• representability/figurability;
  • semiotics;
  • unconscious


  1. Top of page
  2. Abstract
  3. Discussion
  4. Conclusion
  5. References

During the course of treatment with some patients a word or phrase reappears that functions to connect layers of fantasies and to identify a history of conflicts and defenses. These stitch-words are compared to the switch-words proposed by Freud as points of condensation in dreams, as well as to other forms of idiolectic evidence (e.g. metaphors) that inform therapeutic listening. Stitch-words expand on Freud's concept by taking into account syntactic aspects of language that function to hold together layers of unconscious fantasies. A description of the grammatical type of words (syncategorematic) best suited to function as stitch-words is presented and illustrated by their use in two clinical examples (‘normal’, ‘fair’). The therapeutic value of listening to, as well as through, the surface of patients' language is discussed.

Von Wechsel-Wörtern zu Stichwörtern

Im Laufe der Behandlung tauchen bei manchen Patienten wiederholt bestimmte Wörter oder Formulierungen auf, die mehrere Schichten der Phantasie miteinander verbinden und eine Geschichte von Konflikten und Abwehren identifizieren. Diese Stichwörter werden mit den „Wechseln” verglichen, die Freud als Verdichtungen in Träumen erläutert hat, sowie mit anderen Formen idiolektalen Materials (zum Beispiel Metaphern), die für das therapeutische Zuhören aufschlussreich sind. „Stichwörter” erweitern Freuds Konzept, indem sie auch den syntaktischen Aspekten der Sprache Rechnung tragen, die verschiedene Schichten der unbewussten Phantasie zusammenhalten. Die Autorin beschreibt, welche grammatikalischen Wortarten (synkategorematische) als Stichwörter am besten geeignet sind und illustriert dies anhand ihrer Verwendung in zwei klinischen Beispielen („normal”, „fair”). Der therapeutische Nutzen des Hörens auf die Oberfläche der Sprache des Patienten – und durch sie hindurch – wird diskutiert.

De las palabras-puentes a las palabras-costuras

En el transcurso del tratamiento con algunos pacientes una palabra o una frase reaparecen y funcionan para conectar capas de fantasías así como para identificar la historia de conflictos y defensas. Se compararán estas palabras-costuras (stitch-words) con las palabras-puentes (switch-words) que propuso Freud como puntos de condensación en los sueños así como de otras formas de evidencia de idiolectos (e.g. metáforas) que informan la escucha terapéutica. Las palabras-costuras expanden el concepto de Freud tomando en cuenta aspectos sintácticos del lenguaje que funcionan para sostener juntas capas de fantasías inconscientes. Se presenta una descripción del tipo gramático de palabras (sincategoremático) que mejor funcionan como palabras-costuras y se ilustra con dos materiales clínicos (‘normal’, ‘justo’). Se discute el valor terapéutico de la escucha de, así como a través de, la superficie del lenguaje de los pacientes.

Des mots-aiguillage aux mots-couture

Pendant le traitement de certains patients surgit un mot ou une phrase qui sert à relier de différentes couches fantasmatiques et d'identifier une histoire de conflits et de défenses. Les mots-couture sont comparés aux mots-aiguillage proposés par Freud comme points de condensation dans le rêve, ainsi qu'à d'autres formes d'évidence d'idiolectes (ex. les métaphores) qui entrent en jeu dans l'écoute thérapeutique. Les mots-couture ici proposés étendent le concept de Freud par la prise en compte des aspects syntaxiques du langage dont la fonction est celle de relier les différentes couches du fantasme inconscient. Nous présentons une description de la catégorie grammaticale (syncatégorématique) des mots les mieux adaptés à la fonction de mots-couture et deux exemples cliniques (‘normal’ et ‘juste’) sont donnés. Nous discutons de la valeur thérapeutique de l'écoute de, ainsi que de l'écoute à travers, la surface du langage du patient.

