ja Pa

Bonnie E. Litowitz 59/3

FROM DYAD TO DIALOGUE:

LANGUAGE AND THE EARLY
RELATIONSHIP IN AMERICAN
PSYCHOANALYTIC THEORY

The centrality of language for a Freudian theory of mind and treatment

has not been retained by most post-Freudian theorists. American writers
have turned to academic developmental research on mother-child interac-
tions to depict the preoedipal period as preverbal, presymbolic, non-
conscious. This view presents the early relationship as developing in linear
stages in which visual observational data (e.g., contingent behavior action
patterns between two persons) are privileged over aural-oral data of
communicational exchanges. An alternative view is presented that rede-
fines the earliest relationship in terms of communicational exchanges,
mediation, and dialogue. The claim is that understanding the nature of
mediated communication keeps language central to psychoanalysis and
reestablishes an intrapsychic dimension in the concept of relationship that
is lost when relationship is reduced to behavioral patterns.

We shall not cease from exploration,

And the end of all our exploring
Will be to arrive where we started
And know the place for the first time.
—T. S. Eliot, from “Little Gidding”

A merican psychoanalysis in the first decade of the twenty-first century

is not the same as when it first arrived on these shores, whether one
dates its arrival by Freud’s 1909 Clark University lectures or from the estab-
lishment of the American Psychoanalytic Association in 1911. American
psychoanalysis of that early period remained tied to its European roots,
continuing to look for its legitimacy to Freud, living in exile in England, and

Associate Professor, Department of Psychiatry, Rush Medical College; faculty,

Chicago Institute for Psychoanalysis.
Submitted for publication May 29, 2010.

DOI: 10.1177/0003065111406440 483

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 Bonnie E. Litowitz

then to his daughter Anna after his death. The major break with this tradi-
tion concerned training, which only in the U.S. was restricted to medical
doctors. When, during and after the years of World War II, many European
analysts immigrated to America, they consolidated the same perspective,
identified as ego psychological, that then dominated APsaA training centers
in subsequent decades.
However, the roots of a plant, with its inherent DNA, are only part of
the story. The context in which those roots are planted—the terroir—is
also a factor (Mitchell and Harris 2004). In various locales in Europe, psy-
choanalysis had already begun to manifest itself in different forms, from
Jung’s transindividual symbolism in Switzerland to Melanie Klein’s object
relations in Britain. For our part, American soil provided its own unique
characteristics: a democratic, egalitarian ideology; a praxis grounded in
philosophical pragmatism; faith in empirical research data; the forward-
looking, action-prone optimism of an immigrant population. Although per-
haps politically and economically motivated, the medicalization of
psychoanalysis in this country also resonated with these values.
From the point of view of such (arguably overgeneralized) charac-
teristics, the most natively American perspective on psychoanalysis to
have emerged is the interpersonal movement, identified with Harry Stack
Sullivan and the so-called culturalists. This perspective has continued
to grow and evolve as the relational school, benefiting from the talents
of the large pool of nonmedical professionals who had for many years
been excluded from APsaA training centers and membership. Core ideas,
such as a focus on the interpersonal relationship, first espoused by inter-
personalists and relationalists, are increasingly incorporated into other
approaches.
Today, a century after psychoanalysis made its first appearance on
these shores, the hegemony of a single theoretical perspective (and its
attendant technique) no longer defines our profession. Instead, we have
multiple approaches, some organized into “schools,” and can look across
perspectives to identify what is shared and what is not. In 1983 Greenberg
and Mitchell did just that, comparing perspectives from Freud to contem-
porary thinkers along the dimension of one-person versus two-person the-
oretical positions. The authors concluded that there had been a shift in
psychoanalysis from Freud and British object relationalists to self psy-
chologists and interpersonal-relationalists—from an intrapsychic to an
interpersonal focus.

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In this paper I explore another dimension and its consequences: the

changing role of language as psychoanalytic perspectives have evolved,
especially in the U.S., and its impact on perspectives of early development.1
Psychoanalysis started out in Vienna as “the talking cure,” both a theory of
mind in which language figured prominently and a treatment modality that
privileged speech over action. By contrast, some psychotherapists (e.g.,
relationalists, interpersonalists, intersubjectivists)—especially in America—
now view the mind and its treatment as patterned on early dyadic behavior.
In what follows I articulate what has led to this shift in emphasis and describe
the particular view of early relationships that has resulted. I then offer what
I believe is a better alternative: how relationships are established through
specific features of communicational exchanges (dialogues) with others.

THE CHANGING ROLE OF LANGUAGE

I N T H E “ TA L K I N G C U R E ”

When I first became interested in psychoanalysis I was a graduate student

in linguistics, impressed by the dominant role of language in the “talking
cure.” At that time, the late 1960s and early 1970s, a major revolution was
shaking linguistics departments, with reverberations across academic fields
including psychology and computer science, and generating new hybrid dis-
ciplines, such as cognitive science and developmental psycholinguistics. In
a series of books, Noam Chomsky (1957, 1965) dismissed the kind of train-
ing I had originally had in descriptive, anthropological linguistics as useless
on the grounds that no speaker (informant), nor indeed any number of inter-
viewees, would know the rules of his language because those rules are not
conscious. The unique differences of each language are merely superficial
manifestations of a deeper structure, the nonconscious rules of a universal
grammar that is a product of our species-specific (i.e., human) evolution.
Writers were quick to see parallels between how Chomsky described
human language and how Freud had described human mentation: levels
of consciousness; latent and manifest dream contents; primary and sec-
ondary processes; overdetermination of symptoms (see, e.g., Litowitz 1975,
1978; Litowitz and Litowitz 1977). There were even attempts to incorpo-
rate ideas from this new perspective into psychoanalysis as a means of
reconfiguring and updating Freud’s original focus on language. Prominent

