (social communication, behaviors,
etc.). Therefore, it is possible that a child with autism does not have the same symptoms and
will appear very different even if he/she has the same diagnosis.

Autism is not a disease, but a condition, a disorder that affects a person throughout his or her
life and usually has no cure.

EVOLUTION OF AUTISM AT DIFFERENT AGES

The autistic syndrome manifests itself between the first and third year of life. When the
symptomatology appears, there is a developmental arrest, a regression, since they lose
acquired skills, and can be confused with other disorders or disabilities (mental retardation,
hypoacusia, epilepsy, Down syndrome, Asperger's disorder, Rett's disorder). From a
psychological point of view, they are said to be borderline.
The evolutionary characteristics of autistic syndrome are:

First year: (infant)

- Baby less alert to his environment.
- He is not interested in his environment.
- Remains in the crib for hours without requiringattention.
- Does not respond to mother's embrace.
- They are difficult to accommodate in the arms.
- The social smile (four months) does not appear.
- He may look happy, but his smile is not social.
- He rarely sees his mother's face.
- It does not differentiate between family members.
- He is disinterested in people in general.
- He is indifferent togames.
- They cry for a long time without any cause.

Second and third year:(abnormal behavior progresses)

- Lack of emotional response to parents.
- Lack of language (absence of verbal communication).
- No eye contact.
- They produce repetitive movements (rocking, head banging, hand flapping).
- They have a lack of pain.
- They are frightened by noises.
- Disconsolate crying without apparent cause.
- They do not usetoys.
- They don't use carts, they flip them over and spin the wheels.
- They have a delay in acquiringself-care.
- They do not control sphincters.

Childhood:(the same behavioral disorders continue as in the early years but become more
accentuated, more evident, differentiated from children of the same age).
- They do not dress themselves.
- They do not relate to children.
- They prefer to play alone.
- They do not present their own experiences or experiences.
- The language is flawed.

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- They present violent, aggressive and unprovoked attacks.

Adolescence - adulthood:
At this stage the disorders are similar to those of mentally retarded individuals, since the
functioning of adolescent or adult autism will depend on factors such as:
- Language: determining factors to express their needs.
http://www.monografias.com/trabajos4/leyes/leyes.shtmlhttp://www.monografias.com/
trabajos12/higie/higie.shtmlhttp://www.monografias.com/Salud/Nutricion/- Self-help habits:
aims to lead an independent life, must be able to help oneself with personalhygiene,food and
clothing. It can only stock up if it is educated from a young age, it takes a longtime to train and
it is a very difficult task.

THE FIREWORKS IN THE SCHOOL.

The pedagogical discourses of recent times have deployed a series of arguments in favor of the
integration of students with autism spectrum conditions or with any disability in general, in
what is called "regular education school". There are even laws and resolutions that support
school integration, as well as the presence of integration teachers or private non-teaching
assistants in the classroom. Those historical school attempts to equalize and homogenize
students succumb to a social reality that marks and generates differences that demand
answers.

These statements, whether they come from governmental, educational measures and/or from
independent professionals who began to face diverse realities: schools that have vacancies
until parents mention the word "integration", parents who fight for the right to education,
institutions that close their doors out of fear, ignorance or misinformation, policies that
include others that exclude, resolutions that appear and disappear, parents who end up hiding
their child's diagnosis in order to give him/her the possibility of a vacancy, etc. The right to
have educational opportunities is everyone's right.

THERAPEUTIC ACCOMPANIMENT AND AUTISM.

The characteristics of the role of companion in working with autistic people, beyond the
differences, coincided in two fundamental aspects: the need for a high level of tolerance and
patience in the exercise of the role.

Functions of the therapeutic companion:

1) Patient containment.
2) Location as a significant reference.

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 3) Psychic organizer of the patient.
4) Encourage creative capacity.
5) To provide an expanded view of the patient's daily life.
6) Sustaining a place to think.
7) Orientation in the social space.
8) Facilitator of family ties.