Dalle Switch-words alle Stitch-words, ovvero dall'ambivalenza alla multivalenza

Nel corso della cura di certi pazienti, si incontra spesso una parola o una frase che sembra dover funzionare come collegamento fra vari strati di fantasie e indicare una serie di conflitti e difese. In questo lavoro, si confrontano queste parole con funzione coagulante (stitch-words) cone le parole ambigue (switch-words) proposte da Freud nella sua teoria del sogno; parole quest'ultime che costituiscono punti nodali nella condensazione onirica, e che appaiono anche in altre manifestazioni idiolettiche (per esempio nelle metafore). È nostra intenzione ampliare questo concetto freudiano di switch-words, importante nell'ascolto clinico, proponendo le stitch-words che si fondano sulla considerazione di aspetti sintattici del linguaggio e che saldano insieme diversi strati di fantasia inconscia. Viene presentata una descrizione del tipo grammaticale di parole (sincategorematica) che meglio si presta a funzionare come stitch-words, illustrate poi con il loro uso nella prassi clinica (per esempio ‘normale’ e ‘giusto’ nei due casi clinici presentati). Viene quindi discusso il valore terapeutico di un ascolto non solo del livello intrinsico del linguaggio del paziente, ma anche di quello estrinseco.

In this paper I address a phenomenon that occurs in the treatment of some patients. Throughout the course of these therapies a particular word appears and reappears, embedded in one context after another, acting as a ‘stitch’ that connects what is being talked about to other thoughts from other times. One finds that the word acts as a point through which these earlier thoughts have been captured and preserved, outside the awareness of the speaker. Typically such a word is very common, of the type that occurs frequently in ordinary discourse. As a consequence it is ideally suited to serve its function as a portmanteau, both carrying and covering the connections across the layers it stitches together.

Freud (1905) first brought a similar type of word to our attention in the Dora case. In a footnote to Dora's first dream Freud advises:

Now, in a line of associations ambiguous words (or, we may call them, ‘switch-words’) act like points at a junction. If the points are switched across from the position in which they appear to lie in the dream, then we find ourselves on another set of rails; and along this second track run the thoughts concealed behind the dream.

(1905, p. 65)

In the footnote Freud uses the German zweideutig, having two (i.e. more than one) meanings. Such ambiguous or equivocal words can serve as a Wechsel – a point of change or exchange – as in a rail-yard where, depending on its position, tracks may lead from that point in alternate directions.

The example Freud provides from Dora's dream is actually not a word, but a sentence: “Something might happen in the night so that it might be necessary to leave the room” (p. 65). Freud is struck by these words because, he asks: “Are not certain physical needs referred to in the same words?” (p. 65). That is to say, he hears in such a common statement the echoes of others' voices, other contexts; and he interprets the current usage as a screen that both reveals and conceals the meaning of those earlier (i.e. infantile) times and activities. Later, in his analysis of Dora's dream, Freud does offer an example of a single word as switch-word: “The word ‘catarrh’ acted once again as a ‘switch-word’ and enabled the whole set of thoughts upon her father's responsibility for her illness to manifest themselves in the symptom of the cough” (p. 82). That is, Dora's use of ‘catarrh’ served as a key for Freud to unlock the latent meaning of her symptom.

Discussing such words or phrases in relation to dreams, Freud noted that: “The key-phrase serves as a port of entry though which the whole network is simultaneously put in a state of excitation … a port of entry to the whole … phantasy” (1900, p. 497). In other contexts Freud described how the natural ambiguity of words enable them to serve as “nodal points”, on which “a number of thoughts converge” (1900, p. 300) and from which thoughts are “bound to branch out in every direction into the intricate network of our world of thoughts … like a mushroom out of its mycelium” (p. 525). In Freud's examples from Dora's treatment switch-words act as verbal clues to latent thoughts that both reveal and conceal the true meaning of the dream or symptom, a meaning that has been compromised (i.e. disguised or displaced).