1
See Vivona (2006) and Heenen-Wolff (2007) for their perspectives on this topic.

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among those writing during this period were Theodore Shapiro (1979),
Marshall Edelson (1975), and Stanley Leavy (1980).2
Reading Freud one encounters a conceptualization of mind and a
method for understanding it, as well as for treating its disorders, in both
of which language is central. The “talking cure” means listening to patients
for gaps in their narratives, understanding their speech errors and the con-
struction of their symptoms, deciphering their dreams; the method requires
the patient to speak freely, rather than act out, and the analyst to interpret.
From that central starting point, however, post-Freudian theorists have
taken divergent pathways. Only Lacan retained the centrality Freud accorded
language in understanding psychic structure and treating patients. For the
Lacanian school, mental products like symptoms and dreams are formed,
understood, and transformed according to universal structures of language.3
In other theoretical perspectives, language became invisible, the transpar-
ent glass between self and other, self and world.
A key source for this difference is that Lacanian theory builds on
Freud’s earliest texts, considering his later revisions of the structural model
a mistake. By contrast, theorists who followed Freud’s revisions became
increasingly focused on the ego or self’s relationship to the objects in its
environment, especially during the first years, when we are most depen-
dent on others for our survival. In the English-speaking world, the two ini-
tial post-Freudian pathways were taken by ego psychology in North America
and object relations theory in Britain.
Focusing on Freud’s post-1920 writings, in which he articulated his
second psychic model, ego psychologists assigned language to the ego
as one of its many functions. (Among these, ego psychological theorists
emphasized the particularly American ideals of adaptation and autonomy.)
Clinically, ego psychology maintained Freud’s technique of listening
through ordinary language for gaps and errors indicative of a more primary
or primitive (i.e., unconscious) mental stratum. Although Freud described
this deeper, more primitive level as “primary,” he described it in terms of
ordinary language, differing only by its omissions, conflations, and rever-
sals from “secondary processes” (i.e., thinking, speaking). Primary

2
Roy Schafer also maintained a Freudian focus on language, discourse and
narrative in the clinical setting, but not essentially from a Chomskian perspective (1976,
1978, 1981, 1992).
3
For Lacan, language as abstract structure is tied to the abstract structures of
the symbolic register and the oedipus complex, while the earlier, imaginary register is
depicted in visual terms (e.g., le stade du miroir) (Laplanche 1998).

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processes were first articulated in order to decipher how an adult dream is

constructed, but Freud rapidly extended them to include all mental produc-
tions that involve unconscious mentation (e.g., symptoms and fantasies),
as well as creativity and the arts (Litowitz 2007b). For this intrapsychic
model of the mind, the original defense of repression remains the major
mechanism that splits ideas and affects, forcing them “dynamically” out
of preconscious availability. Treatment consists of verbal interpretations
that help the patient decode these constructions and gain insight into his
wishes, the conflicts that arise in expressing those wishes, and the defenses
that result and form a particular character structure. The analyst’s role is
to keep out of the way as much as possible, since change is largely an
intrapsychic process.
Understanding these constructions and this treatment method did not
require any special focus on language structures or knowledge of linguistics
(but see Lacan 1977). Language is simply the medium through which
understanding and change happen. Even unconscious fantasies arising dur-
ing childhood require no special knowledge when childhood is defined, as
it was for Freud, in terms of the oedipal period. The case of Little Hans is
presented to us by Freud (1909) to illustrate the fact that all children move
through this pivotal period of psychic structuration—from two to five years
of age—with symbolic and linguistic capacities that require no special con-
sideration. Hans’s struggle to create a cosmology through which he can
express his needs and wishes, fears and anxieties, is reported straightfor-
wardly as a series of verbal exchanges (as one would with an adult).
The assumed transparency of the verbal evidence as presented is more
obvious to readers now, whose attention would be drawn to the impact on
the report of the relationships among the participants (Hans, his father [Freud’s
acolyte] and mother [Freud’s patient], and Freud) and of the context on these
exchanges. For current theorists, the case illustrates additional facts: the
inescapable role in our constructions of our relationships with others—as
children with parents, as students with mentors, as patients with therapists—
engaged in specific practices, and the ways children use their linguistic and
cultural resources to construct theories about their world (Litowitz 2007b).
The major contender with ego psychology for dominance in our field
was object relations theory, a body of work that had been evolving in
Britain before the confrontation between Melanie Klein and Anna Freud
known as “the controversial discussions” (1943–1944). Taking Freud’s
“Mourning and Melancholia” (1917) as a seminal starting point, the British
focused less on the development of the ego’s functions and its struggles

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with id wishes and superego prohibitions than on the anxiety generated by

the dependent infant’s first relations with its primary objects. Although object
relations theories placed more emphasis on the relation to the primary object
as the first problem the infant encounters (rather than on the triadic oedipal
struggle to come), it still shared with ego psychology the premise of the
motivating agency of the infant. In both cases, the adult is reactive, provid-
ing an environment that is either facilitating or not, retaliating or not.
The crucial difference in the British approach was its focus on the pre-
oedipal period, a period universally viewed as occurring before the onset of
language and the sway of the reality principle. This earlier focus raises a
question for the Freudian emphasis on language and psychic structure, which
was not problematic for ego psychologists. The British answer was that,
while indeed literally in-fantis (without speech), the infant is still capable
of symbolization, as Freud (1911) suggested in his concept of hallucinatory
wish fulfillment in infancy. Thus, the speechless infant can still construct
symbolic fantasies to deal with the objects in his world on which he depends.
The clinician still listens through what the patient says for the deeper mean-
ings and seeks to create insight and growth through interpretation. More-
over, an emphasis on early symbolic capacities justifies the interchangeability
of symbolic play and traditional verbal exchanges. However, in the context
of preoedipal self and object struggles, splitting, cycles of projection and
introjection, and projective identification become dominant defenses, leav-
ing repression to be associated with the later period and with language.
There are, of course, many differences in how the two schools concep-
tualize what the child is struggling with and how those struggles should or
should not be resolved (e.g., the role of anxiety and types of defenses; pos-
ited resolutions in terms of acceptance of ambivalence or of castration), and
variants exist within each school. Much of the controversy between the
two approaches addressed these disparities and their implications for proper
clinical technique. Despite their differences, however, key influences from
these two dominant approaches, as well as from their confrontations, can
be found in our current theories: in the separation of the preoedipal and
oedipal stages, each with distinct challenges and defenses, and in the role
of language in each stage.
As mentioned above, during the early confrontations a question about
language arose that remains relevant in some current approaches. The capac-
ity for symbolization prior to language acquisition posited by Kleinians directly
impacted their therapeutic technique. From that perspective, interpretations
provide linguistic form for the symbolic thoughts the child has/had,