These functions are presented as basic to the role and work of any type of population. Since
there is no curative treatment, it makes us think that the work of therapeutic accompaniment
with this type of population must be developed in a permanent way, valuing the small
achievements and accepting many times the involutions and limitations of the condition.

THE EDUCATIONAL THERAPEUTIC COMPANION AND ITS POSSIBLE SERVICES FROM AN

INSTITUTION.

The work of the therapeutic educational companion, who, aware of the difficulties that these
children have in terms of socio-affective integration, offers them a range of experience in daily
coexistence and in the everyday environment, with which they begin to identify a companion
and relationship model. Children suffering from these pathologies lack the normal affective
availability to establish themselves as "subjects of interaction", and this makes it impossible to
reach them with proposals that modify their behavior towards the natural evolution of
maturity, through spontaneous learning. The therapeutic educational companion is the one
who establishes the closest and most intense bond with him/her.

The TA-child relationship constitutes a very important organizing axis for the integral recovery
of the child, we could say that it acts as a matrix, in which, without replacing the parent-child
relationship, it gives the child the possibility of living an affective model of conduct and
adequate communication. At the same time, it is the mediator between the child and the
world around him, facilitating the socializing experiences that he does not know how to
provide for himself. In this way, it helps you to integrate into the world.

Children and adolescents with early childhood initiation disorders, with notorious language
and communication difficulties, require a specialized lifelong approach, with specific resources
that take into account the particular characteristics of how they communicate, learn and
relate. In some cases, integration in other institutions does not offer alternatives for school
learning as such. Among these we find children with a good cognitive level, suffering from
symptoms of autism spectrum or communication and language disorder, who are attending
the regular school system, and who, due to lack of professional counseling, have failed.

Faced with these realities, an institutional accompaniment program has been organized to
support school insertion, with the following objectives:

 Provide information on the diagnosis and characteristics of the learning modality to

be considered for each child.
 Provide advice to carry out the curricular adaptation, where the delimitation of
objectives, contents, methodologies, evaluation and timing are contemplated.

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  Control compliance with the provision of adequate means for access to the
curriculum.
 Advise managers, teachers, peers or youth and other parents if necessary, to provide
an environment of understanding and acceptance.
 Support the child or young person in the school environment when his or her
cognitive condition demands it, strengthening the resources suitable for the task.
 Support the child/youth in family settings to adjust the parents' expectations and
guide them in sustaining the task for which they generally lack resources.

As for the patient, the following is taken into account:

 First of all: the child's medical history and family characteristics

(Anamnesis. Particular mode of the family).
 Verification of the school's organizational modality and its programmatic guidelines,
offerings and expectations.
 Explanation of work systems offered with our institution to meet the requirements of
the child's orientation, within which the team responsible for this purpose is made
known.
 Written agreement between the supporting institution, the inclusive school and the
parents of the child/youth, to establish in writing the rights and obligations, as
required by the approach program, of each and every one of the parties.
 Periodic monitoring and supervision, in joint meetings of the support team, inclusive
school and parents, on the progress of the process, in order to make necessary
adjustments or revisions.

Regarding the minimum responsible team, the following is foreseen.

A therapeutic educational companion at the service of the school insertion or integrative

educational companion ( a.e.ls) who is responsible for following the child in his or her process
of adaptation to school requirements, advising the school institution on the characteristics of
the child to be integrated, and the teacher on curricular adaptation, clarifying the child's peers
so that they know how to help him or her and promote his or her learning and group
adaptations.The a.e.ls. is responsible for following the child in the process of adaptation to
school requirements, advising the school institution on the characteristics of the child to be
integrated and the teacher on the curricular adaptation, clarifying to his/her classmates how to
help him/her and favor his/her learning and group adaptations, pedagogical reinforcement at
home if appropriate, and advising the parents on how to interact with the child, regulating
expectations.

Some characteristics of play in ASD.