In a letter to Fliess (number 140), Freud presents the Dora case, originally titled ‘Dreams and hysteria’, as an extension of his 1900 book on dreams. Thus it is not surprising that one can discern a connection between switch-words and the dreamwork process of condensation. We are used to thinking of condensation in terms of dream images of persons or objects, perhaps even activities, superimposed on one another (like Galton's family photographs [Freud, 1900, p. 293]) or amalgamated into composite figures (Freud, 1900, pp. 293, 324). Through the processes of condensation multiple latent elements can be represented (i.e. manifest) simultaneously. It would seem that Freud was establishing a parallel between the multiple meanings captured through the ambiguity of words and the multiple images captured in a single (visual) dream image. Indeed, it is the imagic aspect of words – the phonetic similarities of homophones, puns and alliterations – that are often exploited by Freud in his interpretations.

However, when one moves beyond single words or idiomatic phrases (which function as single units) to explain the mini-narratives of layered unconscious fantasies one must take into account other aspects of language. The differences between the two modalities of representation – visual and verbal – become more important (Litowitz, 2007). Specifically, language does not consist only of acoustic images that may substitute for each other, strung together like beads on a necklace. Speech unfolds linearly over time in ordinary, unremarkable (i.e. forgettable) utterances, but how the words are related to one another matters. One word follows another related, not by superimposition, simultaneity, figure-ground, etc., but by grammatical relationships. Thus I am suggesting that Freud's original concept be expanded in order to capture this syntactic function: how a key word may hold together (stitch) layers of unspoken thoughts (i.e. unconscious fantasies) that emerge over the years during development in response to traumas and conflicts.

The metaphorical image of layers being held together by a key stitch is also present in Lacan's description of point de capiton. Lacan uses the vocabulary of upholstery or quilting in which layers of fabric or batting material are tacked together at one point, by one stitch (e.g. “button tie”, “quilting point or stitch”, “anchoring point” [Fink, 1997, pp. 93–4]). In a Lacanian return to Freud, as read through the prism of Saussurean linguistic theory, what is held together is a signifier (Freud's word-representation) and its repressed referent or signified (Freud's thing-representation). Acknowledging that all speech consists of presences (meanings selected) as well as absences (those not chosen but ‘excited’ [as Freud noted]), the Lacanian analyst listens for the “‘corruptions’ of the more standard or more usual expression” in “unusual or polyvalent verbal images or phrases” (Fink, 2010, p. 273).1

Freud's views on language reflected the dominant historical and philological perspectives of his era. Saussure's lectures on linguistic theory from 1906 to 1911 radically challenged those earlier views by introducing new, synchronic and structural perspectives which Lacan imported into his re-reading of the Freudian texts. Of relevance to the present distinction between switch-words and stitch-words is that, of the two axes that Saussure claimed define language, Lacan chose associative relations over syntagmatic linear arrangements (Saussure, 1959, p. 122). The latter were under-theorized during Saussure's time, while other concepts (e.g. signifier–signified, associative patterns) fit closely with Freud's original concept of a specific keyword in the patient's speech – that is, where the interplay of a word's multiple meanings and often its phonic similarities reveal a significant unconscious meaning. The syntactic dimension of language did not become a theoretical focus until the mid-20th century; and the pragmatics of language in contexts, even later. We now understand that the grammatical class to which a word belongs contributes to signification. Switch-words reflect the earlier view of language, while an expansion to stitch-words incorporates a post-Saussurean awareness of the functions of language in creating narratives about oneself and the world.

In his writing about dreams Freud frequently used linguistic expressions as an interpretive technique, listening for layers of personal meaning in fixed expressions: puns and proverbs; memorized lines form literature; idioms and slang; and so forth. By contrast, the key words in different contexts that I am addressing here do not have trans-individual resonance shared by those in the same cultural/linguistic group. Rather, they are ordinary non-memorable words that are spoken in novel utterances and whose special significance is only revealed by virtue of their repetition over time. Only very gradually does one realize that this ordinary word, appearing in many different contexts, may hold the key to individual fantasies or compromise formations that have been laid down over years like sedimentary strata in a geological formation.