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integrating them and making them less frightening. Thus the analyst helps
the patient by giving voice to inchoate intrapsychic experiences from earliest
childhood (i.e., the fantasies that arise as the infant seeks to discharge
instincts into objects). Today a similar line of argument can be found in widely
varying theoretical perspectives. For example, the analyst serves an “alpha
function” by means of which the patient’s sensory “beta” experiences can
become articulated (Symington and Symington 1996), the analyst helps the
patient articulate the “unthought known” (Bollas 1989), or the analyst partici-
pates in the enactment of “unformulated thoughts” (Stern 2010). Whether this
early form of mentation is symbolic, visceral, behavioral, or procedural (or left
unspecified), it is nonetheless hypothesized as occurring before the onset of
language and repression (both still identified with the oedipal period).
In summary, a legacy of the early competition between two psychoana-
lytic theories of mind has been, as Greenberg and Mitchell (1983) document,
the increasing importance of the ego/self’s relationship to its objects during
the earliest years of life. However, what has been assumed (or simply not
questioned) is that language is not relevant for the establishment of those first
relationships that must be described and explained from other perspectives.
For American writers, those alternative perspectives have been derived from
academic developmental research on mother-child interactions.

C O N T E M P O R A R Y A M E R I C A N P S YC H O A N A LY T I C
THEORIES: THE PREVERBAL INFANT

Over the years many varieties of psychoanalytic theory have branched out
from the two original pathways. Several American theorists (e.g., Kernberg,
Schafer) have attempted to combine the intrapsychic and object-relational
emphases of both approaches, while others (e.g., Loewald) have tried to incor-
porate dyadic elements into a conflict theoretical perspective (Mitchell 2000;
Chodorow 2004).4 However, as mentioned above, there was also an estab-
lished, particularly American theoretical perspective derived from the work
of Sullivan and other culturalists (Aron 1996), and this dyadic interpersonal
approach to mind and treatment was evolving into the relational and social-
constructivist perspectives. Their conceptualizations of relations between

4
Some writers (notably Wolff, Brenner, and Green) have remained traditionally
intrapsychic, repudiating the importance of developmental data for psychoanalysis,
which (they claim) should draw conclusions only from its own clinical data. By con-
trast, self psychologists have combined intrapsychic and developmental perspectives,
proposing a series of linear stages for narcissism (Kohut 1977).

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 Bonnie E. Litowitz

persons did not find their source in the infant’s symbolic fantasies about pri-
mary objects, but rather in the actual patterns of behavioral interaction between
child and adults as these are reenacted by patient and therapist.
During this period, as psychoanalytic theories were evolving in these
directions, academic research on early childhood development, including
language acquisition, was exploding. New videotape technology was rev-
olutionizing data gathering, and powerful computers were revolutionizing
data analysis. To varying degrees, American psychoanalytic theorists turned
to that knowledge base, seeking data on which to build a scientific theory
of the preoedipal period. They found a model of linear sequential stages
recognizable from our Freudian tradition.
From very early on in Freud’s evolving theory, a description of a devel-
opmental sequence of stages had been an essential aspect of his creating a
psychological science that could explain both the normal and the patholog-
ical. Freud’s original descriptive list of symptoms defining hysteria quickly
evolved into a theory of fixations and regressions along an epigenetic
sequence of stages, and subsequent writers followed suit (e.g., Anna Freud,
Spitz, Erikson, Mahler).
A linear sequence of universal stages was a defining aspect of struc-
turalism, the intellectual movement that dominated most of the twentieth
century, especially in regard to development. Each stage is defined by a
characteristic structural organization that may cut across all domains (Piaget
and Inhelder 1969) or may be domain-specific (Brown 1973).5 As we move
into the poststructuralism of the present century, alternative approaches
such as nonlinear dynamical systems theory (Thelen and Smith 1996;
Galatzer-Levy 2009) have begun to achieve sufficient critical mass to
stimulate new models of development that would counter the criticisms
brought against structuralism. Those criticisms include confusion of
model-theoretic stages with developmental changes in an actual child
(Toulmin and Feldman 1976); conflation of temporal sequence and causal-
ity (Thelen and Smith 1996); imposition of developmental stages as meta-
narratives (Palombo, Bendicsen, and Koch 2009); and the inevitable (and
questionable) attribution of regression to any behavior outside the “nor-
mative” staged sequence (Inderbitzen and Levy 2000; Fischer et al. 1997).
As the intellectual community moves on to poststructural perspectives, a

5
Piagetian stages are generally epigenetic, although “decalages” may exist. Some
developmental psycholinguistic stages are epigenetic (Jakobson 1968); others are not
(Pinker 1994).