* Simple manipulation of objects, usually for self-stimulatory purposes ( turning objects,
aligning them, etc.).

* Lack of emotional involvement during the game.

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* Great pleasure in physical play (tickling, chasing, rolling on the floor, swinging) with the
exception of those children who avoid physical contact because of their sensory
characteristics.

* Preference for toys involving visuospatial skills (puzzles).

* Games that tend to be repetitive, obsessive and uncreative.

* Absence or limitations in sensory play (stereotyped, limited in content, not very flexible and
spontaneous).

* Absence or limitations of symbolic play (if present it is repetitive, unimaginative, simple or

inflexible).

* Difficulties in respecting turns or rules.

* Problems in understanding the concept of winning or losing and demonstrating it

adequately.

(Indifference, lack of interest or catastrophic reactions).

* Diminished or non-existent ability to initiate social games (invite others to play).

* Failure to respond appropriately to others' invitations to play.

* Difficulties in following the steps of a sequenced game.

Possible interventions from a ludic perspective.

 Encourage the child's exploration and choices (put a variety of toys within reach).
 Always start from the child's interests (follow the child's lead, join in what he/she is
doing and make it interactive). Generate shared playful pleasure.
 Encourage social interaction and the pleasure of playing with the therapist (use toys
that attract the child's attention to the adult's face or actions and facilitate reciprocal
alteration), achieving shared pleasurable emotional states.
 Teach how to use different toys in a functional and conventional way, always
remembering that it should be fun and pleasurable for a child.
 Gradually introduce changes in games, in the form of problems to solve,
interference, fooling around, getting it wrong, undoing.
 Encourage play with peers/siblings either at the child's home or by scheduling outings
to children's places.
 Do not interrupt or interrupt playful situations.
 Encourage the emergence of different types of play, without skipping evolutionary
levels.
 Teach them to play on their own.
 Teach them to understand the concepts of winning/losing in a game and how to
express these emotions.
 Provide the game with plot structure and narrative consistency.

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  Open the door to symbolic play, even at rudimentary play levels.
 Teach games with beginning and end and implement adaptations.
 Encourage through play or other situations the emotional expressions and content,
directing their performance towards the expression with control of their own
impulses.

Parents define ASD.

Families will have very different responses to the diagnosis, so it is often necessary that they
have specialized support, according to the needs of each family group. Many parents have
already traveled this road. They began by observing their children engaging in unusual
behaviors. Witnessing these differences is hard, it generates anxiety, fear and concern for the
future. For parents, autism is a world of its own, not easy to understand, at a great distance
from our own, which leads you to build bridges of complication between these two worlds,
bridges that sometimes are filled with stones that you have to move as time goes by, you
realize that these stones have determined strengthening and will continue to do so. Those
stones are not obstacles, but opportunities that activate you and suddenly you feel that you
are getting closer and closer to achieve a true knowledge about that world that at the
beginning seemed so unreachable, so difficult to understand. There are also support groups for
parents of children with ASD. In these spaces, it is the parents who acquire certain skills, learn
to respond to the needs of their children with autism and of the family as a whole. The group
spaces where they coincide with other parents give them the opportunity to share knowledge,
emotions, worries, fears, as well as the appropriate answers and solutions.

Conclusion:
We have tried to provide solid knowledge about autism spectrum disorders. The more
possibilities offered to the child with autism, the more easily he/she will be able to develop
his/her abilities and become more autonomous. Families will have very different responses to
the diagnosis, which is why it is often necessary for them to have specialized support,
according to the needs of each family group. Helping parents to look at their children's
strengths, giving them tools to play and bond with their children, and not just focusing on
needs and/or difficulties, will lead to greater awareness and understanding, and they will likely
be more sensitive to what it means to have an autism spectrum condition.

We need to convince ourselves that parents are the best resources for their children. Without
trying to turn them into therapists, we are obliged to share with them our "toolbox", any
advice that will allow them to better understand their children, teach them different skills,

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accompany them in their growth without forgetting, of course, to play and enjoy them in order
to ensure their full development.