In order to serve as a stitch-word, a key word must lend itself to a particular form of ambiguity. Usually, words become ambiguous by virtue of our having used them in multiple contexts and, thus, are “predestined to ambiguity” (Freud, 1900, p. 355). For example, ‘table’ can be used to refer to a particular piece of furniture, or a postponing activity, or a diagrammatic presentation of data. Such polysemy is the norm for most content words, which is why they are such a rich source for insights in psychoanalytic data (e.g. from dreams, free associations, parapraxes). As Freud noted: “Neuroses (e.g. in framing obsessions and phobias) no less than dreams make unashamed use of the advantages thus offered by words for purposes of condensation and disguise” (1900, p. 341).

However, there are some words that are intrinsically ambiguous, whose very meaning is only contextually determined by the conceptual/semantic category they modify in a particular utterance. Such a word is called a syncategoreme (–ata); it only has significance in conjunction with another expression (i.e. it cannot stand alone).2 As a consequence, this type of word is particularly well suited to serve as a stitch-word. I will discuss two examples below – normal and fair – to illustrate how a stitch-word may repeatedly appear in varied contexts during the course of a treatment.3


Arguably, every patient seeking treatment feels he or she is ‘not normal’, but for Zoe (a severely dysfunctional 32 year-old) the phrase “not normal” dominated our sessions. During the long course of our meetings that began with intensive psychotherapy, nothing in the realm of self–other relations ever seemed to her to be normal – not how she felt at any given time, nor how she perceived others treated her. The mental or physical state she reported (“My mind is racing; I can't focus”; palpitations, difficulty breathing, dissociative episodes) or thoughts (suicidal, persecutory) were always accompanied by the commentary: “It's not normal”/“That's not normal”. The reactions of other people were equally dismissed as not according to a normal standard (“rude”, “stupid”, “ignorant”).

Zoe was not looking to me to explain to her that these self-states and responses from others were indeed normal. Rather, there was an appeal to me to hear (contain) her reactive rages until they spent themselves. Then I would offer an explanation of what I thought she was experiencing – which she would refuse. However, from the perspective of my earlier writing on the types of negation that emerge during development, I viewed refusal as a more advanced form of self-protection than rejection. Refusal is a struggle for one's subjectivity within a relationship, while rejection is a foreclosure of a relationship altogether (Litowitz, 1998, 2011). Thus I considered this step as a good sign and, indeed, Zoe would often later reiterate what I had previously told her but articulated as her own thoughts, even as she continued to refuse my current explanations. I saw this development as Zoe's attempt to use me, not just as a container for her rage, but as a possibly safe object to internalize, albeit on her own timetable. Over time the original rhythm of each session (rage-refusal) appeared less regularly and only under specific stressful conditions, a pattern we could observe together. Gradually, I was able to interpret the present in terms of the past, and we were able to move from psychotherapy to analysis.

During this later interpretative phase, “not normal” remained a frequent response but it was used in new ways. Rather than an impersonal, abstract concept, in contrast to which all her experiences were “not”, normal became personal and specific: “I don't feel normal in groups because I'm shy”; “I just want to be normal and not have to have special help with my work”; “Mrs. X/Mr. Y didn't think I am normal when I couldn't speak up at the meeting.” Accompanying the personal attribution of “not normal” was an acknowledgement of shame, which opened up the possibility to discuss her rages as a response to shameful feelings. Focusing now on specific, personal situations, Zoe recalled many shameful memories, both due to others' treatment of her as well as her remorse for her own behaviors towards others. As she was more in touch with her own feelings and motivations she was more able to interrupt her rages at others with some empathy for what they might be experiencing: perhaps they are not unlike her. She would also often follow up on her more tumultuous sessions with a telephone message of apology or appreciation for me.