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hallmark has been the rejection of sequential stages defined by universal

structures (and the resulting metanarratives), replaced by local, thick descrip-
tions of constantly shifting states or phases that emerge in complex systems.
Nevertheless, developmental stages remain a prominent feature of
many psychoanalytic theories about the preoedipal period—clearly evi-
dent in the designation itself, as in preverbal and presymbolic. A promi-
nent example is Daniel Stern’s widely cited book (1985) delineating the
development of a sense of self from birth through a series of stages. Con-
sistent with earlier psychoanalytic descriptions of this period, language
does not play a role in the key early stages (“phases,” “domains”) of
infancy. When it does appear at two it is described as a force of distance,
disguise, and deception: “Language can thus fracture amodal global expe-
rience. A discontinuity in experience is introduced” (p. 176). Since Stern
provides such an articulate account of this commonly shared conception
of infancy as preverbal and presymbolic, he is worth quoting at length.

Infants’ initial interpersonal knowledge is mainly unshareable, amodal, instance-

specific, and attuned to nonverbal behaviors in which no one channel of com-
munication has privileged status with regard to accountability or ownership.
Language changes all that. With its emergence, infants become estranged from
direct contact with their own personal experience. Language forces a space
between interpersonal experience as lived and as represented. And it is exactly
across this space that the connections and associations that constitute neurotic
behavior may form. . . . Finally, with the advent of language and symbolic think-
ing, children now have the tools to distort and transcend reality. . . . Prior to this
linguistic ability, infants are confined to reflect the impress of reality. They can
now transcend that, for good or ill [p. 182].

Stern claims that “by the time babies start to talk they have already acquired
a great deal of world knowledge,” including “how social interactions go”
(p. 168). Yet that internal world of the child, composed of “representations
of interactions that have been generalized” (RIGs, p. 97), is presented as a
veridical reality constructed by the child, unmediated by a caregiver or by
language (for a contrasting position, see Loewald 1960).
Such a view of the lone infant negotiating its environment (including
significant objects) before acquiring language at two years of age or so
continues a psychoanalytic tradition dating back to Freud. Psychoana-
lytic writers who turned to academic research found cognitive and lin-
guistic research that validated the same “competent infant” (see the series
of that name edited by Stone, Smith, and Murphy 1978). Piaget’s large

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 Bonnie E. Litowitz

body of work also provided scientific respectability for this view of the
lone child building up an inner world by means of his actions on an envi-
ronment whose passive role is to provide aliments (maternal provisions
such as holding, containment) for the child’s consumption. These actions
result in internal schemata and cognitive operations that form the child’s
personal knowledge of reality. Only after this knowledge has been so cre-
ated (well into the second year) is language hypothesized as a factor, rep-
resenting but also misleading the child’s perception and thought (Piaget
and Inhelder 1969).6
Piaget derived his cognitive theory, as well as his early method cli-
nique, from his training as a psychoanalyst (Litowitz 1999). To cite but
one example: Piaget’s two principles of adaptation, assimilation and accom-
modation, are derived from Freud’s two principles of mental functioning,
the pleasure and reality principles (respectively). Although for Freud the
former dominates early life, for Piaget both principles fluctuate in cycles
throughout development, with the organism striving for equilibration (i.e.,
homeostasis for Freud). It is little wonder that so many psychoanalytic
writers who sought a theory of early development found Piaget a compat-
ible resource, but psychoanalysts who look to Piaget for legitimacy are
caught in a vicious circle. In an interesting further turn, as Morris Eagle has
pointed out (Lyon 2003), Stern’s claim that reality dominates infancy actu-
ally reverses Freud’s original sequence!
Some critics have claimed that psychoanalytic writers who create
theories of infancy out of the data of other fields have also imported biases
from those alien methodologies into their models. For example, André Green
(1996) attributes the downplaying of language in current American theo-
ries to the very nature of infant-observational research that privileges see-
ing over listening (p. 877). What researchers observe are often frame-by-frame
video analyses of mother-child contingent behaviors unfolding in real
time. The influence of this research method is clearly evident in the clini-
cal search for the same moment-by-moment analysis of analyst-patient inter-
actions (e.g., “moments of meeting”) that unfold in real time (e.g.,
“now-moments”). The same evidence—nonverbal behaviors or verbaliza-
tions as behaviors—is ascribed to the same purposes: to establish affect
regulation, attunement, and attachment. In other words, the clinic is pre-
sented as reproducing the research nursery, with treatment and observa-
tional research replicating each other.
6
The developmental goals of adaptation and autonomy in Piaget’s theory, as well
as his avowed structuralism, resonated positively with American audiences.

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The influence of methodological constraints in academic research can

be seen in the familiar example of the attachment paradigm, which has had
a major impact on our field (Goldberg, Muir, and Kerr 1995; Mitchell
2000). In attachment studies, observational conditions (independent vari-
ables) are set up by researchers to observe specific aspects (dependent vari-
ables) of behavioral responses across a number of participants statistically
determined to wash out individual variations. Observed behavioral responses
cluster into types that are then designated as secure, insecure (ambivalent
or avoidant), or disorganized, and these patterns are then claimed to be
both normatively and pathologically explanatory. For many writers, attach-
ment has become the key dyadic point of psychic structuration—a sort of
“preoedipal oedipus”—in that how one navigates attachment both reflects
past and predicts future self-with-other interactions.7 Since attachment
research involves children under two, in typical fashion one does not find
a role for language in the infant-caregiver interactions that are hypothe-
sized as formative.8 But, ironcially, verbal data in adult research subjects
are used to provide evidence for type of attachment retrospectively (when
the adult was a child), as well as being predictive of intergenerational pat-
tern transmission into the future (the type of attachment pattern that will
emerge in the subject’s child).
Experimental research methodology (as in attachment research)
separates the experimenter from the subjects being studied, an impossible
goal in the clinical setting, where we are always also participants (albeit
attempting also to observe). Greenberg (2005) makes the same point from
the perspective of agency: we are “simultaneously acting and being acted
upon” (p. 108). We cannot observe ourselves very well, which leads
to admonitions to learn from the patient (i.e., treat the patient too as
a participant-observer). Thus we are caught not only in the “hermeneutic
circle” (as often described); we are engaged in a “double hermeneutic,”
interpreting others who are simultaneously interpreting us.
This difference in contexts is often lost when research findings are
presented as the normal (or at the very least, normative) pattern, rather than