Parents and professionals must maintain the illusion of advancing and pursuing new goals that
will benefit the child in his or her adaptation processes. It is not an easy task because it
requires effort and a lot of patience, but it is worth it.

Table of contents:

Caratula........................................................................... 1-2.

Hypothesis......................................................................... 3.

Introduction................................................................... 4.

Development....................................................................... 5-12.

Conclusion......................................................................13.

Bibliography.....................................................................15.
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Annex..............................................................................16.

Bibliography:

Book: Autism, Guide for parents and professionals. Editorial

Paidòs.

Book: Argentine Psychosocial Center. Therapeutic companion,

Modules I and II

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Annex:
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A bridge between the child who does not play and the one who can play.

The game is an extremely important factor as a clinical device in the therapeutic

accompaniment. By means of a clinical case, possible interventions in the field of play
are presented and knowledge and technical elements are provided in relation to
children with serious difficulties and pathologies.

Theoretical development Playing is bridging the gap between fantasies and precarious
hypotheses built with material unknown to the child... Material that seeks to be clarified,
explained and, above all, reconstructed. The bridge inevitably crosses into known, familiar,
concrete territory. This space is reality, where each child can take up his enigmas, his conflicts,
his pain and his desires to turn them into fairy tales, into a soldier's combat, into games of

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competition or into being a superhero capable of defeating the invincible. Winnicott (1980) tells
us that the driving force that leads children to play activity is the pleasure that the child feels
when going through the experience of "playing", which manifests itself both physically and
emotionally. But he also shows aggression or hatred in his play. It is important to understand
here that the pleasure lies in getting him out of himself, in freeing himself from the hostility that
invades him and, above all, in rescuing the fact that he is doing it in a way that is socially
acceptable. Playing gives the child tools to control his anxieties and to appease his fears. The
therapeutic companion (T.A.) who works with children must have knowledge of the importance
of play, because in many opportunities the child with difficulties will demand that the T.A. help
him to build a game that relieves his conflicts, his guilt, his fears; he will ask him to accompany
him to cross that bridge between his inner world, sometimes precarious or fragmented, and the
reality that the child is unable to sustain, to articulate and to live. Will the function of the A.T.
propose a game to alleviate the child's conflicts? The A.T. will be able to sustain and healthily
guide the child's play. You will be able to build creative solutions together with the child or
rebuild games that the child asks to repair. You can provide alternatives and wait for the child to
build their content. The A.T. always be careful not to invade the child with your own play. It is
interesting to think about the effectiveness of the A.T.'s intervention. in this bridge, where play
emerges as one of the possibilities that rescue the child from the traumatic. Kleber Barreto
(2005) tells us: "Intervention through which some change is achieved, but which is used taking
into account the repertoire offered by the patient himself.... We respect their game and seek to
intervene on the basis of these elements... There is nothing more traumatic and invasive than
the breaking of the game, which implies a rupture of the subject's symbolic capacity, in case this
is not sufficiently established". The A.T. will function as a bridge that will enable the child to
move from his or her suffering to his or her wellbeing and where "by accompanying the child, a
bond is created with the patient.... A space between desolation and hope, between disconnection
and relevance, between strategic silence and the guiding word... Transitional, moreover, because
it founds a temporary space between what was and what is to come, where a future can be
conceived as possible...". Kuras and Resniky (2000). Now, what happens when the child is
inhibited from playing? Is it possible to lend oneself as a transitional bridge, when this bridge is
fragile and impossible to cross? When the transitional area does not exist, the child's inner
world, where his or her most unknown conflicts dwell, and the shared daily reality are
dissociated, ignorant of each other. This is where the pathology, illness and suffering of the child
takes place. The intensity of each pathology will depend on the degree of dissociation between
the internal and external world. The A.T. must provide a space of trust so that the child is
encouraged to cross this bridge that goes from his or her solitary inner world to the subjective
and shared reality. It will then be a function of the A.T. first build a link that rescues the child
from passivity and perplexity, but not with an invasive modality, but with that modality that
allows the child to identify with the A.T.'s proposal, because only in this way the accompanied
person will feel that in that proposal there is something of his desire that mobilizes him to
continue the journey. In cases where the child does not play because of inhibition, it is
important to know that the empathic process, which must take place for the cure to progress, is
sometimes empty of symbolism, words, looks, and that this emptiness is part of what the child
suffers, because he finds nothing to hold on to... Vacuum that the A.T. should not fill, but know
how to recreate in order to be able to decipher the emotional states of the other and react to
them in the affective exchange. Therefore, in order to read both body and emotional language, it
is necessary to be in touch with one's own background in order to have a reflexive sensitivity to
the child's expression. In children with severe pathologies it is important to consider "the
presence of the T.A.", where the look and the gesture play at being words and actions, where
silence enables the child to search and explore his sounds and sensations, waiting is what makes
this search feasible, because the child, even if he does not manifestly play, knows that there is
another willing to draw answers and to support gaps that make his suffering be shared. In these
cases, play cannot be expected to arise spontaneously as a proposal from the child, because there
is no possibility from the structure for this to happen. The intervention of the A.T. will be to be
attentive to any sign to start weaving and inscribing symbolisms. Most of the time we are silent
but active with our gestures, our gaze and our body. These cues, which are sometimes sounds or
primitive gestures, will be as rich for the analyst as if this child could play and use his play box
during his session. The A.T., in this position, will not propose games, nor will he accept imposed
roles, he will only be there to accompany a subject who is stopped in his most primitive
maturation. Winnicott (1962) maintains that children who do not play, including primarily
autism within these disturbances, are always on the verge of an unthinkable anguish, being the
mother the one in charge of keeping this anguish away by means of her holding function; but