As we explored her past experiences it became clear that over the years Zoe had created many layers of fantasy around the concept of ‘normal’, theories that explained why people treated her as they had and why she felt as she did. A common core of these theories was her damaged sense of self: there must be something fundamentally wrong with her. That would explain everything and also keep alive the hope of some remedy. It might still be possible to have “a normal life.”

Zoe had been adopted during the first year of her life into a loving family but she had several developmental difficulties and, subsequently, suffered several wrenching losses (deaths, divorces). Her underlying fantasy was that she had been given up because she was ‘not normal’; adoption itself was a ‘not normal’ family situation, setting her apart from her friends. Disruptions at home and difficulties in school again set her apart from her peers. And so it continued through the years: every experience became a new piece of evidence substantiating the fact of her damage as its cause. Each fantasy was an attempt to defend against that ‘truth’ by: projection (“Something isn't normal but it's them, not me”) and self-sufficiency (“I don't need them”); or aggression (“It's their fault that I'm acting out”) and grandiosity (“They're no match for me – I could destroy them”).

Zoe is not the only patient whom I have seen with an adoption history for whom the concept of ‘normal’ is a dominant theme in their discourse. I would not speculate beyond my own clinical experiences, but the fact of this early loss, even if not consciously recoverable, provides a ready core to which multiple meanings can attach later in life (Nachträglichkeit). For such patients, taking onto oneself the onus of ‘not-normal’ seems a reasonable price to pay for maintaining the illusion that the ‘normal’ mother–child union exists and, with it, the hope of attaining that ideal state.

There are several nosological categories that one might apply to Zoe; and/or several psychodynamic formulations that could be proffered to explain the changes in her internal world as a consequence of a lengthy treatment. For example, a lack of self-cohesion with states of fragmentation that has been replaced by a more cohesive sense of self and better affect regulation; a development from paranoid–schizoid attacks and collapses to the mourning and repairs of the depressive position; traumatically induced dissociated self-with-other ‘not-me’ states that have become more recognized and integrated. With more detailed data one or another might appear most useful, and during the course of treatment these (and other) theoretical formulations were in my mind at different times and guided the forms of my interventions.

However, I never explicitly called attention to the key word or phrase, lest I inhibit its expression (Arnold, 2012, p. 116). I would not, for example, ask the patient for associations to normal as one might with a switch-word since it would be meaningless outside a specific context. Instead, I try to address each underlying fantasy that is operative in a particular context: persecutory, envious, seeking recognition, grandiose, etc. Once I became aware of their repetitive appearances, the changes in their usage were a guide to my understanding the changes in my patient and our relationship.4

Here I only want to stress the utility of listening for key words or phrases of a certain type that serve as entry points to layers of fantasies, whose mutual exploration by patient and therapist can reveal the premises that determine one's theories about oneself, others and the world. The changing usages of the key word/phrase over the course of treatment can serve as indices to shifts taking place in the patient and in the therapeutic process.

“Normal” continues to appear in Zoe's speech, but increasingly as what is usual or expectable for me (or her or him) in this (or that) circumstance. In other words, ‘normal’ is becoming just the syncategoreme that it is, dependent upon a specific context for its meaning.


Fair is a syncategoreme whose meaning varies greatly from one domain of discourse to another. In competitive games, fair means within the rules; in appearance, comely or of light complexion; in weather, pleasant and not stormy; in legal ethics, just and impartial; and so forth. Moreover, every English-speaking child has heard: “Mirror, mirror on the wall, who is the fairest of us all,” and knows that “the fair-haired boy (or girl)” is the chosen, preferred one, regardless of actual complexion or moral standing.

Analytic treatment began for May (a 28 year-old professional) with a worried discussion of what would be a fair fee – fair to the parents who were paying but also fair to me. Although on the surface the question seemed focused on concerns for the other persons involved, the deeper worries were how a decision would reflect on her in the minds of others (parents, siblings, me). Specifically, was she wanting too much; would too much be expected in return; was she getting more than her rightful share; would others be angry or envious of her?