7
By “point of structuration” I mean the resolution of a critical problem, the solu-
tion to which reorganizes the psyche in ways that are significant for future develop-
ment or on which future development depends. Such critical moments of reorganization
are typical of structural theories (e.g., pre>concrete>formal-operations in Piaget).
8
An interesting historical note: Freud’s example of a child’s mastery over separa-
tion involves language: ‘oo’–‘aa’ (‘fort’–‘da’) as the child throws out a spool of thread
and reels it back in.

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as results generated under specific conditions in a particular context (i.e.,

with particular methods and subjects).9 Patterns from specific research par-
adigms become reified and interpreted as applicable for the child in all dyadic
interactions, or are generalized to dyadic interactions of adults in treatment
(Tronick 2003). Stern (2004), for example, claims that “implicit relational
knowing” (IRK) is one such generalized pattern that the child takes away
from his particular attachment experiences. Just as primary process was, IRK
is defined in opposition to a verbal standard: nonsymbolic (vs. symbolic),
nonverbal (vs. verbal), procedural (vs. declarative), and nonconscious in the
sense of not having been repressed from consciousness (i.e., not “dynamic”)
(p. 113). Recasting Bowlby’s “working model” from the attachment par-
adigm as IRK, Stern writes, “At only 12 months of age (well before speech)
the infant implicitly knew what to do with his body, face, feelings, expecta-
tions, excitation, inhibitions, redirection of activities, and so on. He ‘knew
whether’ to approach her [the caregiver who had left], lifting his arms for
an embrace and body contact, or whether to not move and pretend that her
return is a non-event” (p. 114). The relationship between self and other is
described in terms of observed behaviors, with the child as subject/agent—
what did he do, how did he act—that exhibit a repertoire of behaviors pre-
sumably based on her past contingent responses to the stimuli of his past
initiated agency (Litowitz 2009). That pattern is posited to generalize (as a
RIG) to all relationships, including interactions in therapy.
Tronick, in particular, has questioned this interpretation of mother-
child research patterns as dyadic prototypes, noting that “all relationships
are unique.” All behaviors are “specific to a particular relationship . . . and
even when the same behavior occurs in several dyads, the meaning of the
behavior in each relationship may be unique” (pp. 473, 478).
Fonagy and colleagues (2002) have attempted to add an intrapsychic
dimension to dyadic models of two persons interacting in contingent behav-
ior patterns. They introduce the concept of “mentalization” to describe
how children come to understand that the world is mediated through their
minds and that other people also have mediating minds. (In other words,
the child’s inner world is not simply the imprint of reality or the result
of his actions alone). As mentalization enables the child to understand
and regulate his own affect states and contributes to a sense of self, how a
9
As Niels Bohr noted, one cannot ask if light or matter consists of waves or
particles; only whether it behaves as one or the other, and then “if and only if one
specifies the experimental arrangement by means of which one makes observations”
(Pais 1991, pp. 22–23).

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caregiver enables mentalization to emerge is critical for normal psycholog-

ical growth in the child; but it also serves as a model for therapeutic inter-
vention when growth is thwarted. Thus, on this view the caregiver is not
just a passive provider, one who does not interfere with the independent
child’s agency and impede his progress: “The caregiver facilitates the cre-
ation of mentalizing models through complex linguistic and quasi-linguis-
tic processes, primarily by behaving toward the child in such a way that the
child is eventually led to postulate that his own behavior may be best under-
stood if he assumes that he has ideas and beliefs, feelings and wishes, that
determine his actions, and the reactions of others to him can then be gen-
eralized to other similar beings. The caregiver approaches the crying infant
with a question in her mind: ‘Do you want your nappy changed?’ ‘Do you
need a cuddle?’ ” (p. 53; emphasis added).
Fonagy and colleagues present an elaborated theory of capacities
(“reflective function”), processes (“mentalized affectivity”), and mechanisms
(“interpersonal interpretive mechanism”) that they claim are descriptive of
normal development, as well as usable in evaluating and treating disorders
of mentalization—the very concept they have hypothesized. Leaving aside
the questionable explanatory adequacy of this form of argumentation (Toul-
min and Feldman 1976), these authors nevertheless provide many examples
of adult-child practices: for example, the question in the mother’s mind
as she approaches her child (p. 53) or the mother’s affective “marking” of the
child’s affective expression (p. 193). Examining practices redirects atten-
tion away from hypothetical mental operations or processes in the child’s mind
and toward the sociocultural matrix within which the adult-child system
is functioning, including the “complex linguistic and quasi-linguistic”
features of their communicational exchanges that mediate between minds
and worlds (Cowley, Moodley, and Fiori-Cowley 2004).
As early as 1960, in one of the most cited papers in modern psycho-
analysis, Loewald introduced the concept of mediation, invoking the parent-
child metaphor to explain how change occurs through analysis. Loewald
claims that the mind of the parent/analyst holds a vision of where the child/
patient could be and communicates in such a way as to enable the child
to share it; or, as Fonagy et al. say, “the caregiver . . . .behav[es] toward
the child in such a way that the child is eventually led to postulate. . . .”10
Although Loewald clearly indicates that language is the primary means
10
Loewald’s description evokes Vygotsky’s concept of the “zone of proximal
development” (1976), the difference in the child’s functioning on its own and in a dyad
with an adult equipped to use various means for mediating better performance.

