Psychoanalysis as cognitive remediation: Dynamic and Vygotskian perspectives in the analysis of an early adolescent dyslexic girl.

The interface of neurocognitive problems and dynamic concerns are examined in the treatment of an early adolescent dyslexic girl. Despite previous intensive remediation, she had been unable to master reading and spelling, but made remarkable progress after a relatively brief period of psychoanalysis. Psychoanalytic and Vygotskian perspectives are integrated to provide a model of how play, within the analytic context, is mutative for learning disabled children. Through the process of reexteriorization in the transference, play allows for the interpretation and resolution of traumatic situations which have become associated with learning. As the act of learning becomes separate from the personal and affective context in which it took place, the child gains access to other, more normative, functions of play. These functions include the development of the capacity to separate meaning from action and the ability to understand words as generalized categories which represent objects, rather than being part of the specific object named. These two capacities, fundamental to the development of abstract thought, will support reflective awareness and help modulate affective states. The abilities furthered in play also act to remediate one component of dyslexia-the difficulty separating context from more abstract bits of knowledge. Finally, the child learns to "play at reality, " often trying on the new role of "student". As Vygotsky notes, play is essential in allowing the child to become aware of what she knows. For a dyslexic child, for whom reading may never become completely a part of procedural memory, becoming conscious of what he knows may also enhance mastery of the skills of phonological processing, albeit more slowly than normally developing readers. The pleasure in play and the repetition it generates aids the internalization of the task and the development of automaticity.