“Is it fair?” “Am I being fair?” “I want to be fair”, “In all fairness”, “To be fair” – these phrases reappeared regularly throughout May's analysis, ready-at-hand to express whichever area of conflict was uppermost in the therapeutic discourse. Initial conflicts over greediness revealed early experiences with an often depleted, overwhelmed mother who had first to be taken care of before demands could be made of her. In a large sibship, competition for what little was emotionally available could be fierce, as could the accompanying guilt over getting and the rage over losing.5 The stormy affects of both excitation and anger that competition for attention from others generated were managed through inhibition (avoidance) and a careful presentation of herself as fair in every way: non-confrontational; rule-observing; bending over backwards to see the other's side; and so forth. In fact, May sought treatment because she wanted to feel more intensely in her relationships, less fearful of and dependent upon others' reactions.

May's relatively organized and successful life would provide ample evidence for a psychodynamic formulation that would surely include neurotic descriptors (e.g. oedipal conflicts and character defenses), noting as well unresolved conflicts with significant early objects on whom she was dependent (e.g. around attachment and affect regulation). In such a case, the stitch-word or phrase serves as indicator of various intrapsychic and interpersonal conflicts and their defensive adaptations, all connected by the shared compromised “fairness”. During the course of May's analysis, each appearance was an opportunity to explore a conflict-defense construction with the patient, as it appeared in the transference and in her life.

I first became aware that fair was not functioning as usual by my countertransference reaction to its repeated appearances. I found myself thinking: “Oh no, not fair again!” I realized that I had thought that fair, as a syncategoreme, must be tied to a specific context; in particular, ones we had already been working through over many months. So, why was it reappearing now in a different context? It was then that I realized that fair was functioning in a different way. It had become freed from specific contexts, an abstract ideal that could hold many different affect states in abeyance. A conflict that might generate an affect – aggression, competitiveness, envy, guilt, anger – which could neither be contained nor expressed, could be managed by invoking an abstract concept of fairness. In fact, as noted above, fairness as a defensive strategy defined her character, much as Reich (1931) described the role of ‘key-words’ in characterological resistances.

As I came to view the reappearance of fair as an index of a new compromise formation, we were able to explore the dynamics of each specific experience. In each case, being fair avoided some unwanted feeling (e.g. envy, jealousy, competition, anger) in the hope of her being special and loved. A sense of superiority (‘the fairest one’) was little consolation, however, as her self-sacrifice and attention to the feelings of others went unappreciated. Over the course of the analysis, May began to acknowledge that even something or someone that is fair could also leave her feeling envious or angry. Whether something was abstractly fair or not became less important as she recalled a specific memory of what had happened and how she felt about what she was experiencing. She could acknowledge that most of the time the situation was complex, her feelings were in conflict, and she was ambivalent about the other persons involved. Ultimately, she could reflect herself on her use of fair, which she picked up on herself, and then fair became almost an inside joke between us:

There's that fair again but when he said that I felt all those old feelings of competition with the other kids. They envied me because they thought I was the favorite but I wasn't and they never paid any attention to how I was feeling, how hard it was for me.

Yet, at the same time, she could acknowledge how she had been more fortunate than others and how they might resent her for it. In other words, fair does not need to be rigidly maintained as an abstract ideal when it no longer functions as a defensive compromise against unacceptable or uncontainable feelings. Nor does maintaining a connection to needed others require suppressing the complexity of feelings towards them under the rubric of fairness. For example, competition can be fair (i.e. playing by the rules) but she can still want to win without her aggression hurting others. As a result, May has become more comfortable in being assertive professionally and in being aggressive in competitive sports, as well as more open and spontaneous in her friendships.

In the several cases in my practice where ‘fair’ has been a stitch-word there has been an actual fair-haired person – sometimes the patient, sometimes not (e.g. parent, analyst, sibling) – whose literal fairness has been a catalyst for the reactions of others, playing a role in meaning-making for the patient. Again, as with adoption, I cannot speculate if this bit of reality is necessary or merely coincidental. It may be that these common words, appearing in everyone's speech, only take on the function of a stitch-word if there is an objective environmental catalyst.