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 Bonnie E. Litowitz

through which such mediation takes place, in 1960 he still retained ego
psychology’s designation of language as an ego function identified with
the oedipal period. However, as Mitchell (2000) notes, in his later work
Loewald suggests “that the very distinction between preverbal and verbal
developmental epochs is misleading, that there is no preverbal domain
per se. . . . The most important distinction is not between preverbal and
verbal, or between primary and secondary process, but between the ways
in which language operates in these two developmental eras and levels of
mental organization” (p. 8). In other words, the differences should be sought
in forms of mediation and the contexts of their use.
Fortunately, we actually know a great deal about how language oper-
ates in the varied contexts in which human development takes place, and
the implications for therapeutic dialogues are significant.

THE ROLES OF LANGUAGE IN THE FIRST

R E L AT I O N S H I P S : E A R LY D I A LO G U E S

As we all know, the altricial birth of every human baby necessitates a

lengthy period of dependency that requires the newborn to make an attach-
ment to an adult in order to survive.11 For this reason, in humans the dis-
tance receptors necessary for attachment develop prior to motor capacities.
Of the two major distance receptors—sound and sight—hearing is up and
running even before birth, while the baby is still in utero.12 Research shows
that the uterus is permeable to sound; infants only a few weeks old are able
to differentiate the intonational patterns (graded and analogical) of the
parental language from those of other languages and to distinguish between
patterns of the two parents. Since infants will master the phonetic distinc-
tions relevant to their native language and can even demonstrate recogni-
tion of word and phrase boundaries by six to eight months, it is clear that
humans must arrive prepared with “perceptual-cognitive systems” for ana-
lyzing speech sounds (Nelson 2007, p. 70).
What the infant hears is adults’ infant-directed speech (“Motherese”)
that uses the acoustic contours of varying intonational patterns to which

11
Of course, Freud was well aware of the continued need for the mother to provide
for her infant after birth, but it was the post-Freudians who first detailed self-other inter-
actions during that early period.
12
Although the auditory system matures after birth, subcortical pathways are
already present and ideally suited for graded (analogical) signals critical for affective
messages (Fernald 1994, p. 85).

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infants are already attuned. By means of these verbal markers the adult
secures dyadic attachment, quickly establishing meaningful patterns of affect
management: to direct attention; to provide comfort; to indicate approval or
prohibition (Fernald 1994). Infant-directed speech is distinguished by its
exaggerated prosodic features (stress, tone, pitch, length); these register
psychoacoustically as suprasegmentals. That is, these analogical (graded)
aspects of the speech signal range over discrete (segmental) units, the units
that we hear as meaningfully distinct in our language. The intonation con-
tours are the prosodic envelopes out of which all language will emerge, and
their first function is regulating affect states. That primary function remains—
for example, in Fonagy et al.’s example of “marking.” Marking also incor-
porates a function that the child will master later: expressing an attitude
about the truth-value of verbal content, which we exploit in irony, sarcasm,
or pretense. At the same time, the infant is using the segmental input within
the contours to determine significant sound units and boundaries (phonemes,
phrases), pruning away those that are not needed in his language and which,
by eight months, will no longer be perceived as linguistic signals at all. In
other words, discrete (digital) units are meaningful if, and only if, they
become shared and related to other units; the rest is noise.
The nature of the aural-oral system engenders a relationship between
self and other that is unique. Consider that the speaker is also always her
own listener, no matter to whom her speech is addressed. In contrast, visual
recognition of others does not include looking at the self who is looking.
Therefore, to look is to objectify, while speaking and hearing ineluctably
entail intersubjectivity.13 From birth there is an entanglement between the
one vocalizing and the one who hears the vocalizations, between oneself
for another and oneself as another (Ricouer 1992). That doubled entangle-
ment creates a unique self-other relationship that is instantiated in the very
features of language itself: namely, in the reversibility of the speaker (“I”)
and addressee (“you”) discursive positions; and in the capacities for self-
reference (reflexivity) and recursiveness that are unique to linguistic sys-
tems (Jakobson 1957; Hauser, Chomsky, and Fitch 2002).
An important consequence of this unique I-you entanglement is the
complexity of identification in humans when compared to imitation
in other primates (see Mitchell [2000, pp. 43–44] on Loewald in this
regard). Imitation can be described in terms of actions and behaviors, while

13
One consequence is that visual self-recognition does not occur until into the
second year, at least as demonstrated in the mirror and smudge paradigms.

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 Bonnie E. Litowitz

identification requires both shared reference and shared intentionality

(Tomasello 1999). The establishment of shared reference by means of
identification with the adult caregiver’s intentions is a major function of
infant-directed speech. As Luria (1973) states, “It would be a mistake to
imagine that the attention of the infant can be attracted only to powerful
and novel stimuli, or by stimuli connected with immediate demand. From
the beginning the child lives in an environment of adults. When his mother
names an object in the environment and points to it with her finger the
child’s attention is attracted to that object, so that it starts to stand out from
the rest regardless of whether it gives rise to a strong, novel, or vitally
important stimulus” (p. 262). Thus, the infant acquires, along with affect
regulation, knowledge of culturally significant referents; the intentions of
others with whom he identifies; and the mediational means for conveying
messages in patterns that are distinctive for his environment. And all are
“specific to a particular relationship” (Tronick 2003, p. 478).
As Fonagy et al. say, “the caregiver approaches the crying infant with
a question in her mind,” but that question will not be “Do you want your
nappy changed?” if the dyad are living in an Amazonian village where
babies don’t wear diapers. Among the Beng in West Africa, for example,
infant cries are viewed as expressions of the language of dead ancestors
whose souls the babies embody: the mother, who has lost her capacity to
understand that language (as her baby sadly will), must try to decipher what
the baby/ancestor wants her to do (Gottlieb 2004). Mothers in all cultures
rely on experts for help in figuring out “What does my baby want from me?”
and “What should I be doing?”
Expressing desires and getting others to do something are basic to all
communicational exchanges. These aspects of language have often been
described as the pragmatic functions to which young children are first attuned
(Halliday 1973). In other words, before one is aware of what is being said
(i.e., semantic content) or how content can be phrased (i.e., syntactic struc-
ture), communicational exchanges are attempts to accomplish something
by means of speech (Dore 1975; Bruner 1975), and the desiderative (express-
ing desires) and the instrumental (getting something done) appear to be the
earliest of those functions (Lyons 1977, p. 826; Litowitz 2005).
Speech functions may be familiar to readers from Roman Jakobson’s
information-processing model from the 1960s, in which messages are trans-
mitted from “sender” to “receiver” (rather like Freud’s telephone exchange
metaphor [1912, pp. 115–116]). Jakobson’s goal (1960) was to show that
language is used to express different functions in different contexts: for

