Journal of the American

Psychoanalytic Association
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The Clinical Implications of an Integrative Theory: Commentary On

Fonagy and Target
Peter B. Dunn
J Am Psychoanal Assoc 2007; 55; 479
DOI: 10.1177/00030651070550020201

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jap a

Peter B. Dunn 55/2

THE CLINICAL IMPLICATIONS

OF AN INTEGRATIVE THEORY:
COMMENTARY ON FONAGY
AND TARGET

W hile psychoanalysis had been evolving (or devolving) into a

psychology with multiple competing models of the mind, there
has been a counterbalancing movement toward theoretical integration.
“The Rooting of the Mind in the Body: New Links between Attachment
Theory and Psychoanalytic Thought” by Peter Fonagy and Mary Target
is a contribution to this movement. They carefully delineate a theory
to provide attachment theory and psychoanalysis a common theo-
retical base consistent with contemporary neuroscience and cognitive
psychology. Such a theory would, in Fonagy and Target’s view, further a
mutually beneficial rapprochement. As Bertram Lewin once said, “There
is nothing as practical as a good theory.” With this in mind, I will assess
the utility of Fonagy and Target’s integrative theory by considering its
practical, or technical, implications.
Fonagy and Target’s theory is highly abstract, detailed, and, to the
extent that it draws from the linguistic theories of Ivan Fónagy on ges-
tural language, it is bold and speculative. Their theory of the embedded
mind posits that the mind is organized around a series of core concepts
and representations, which arise from the child’s sensorimotor, emo-
tional, and enacted experiences with primary objects. As children
develop the capacity to abstract, they infuse these concepts and repre-
sentations with meaning by drawing metaphorical comparisons
between abstractions (such as the concept of a mother) and sets of men-
tal images drawn from experiences with the primary objects. While
Fonagy and Target derive these aspects of their theory from the work of
the linguist George Lakoff, the core assumption that thought is rooted

Director of Clinical Services, New York Psychoanalytic Institute and Society.

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 Pe t e r B . D u n n

in body-based experience is also basic to Freud’s theory of thought,

while the emphasis on the centrality of metaphor is consistent with
the conclusions of later analytic contributors such as Arlow.1 The theory
moves beyond past contributions when Fonagy and Target explain
the ontogenetic origin of language and the sources of the particular
metaphorical links between core concepts and core infantile experi-
ences by applying Ivan Fónagy’s linguistic theory of gestural language.
The theory of a gestural protolanguage has its own long and interest-
ing history—Darwin, for example, believed that words arose phylo-
genetically from gestures—but it is unfamiliar to most analysts and the
authors’ elaboration and application of it are original. In the view of
the authors, language begins when the child develops the capacity to
form microgestures with tongue, mouth, and larynx, which mimic and
are isomorphic to the bodily gestures that were the earlier mode of
communication. The child abandons this mode of protospeech upon
learning the culture’s common language, but the gestural language
remains stored in procedural memory and shapes the person’s dis-
tinct pattern of speech and language through the idiosyncratic use of
480
words, syntax, prosody, and phonation. While the person communicates
primarily through the culture’s formal grammar and lexicon, the deriva-
tives of gestural language continue to serve as a secondary channel
of communication conveying what is nonconscious and, later, what is
excluded from consciousness for reasons of conflict. This gestural
language is seen as the first linkage of concrete experiences with proto-
abstractions (the early sound language) and is proposed as the source
of the metaphors that organize the mind.
Fonagy and Target’s theory would appear to have a great deal
to of fer attachment theorists. It revises the internal working model
to conform to contemporary cognitive psychology, the discipline that
underlies the representational dimension of attachment theory. Just as
important, it adds to attachment theory the dimension of the body, of
particular relevance to a theory that began as a branch of biology yet
has had no place in its theory for the influence of the body on the mind.
For attachment researchers, Fonagy and Target’s theory of gestural lan-
guage is also appealing because it further develops the understanding

1“Metaphor can be understood . . . as a fundamental aspect of how human thought

integrates experience and organizes reality. [It] is an inherent quality of language in
general and of how the human mind integrates the experiences of the individual”
(Arlow l979, p. 367).

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 COMMENTARY ON FONAGY AND TARGET

that Fonagy and Target and their coworkers have offered in earlier work
to address the puzzle of why the narrative style of the mother cor-
relates so closely with the attachment style of her offspring. The further
elucidation that emerges from the present paper is that the mother’s
narrative style correlates how she communicates through gesture, since
verbal language grows out of bodily gestures. That is, her narrative style
is consistent with and reinforces her manner of caressing, cuddling,
grooming, and playing with her child and as the child grows older the
use of language becomes her way of holding her child at a distance.
However, while Fonagy and Target’s theory widens the purview of
attachment theory, it narrows the perspective of psychoanalysis by
privileging the role of attachment relationships in mental life. To the
extent that Fonagy and Target elaborate an overall model of the mind
from the security dimension of the mother-infant relationship, the
effect is an inverted explanatory pyramid in which a vast superstruc-
ture of theory is supported by a small set of observational data. Thought
and language at its core are seen here as memorializing and represent-
ing the early attachment relationship. Later phases of development, later
481
developmental transformations, and motives such as sex, aggression,
narcissistic integrity, strivings for individuation, and so on are not given
weight.2 The provocatively speculative idea of gestural language is
circumscribed in its application to early attachment relationships and
not extended to illuminate the way the child might come later to repre-
sent, in a quasi-visual fashion, the sexual and aggressive fantasies of
the self in kinesic interaction with objects. In addition to narrowing the
content of analysis, the stress in Fonagy and Target’s theory on proce-
dural memory has the potential to skew technique. What is central here
is that the nonconscious, which is presumed to play such a prominent
role in storing attachment styles and basic cognitive structures, influ-
ences the patient’s actions but cannot be translated directly into con-
sciousness through analysis or any other method (Davis 2001). I would
hazard a guess that a theory that stresses the nondynamic unconscious