  1. Top of page
  2. Abstract
  3. Discussion
  4. Conclusion
  5. References

In listening to our patients we are attending on many levels: to gaps, omissions, inconsistencies in their narratives that may indicate defensive strategies; or for major conceptual themes (e.g. loss, separation, competition) and affect states (e.g. guilt, excitement). Most often we listen through the surface of language to seek out deeper meanings, guided by our theories. We may not usually attend to syncategoremata, focusing instead on the content words (categoremata) that determine the relevant semantic context. In a sense, therapeutic listening is just a special case of how we listen in general. We routinely listen through the surface to hear the speaker's meaning. In fact, unless we practice to memorize, we do not remember the exact wording of what we hear in each unique utterance. To do otherwise is an indicator of an altered state of consciousness (e.g. acoustic images in dreams) or of pathologies (e.g. echolalia in autism and psychotic speech).

There may be times, however, when the surface of language grabs our attention; as, for example, when we are impressed with a patient's style of speaking. Then we must judge whether clever turns of phrase, harsh pronouncements or equivocations indicate identifications with significant figures or deeper conflicts and defensive strategies. Similarly, our attention might be drawn to particular or unusual metaphors that appear in our patient's speech. In such cases we must evaluate whether the metaphor is simply natural language at work or a compromised expression of a deeper conflict, both revealed and distorted as in a dream image. Comparing types of surface language evidence such as metaphors to stitch-words can illustrate how they differ.

Without reviewing the lengthy arguments put forth concerning what metaphors are (e.g. substitutions, displacements or comparisons) or how metaphors work (e.g. to unite, expand or transform), there is a general consensus that metaphors confer iconicity. That is, a metaphor illustrates an abstract concept by creating a tie to a concrete, physical image, in the way that the image of a trashcan on a computer screen concretizes the concept of deletion. Through the importation of an image of a physical object, the latter concept acquires the immediacy of the former's sensory impact (Buchler, 1955, p. 105). A metaphor combines two conceptual domains: one abstract; the other concrete.

Because of their ability to confer iconicity, metaphors have long been associated with the visual imagery of dreams (Sharpe, 1940) and been explained as rooted in bodily states (Lakoff and Johnson, 1980; Modell, 1997). Metaphors serve as a means of carrying over something perceptual, outside of language – image, affect, bodily experience – into verbal expression, thereby imbuing meaning with a concrete reality. All language is highly metaphoric, especially when extending concepts into new territory. (Two examples in this paper are Freud's evocation of rail-yard images and my use of quilting or upholstery.) For this reason, writers have focused on metaphors that appear during the treatment process as signaling something ineffable or inchoate seeking expression, representing either a defensive compromise or the leading edge of substantive change.6

By contrast to the metaphoric use of language, syncategoremes such as ‘normal’ and ‘fair’ do not, by themselves, evoke a concrete image. They only evoke an image when connected to a specific context (e.g. weather or appearance for ‘fair’). One would not expect to hear reports of a dream-image of either word apart from its instantiation in a specific context that provides the domain of its meaning. Stitch-words do not enhance meaning by combining conceptual domains; nor does the repeated use of these syncategoremes represent a form of identifying with significant speakers in one's environments.

Because syncategoremes are ordinary, common words, it is easy not to notice when they appear as we look through our patients' speech for deeper meanings. Only over time, through repeated usage, one may notice that the word is being used differently – abstractly, indiscriminately across domains; that it actually obscures, rather than enhances, meaning. With the patients described in this paper, it was the absence of meaning in the contexts where it was being used that alerted me to its alternate function: as a defensive strategy. I was then led to explore what that function might be and found that the word served as a connecting link to unconscious fantasies.