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instance, using it to solidify social relations stresses its phatic function, while
language used in science stresses its referential function. At the same time,
linguistic philosophers were noting that the overarching goal of all speech
is to “do things with words” (Austin 1962). Every speech act begins when
“I–the speaker” (Jakobson’s sender) uses speech to act upon “you–the
addressee” (Jakobson’s receiver). Exploring the performative components
of speech as action, these philosophers separated out a speaker’s intention-
ality (illocutionary force) from the locutionary form chosen to accomplish
that end and from its actual (perlocutionary) effect on others’ behavior (Searle
1969). The important contribution from speech act theorists’ analyses is that
intentionality is not so easy to determine objectively. Since intention can be
expressed in a variety of forms and may not necessarily lead to the desired
behavior, neither expressed form nor observed behavior is a sure indicator
of what one is trying to do with words. Despite the potential in speech act
theories for exploring ambiguities in communicational exchanges, still in
these models “I” and “you” are treated simply as separate place holders for
their discursive positions: whoever speaks is an “I”; whomever is addressed
is a “you.” Other academic theorists have written about the power relations
inherent in performative speech acts (e.g., not everyone can christen a ship
or certify you as a psychoanalyst or make you do something you don’t want
to do), but academic methodologies cannot explore the intrapsychic com-
plexities of these interpersonal relations. Those complexities are best exam-
ined in clinical settings (Rizzuto 1993; Litowitz 2007a).14
Language functions and speech acts are part of the growing field of
pragmatics that includes aspects of linguistics and philosophy, as well as
research from sociology (e.g., ethnomethodology, discourse, and conver-
sation analysis; see Levinson 1983). These disparate fields are united in the
beliefs that (1) speech cannot be separated from action and (2) the context
of speech use affects the content. In other words, what is said and how it is
said depends on who is speaking to whom, when and where, and to accom-
plish what ends. The pragmatics of communicational exchanges in analy-
sis is less often the topic of our clinical discussions than the topic of meaning
(but see Rizzuto 2002, 2003), yet meanings are constrained by their com-
municational contexts (Litowitz 2007a).
As Tronick has noted, the same behavior may have different mean-
ings in the contexts of different relationships. Cathy Urwin (1984, p. 274)
14
A notable exception is Henriques and colleagues (1984), academics who
turned to psychoanalytic theory to understand the nature of subjectivity and its resis-
tance to change.

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 Bonnie E. Litowitz

cites an example that demonstrates the kind of contextual knowledge

already available to a two–year-old: Faced with an empty milk glass next
to a bottle of milk, the child says to her mother, “Mommy. I want milk.”
But with her father, the following dialogue ensues:

Child: “What’s that?” Father: “Milk.”

Child: “My milk, Daddy?” Father: “Yes, it’s your milk.”
Child: “Daddy yours. Yours Daddy?” Father: “OK. Yours. OK. Mine.”
Child: “It’s milk, Daddy.” Father: “Yes, it is.”
Child: “You want milk, Daddy?” Father: “I have some. Thank you.”
Child: “Milk in there, Daddy?” Father: “Yes.”
Child: “Daddy, I want some please? Please, Daddy, milk?”

Thus, in her first two years this child has indeed learned, in Stern’s phrase,
“how social interactions go”: to whom she can appeal and for what, and
what form that appeal needs to take. And that knowledge is thoroughly
mediated by the adults in her world and their mediational systems.
Mothers, fathers, and babies are beings-in-the-world-with-others, and
the ethics of their relationships are determined by figuring out what the
obligations of each to “the other” are; who has the right to make demands;
what is promised, prohibited, or permitted—by whom, for whom, under
what circumstances.15 These are the deontic entailments that define rela-
tionships. As mothers and infants are using speech to regulate affect states
and create ontic/epistemic categories of what exists in their world (i.e., what
is), their relationship is being defined deontically by ought, must, should,
can, want to, will, wish, and so forth (Litowitz 2005).16
The mother in Fonagy et al.’s example who approaches her baby with
the question “Do you want your nappy changed?” is establishing that there
are such things in the world as nappies and that she accepts her obligation
to change them. However, also expressed is what the baby should want—
to be upset by a dirty diaper: a desire that will become an obligation between
two and three to “Tell me when you have to go potty!” A psychoanalyst
who has commented on this ethical/relational aspect of early exchanges is
15
The philosopher Emmanuel Levinas (1961) has focused our attention on the
ethical entailments, conflicts, and ambiguities of being a self-in-the-world-with-
an-other. My thinking on the ethics of relationships is indebted to his work.
16
Note that deontics depend upon being born into a linguistic system. How would
a nonlinguistic animal express “must” or “wish,” or engage in “sexual researches” like
Little Hans? The ontic-deontic distinction makes counterfactuals possible, a necessary
condition for imagination and fantasy, and therefore critical to all our work.