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when this function fails, "autism" will appear in the child as a sophisticated defense that will
protect him/her from such massive anguish.But when this function fails, a sophisticated defense
"autism" will appear in the child as a sophisticated defense, which will protect him/her from
such massive anguish. I have always had the impression that autism is the manifestation of an
infant who has suffered too much during its first months of life. Because of a mother who is
"totally" indifferent to its basic needs, the baby has not been able to erase so much suffering
from its body and psyche and therefore decides to give up its attachment to another and thus
"withdraws from the world and chooses another world where its integrity is not in danger". A
clinical case Li is an autistic child. His gaze is selective and where pleasure impacts, he stops his
eyes; where the enigma saturates him, he breaks his limits. I began accompanying this little one
who at times invaded me with emptiness and at the same time with challenges. Li is five years
old and does not speak, he is in permanent absence of everything and immersed in the
mysterious bowels of his universe. One of those routine days, when we went for a walk in the
park, I noticed a sound that the child emitted frequently, but this time its intensity was
noticeable. The sound was as follows: "Uuu.... yyy... uuu... yyy". I immediately let go of his hand,
stopped and took his sound, but painted it with a subtle and dosed symbolism, started to sing
and dance saying: "Oops...". Oops... Uyy", repeating over and over again this sound with
different rhythms, with different voices and with movements. Li, grabbed me by my bag, pulling
me down to his height, took my face in his hands and pressed it hard, resting his eyes on my
mouth, and then dispersed. Weeks of singing his sound went by, but the boy was no longer
interested in my proposal. After several months, and in another one of our walks, it started to
make another sound: "AAA.... UUU... AAA", and so my song became another song. The boy
repeated that day to perfection, took my face, pressed my cheeks and rested his eyes on my
mouth. In this case, the song emerged as a symbolic act, it was the one who inaugurated the
bond with the child. When the known burst into the music of my voice, it conveyed those words
of Li's that tried to find an echo to contain them, but what was fundamental for the child was to
feel that my singing was in accordance, familiar to what he was living or had lived, in accordance
with some feeling, some experience. I understood from my subjectivity that in the midst of his
familiar and known universe, the strangeness of "another" that was outside himself emerged.
The child knew, at least for seconds, that he could throw himself into the unknown because
something known lived there, to recognize in my song its sound that protected and sustained
him. Perhaps Li found some familiarity in the unfamiliar space. This clue was taken to her
analysis, where the therapist took these sounds of the child and my voice as two tools to start
building a possible playful way to free the child from his anguish and especially from his
prolonged silence. Conclusions It is important to consider the game as a clinical device for T.A.
work. with children. Play as a manifestation of human behavior has an evolutionary process that
begins with functional games and then moves on to fictional or symbolic games and, finally, to
regulated play. Within each of these playful stages there will be indicators that will show
fundamental evolutionary aspects such as: the structuring of the body schema, the mastery of
space and the configuration of time that will give the child the notion of continuity. The games
will also contribute to the psychosocial sphere, both in the development of autonomy and
emotional balance. To think, then, to the A.T. The role of a "playful companion" would be more
than relevant, because if he/she has the knowledge of each of these stages of the game, he/she
will be able, through subtle triggers, to make possible the evolution of the game. Does the A.T.
Will it have the function of making the child play in order for him/her to develop healthily? The
child will only dare to play in the presence of the A.T. or with the A.T. if a bond of trust has been
previously established. The child does not play with just anyone, but only with those who
sympathize with him. The A.T. should not make the child play but should play "with" the child
and support his playful desire, accompanying him in the search and development of his own
imagination and creativity, fundamental elements for any game to emerge. Winnicott tells us
that these elements are present from very early on in the baby, since he is from the beginning a
great creator, because of his capacity to create the maternal breast in the absence of the mother's
breast. Now, what happens to those children who do not play and what will be the role of the
A.T.? Children who have difficulty playing, according to psychoanalysis, are children with
serious pathologies. What happens is an inhibition in the field of creativity and imagination,
these elements are not found here or are detained. For this reason we will observe special
characteristics in these children such as: disorganization and lack of complexity in any playful
undertaking, absence of sequences, lack of continuity, fragmented and illogical manifestations
or total absence of initiative. The T.A., when detecting these indicators or some of them, will
know that he is himself the ludic tool, that he will have to lend himself as a possibility of play,
rescuing from the child those indications of pleasure to give him a sound, a rhythm, a color or a