Unconscious fantasies are constructed throughout development in response to specific situations: to trauma and distress of overwhelming affects; to conflicts between one's wishes or needs and the environment. These theories about how the world of interpersonal relationships works have been thought but never expressed (Litowitz, 2007). They therefore remain habitually true (i.e. unmarked by tense or aspect) and independent of their original context (ibid.). By using the syncategorematic word as an abstract stitch-word the patient can create a distance from the specific context in which the defensive fantasy arose, including a distance from the overwhelming or conflicted feelings (e.g. aggression, envy, greed, shame). As those fantasies are explored in treatment, episodes in the patient's history are discussed, and the feelings attendant on the original circumstances emerge. Then the syncategoreme no longer serves as a decontextualized, abstract stitch-word. It reverts back to its normal linguistic function: contributing to meaning within a specific semantic/conceptual domain and appropriate to particular circumstances.


  1. Top of page
  2. Abstract
  3. Discussion
  4. Conclusion
  5. References

This paper highlights the continued relevance of attending to the surface of language as it is spoken in therapeutic settings, arguing that the surface may provide cues to conflicts, defenses and compromised fantasies.7 I draw attention to ordinary, common words that may easily be overlooked, whose lack of meaning may only be evident over time as they repeatedly and indiscriminately appear across many contexts. One can then see that this type of word (a syncategoreme), inherently dependent upon a specific conceptual domain for meaning, has become freed from those contexts and used defensively as an abstraction to connect unconscious fantasies and to contain disturbing affect states. As the fantasies are explored in terms of the individual, personal circumstances that gave rise to them in the first place, the syncategoreme returns to its usual linguistic function. That function is to contribute to meaning according to context-dependent situations. In ordinary discourse our background knowledge determines which context is appropriate in any given exchange: are you discussing the weather, games, justice, or complexion? However, for some patients the syncategoreme becomes an abstract concept that connects idiosyncratic, personal meanings across contexts: something is either fair/normal or not, without having to establish a specific context. Freed from the original contexts of each unconscious fantasy, it serves as a stitch across prior contexts whose personal significance can be represented but left unexpressed until explored for the first time in the exchanges between patient and therapist.

  1. 1

    A Lacanian perspective views the point de capiton as an essential developmental step in moving from dyadic to triadic relations, created by the paternal ‘no’ that symbolically anchors words and things, or at least provides the necessary illusion that such an anchoring is possible. The temporary stopping of the signifier's sliding, or glissement, enables the illusion that meaning can be fixed and establishes faith in language, thereby avoiding the constant slippage seen in the psychotic's distrust of language (Fink, 1997, p. 94). One listens for the breaks (hesitations), interruptions (gaps), distortions (parapraxes) in speech as opportunities to punctuate the patient's discourse, revealing underlying structural configurations (Evans, 1996; Fink, 1997).

  2. 2

    The considerable literature on syncategoremes by semioticians, linguists and philosophers is too detailed and technical to review here, but see Eco (1984) and Klima (2006) as examples.

  3. 3

    These illustrations are not intended to represent complete cases or demonstrate clinical process.

  4. 4

    Similarly, as noted, I have found that attending to types of negation used by patients can indicate how the patient is experiencing or using the therapist's interventions (Litowitz, 1998, 2011).

  5. 5

    “It's not fair” is a common retort by children expressing feelings of exclusion and impingement in their interactions with others.

  6. 6

    There is a research tradition of mining the surface of language for deeper or evolving meanings (e.g. Spence and Lugo, 1972). Langs et al. (1993) created a coding system to trace ‘referential activity’, i.e. processes of bringing nonverbal feelings, sensations and memories into verbal expression. Such coding systems have been used to track therapeutic change over the course of treatments (Bucci, 2003; Halfon and Weinstein, 2012); and increased use of metaphors is rated positively.

  7. 7

    It is worth noting that in German Stichwort is defined as ‘key-word’ or, in a theatrical context, as ‘cue’.


  1. Top of page
  2. Abstract
  3. Discussion
  4. Conclusion
  5. References
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