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Jean Laplanche (1998), who provocatively remarks that when the mother
offers the breast, the baby wonders, What does the breast want from me?
In other words, is this a permission—“You may suck”—or a demand—
“Suck!”? From this point of view, the behavioral patterns that manifest IRK
for Stern are expressions of the complex ambiguities of self-other relation-
ships: Do I have a right to object to her leaving? Can I make a demand for
comfort when she returns? Do I have her permission now with others pres-
ent, but will I pay for it later? In the aversive response the child feels that
he does not have the right to make a demand or to express any feelings of
anger, frustration, or anxiety that arise (Newman 2007). On the other hand,
it is also possible that this child ignores his mother’s return because it is his
obligation to validate her “good mothering” by demonstrating his indepen-
dence from her (highly valued in America but not everywhere). Such a child
may ultimately feel guilty that he is so angry with her, or he may feel
ashamed that he missed her so and assume he is to blame (Litowitz 2009).
Even in the case of the secure response to the mother’s return, or in
Fonagy et al.’s example (“Do you want a cuddle?”), I would argue that it
is never completely clear whose desire is being expressed (Litowitz 2009).
Neither the mother nor the baby can be certain what the other is commu-
nicating, but the mother—“carrier of social responsibility with respect to
her child” (Sullivan 1953, p. 113)—uses her knowledge to establish a “tem-
porarily shared reality” (Rommetveit 1974) on which the baby can com-
ment with its available vocabulary (e.g., facial expression, postures, crying,
fussing). The baby now has a culturally validated concept to attach to its
affective state, but also an ambiguity about where the concept-state con-
nection arose: Did it come from her or from me? Is it what I want or what
she wants?
In attempting to explain these internal confusions and uncertainties, we
usually read descriptions of an agentive self who has desires that cause con-
flicts and result in compromises or who has needs, either adequately met
or enacted; a self forced to relate to, rather than free to use, another self;
and so forth. Psychoanalytic theories have tended to assume a bounded self,
its psyche split (horizontally or vertically), with a potential to lose both its
cohesion (fragmented or splintered into dissociative me/not-me states) and
its boundaries (merged or undifferentiated). By contrast, a self-with-an-
other-in-the-world is neither “guilty man” nor “tragic man” (Kohut 1977)
but rather is more like a character in a Dostoevsky novel or Chekhov short
story whose thoughts as interior monologues are saturated with dialogue

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 Bonnie E. Litowitz

(Morson and Emerson 1990). Thus, this entangled self’s subjectivity is always
already intersubjective and his agency always uncertain.17 Freud already
revealed that our sense of self-mastery is an illusion. Post-Freud we find that
a self, existing apart from others, is also an illusion. The further task for psy-
choanalysis is to attempt to describe the nature of self-other entanglements,
and, toward that end, we must better understand the relationships among
our conflated concepts of self, subjectivity, and agency (Litowitz 2009).

SUMMARY

Ever since Freud’s Three Essays on the Theory of Sexuality (1905), psy-
choanalytic theory has included some description of normal development
against which pathologies could be explained (Palombo, Bendicsen, and
Koch 2009). Early developmental models found data to confirm psycho-
analytic theory (e.g., Little Hans’s oedipus complex, Mahlerian stages from
symbiosis to separation-individuation). Later developmental models, espe-
cially among American theorists, were based on research findings from
academic disciplines (infant and child research, cognitive neuroscience)
and were then grafted onto earlier psychoanalytic theory regarding the two-
to five-year-old oedipal child. A consequence has been a description of the
first years of life—the preoedipal period—in terms of visual-behavioral
evidence (e.g., nonverbal, gestural expressions of affect, action, and enact-
ments), of the nonconscious mind (e.g., unthought, unmentalized, unfor-
mulated), and of the reparative roles of behavioral interactions such as
enactments in a dyadic relationship. The resulting theories search for
psychological/cognitive processes such as implicit relational knowing or
mentalization, functions such as the reflective function, or structures such
as RIGs or interpersonal interpretive mechanisms—all said to develop from
adult-child dyadic interactions. Pathologies are hypothesized as results
of faulty or absent early interactive behaviors; treatment interventions
are aimed at fostering the necessary processes and structures through cor-
rective behaviors in the analytic dyad.
These hybrid academic-psychoanalytic models have resulted in a rad-
ical deemphasis of language and the symbolic nature of all human menta-
tion, and, in consequence, a deemphasis of the role of unconscious fantasies,

17
By way of contrast, see “the interdependence of subject and object,” the
“unconscious interplay of individual subjectivity and intersubjectivity” in “the
analytic third” (Ogden 2004, p. 168; see also Benjamin 2004).

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of the dynamic unconscious, and of insight and reflection gained through

clinical dialogue. Language has come to be identified with a very circum-
scribed view of the mind: as described only by intrapsychic models; rel-
evant only for pathologies of the oedipal-age child; a necessary condition
for only one defense (i.e., repression); and equated with interpretation
regarded as the sole mode of therapeutic intervention. Developmental
models imported from mother-child observational research have not taken
into consideration the effect of the earliest communicational exchanges on
a sense of self in relationships with others. An alternative perspective locates
the origins both of a sense of self (subjectivity) and of what constitutes
relationships (intersubjectivity) within self-other systems engaged in com-
municational practices. This perspective shifts our focus from semantic
content (e.g., co-constructed meanings) to pragmatic contexts, from observ-
ing behaviors (e.g., enactments) to those aspects of dialogue that mediate
self-with-other relationships. Understanding that we are born into language
refocuses our attention on the ways that specific features mediate our rela-
tionships with others and with the world, reestablishing an intrapsychic
dimension to the concept of relationship.

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