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movement. Only in this way will the child trust that outside of him and in the "other" there is
something of his world, of his pleasure, of his person that motivates him to trust and to bond. In
all cases it is important to consider that the purpose of the companion is not to propose a
subjectivity that is alien to the child's subjectivity so that the child can take it as his own and
thus make the game possible, nor to accept roles that the child wishes to manipulate or destroy.
Its aim is to be "transitional bridges", bridges that make it possible to cross from suffering to
health, from total disconnection to relative connection, from dissociation to integration, from
loneliness to company and that, once the proposed objectives have been met and the child has
visibly improved, the T.A. will be able to provide the child with a "transitional bridge", a bridge
that makes it possible to cross from suffering to health, from total disconnection to relative
connection, from dissociation to integration, from loneliness to company. to withdraw in doses
from the scene. Viviana Edith Balsamo* * School of Therapeutic Accompaniment of Córdoba.
Contact e-mail: vivianaebal samo@yahoo.com.ar Bibliography: - Freud, Sigmund (1919). "The
ominous". Ed. Amorrortu. Bs. As. - Kuras Susana de Mauer-Silvia Resnizky (2000).
"Therapeutic companions". Papirus. Bs. As. - Kléber, Duarte Barreto (2005). "Ethics and
Technique in Therapeutic Accompaniment". Ed. Unimarco. Sao Paulo, Brazil. - Rosfelter, P.
(2001). "The Bear and The Wolf". Ed. de la Flor. Bs. As. - Winnicott, D. (1980). "Reality and
play". Ed. Gedisa. Barcelona.

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