2 Compare Fonagy and Target’s perspective to the view of Blatt and Blass (1996),
who discuss the identical issues addressed by Fonagy and Target but do not privilege
the attachment dimension: “Both attachment and psychoanalytic object relations the-
orists have increasingly recognized that the infant does not internalize a static image
or representation of the self and of the other, or actual attachment related transactions,
but the infant internalizes constructions of various dimensions of the affectively
charged relationship between self and other that are established around fundamental
experiences of gratification and frustration in caring relationship.”

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 Pe t e r B . D u n n

will, in hands less sophisticated than Fonagy and Target’s, tend to dis-
courage the use of dynamic interpretation, and to encourage early recourse
to preoedipal reconstruction (informed by developmental research) and
the offering of feedback about aspects of the patient’s attachment. Patients
would be presumed to be as unaware of this behavior as of their style
of walking. There is then much in this theory that would revise “standard
technique” to more closely resemble the technique of the attachment
therapies, both in the stress on attachment per se and in the deemphasis
of the importance of the dynamic interpretation of the transference and
the recovery of warded-off thoughts, feelings, and memories.
Where the clinical strength of Fonagy and Target’s theory lies is
in its approach to attachment needs that are clearly dynamically un-
conscious or preconscious but that influence the manifest language
content of an analytic session. In particular, Fonagy and Target explicate
how mental contents become proxies for objects. The patient then ex-
presses latent attachment wishes and fears, by clinging to or rejecting
particular words, ideas, memories, beliefs, scientific theories, or other
symbolic contents. In this way the person is able to internally evoke
482
and to communicate to others a deep bodily sensation of a secure attach-
ment, a painful sense of isolation and loss, a desperate seeking for a
secure base, or a need to remain gloriously isolated by derogating at-
tachments—while all the while warding of f knowledge of all that is
being felt and communicated. A partial listing of the ways that Fonagy
and Target convincingly demonstrate that these themes enter into the
manifest language of a session would include choice of metaphor
(“I can’t grasp what you’re saying”), metaphoric mental actions (tightly
holding on to old and no longer adaptive beliefs in the face of a felt
threat to security), sentence structure (words may be omitted and the
analyst invited to fill them in), narrative form (as when one idea does
not relate to the next), particular characteristics of cognition (a compul-
sive need to integrate contrary ideas), idiosyncratic use of words, and
subliminal communications encoded in the paraverbal elements of
speech (exaggerating the affect associated with a reported misfortune).
Fonagy and Target do not discuss the technical question of how one
analyzes the symbolic expression in the manifest content of latent
attachment needs, but it is clear that they can be analyzed as one would
analyze an element in a dream. As a clinical example of this I will briefly
describe a first consultation with a seventy-seven-year-old woman,
recently widowed and referred by her neurologist for hysterical memory

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 COMMENTARY ON FONAGY AND TARGET

loss. In the consultation the complaint of memory loss emerged as the

manifest symbolic expression of her sense of object loss. The painful
life experiences that lay behind her subjective sense of memory loss
came to be understood through her particular manipulation of lan-
guage—the choice of a word (“disparate,” pronounced as “dis-spirit”),
simile (“memories like confetti”), and a metaphor (“thoughts not
hanging together”)—as well as through her desperate need to cling
to the familiar that emerged later as the source of her difficulty accept-
ing interpretations.

Mrs. B began the consultation with the words “I seem to have lost
my memories.” She went on to say that she had memories but they
were disparate. I was struck by her choice of such an uncommon word
and her doleful pronunciation, and I asked her why it was apt. She said
that her memories were sad and also separated from one another. As
she reflected on this she added that her early life was marked by fre-
quent moves. No sooner had she gotten used to one place than she was
moved to another, losing all her friends. Perhaps her memories were
separated, I said, because her life had been little islands of separated
experiences. She went on, “My memories are like confetti.” Why con- 483
fetti? Isn’t that a happy image? She remembers a day from her child-
hood: The Nazis marched into Austria. Then the streets were strewn
with confetti. Soon after, each member of the family was sent to a
separate concentration camp. I pointed out that confetti referred to
something once whole and now shredded into isolated little scraps
and no longer part of a cohesive fabric. That is what she must have felt
happened to her life as a little girl and now again when she’s lost her
married life. Later in the session she returned to her presenting symptom
saying, “My thoughts don’t hang together.” Why hang together? She had
witnessed a family being hanged during the war. Her fears then were less
that she would be killed but more that she would die apart from her mother
and father. Now that her husband had died first, her long ago fears of
having no one special person to comfort her in the face of her fears had
come back to haunt her.

Fonagy and Target have not succeeded in demonstrating that their

theory of embodied mind is broad enough in scope or sufficiently psy-
chodynamic to be a clinically useful, comprehensive model of the mind
for psychoanalysis. However, they have demonstrated that their daring
and original application of Ivan Fónagy’s theory of gestural language is
of great utility in explaining how latent attachment themes appear in the
manifest language of a session. They have also presented a revision of
attachment theory that, if adopted, would bring the two disciplines into

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 Pe t e r B . D u n n

close alignment. And that is the specific attachment relationship they

aim to foster in their paper.

REFERENCES

A RLOW, J.A. (1979). Metaphor and the psychoanalytic situation. Psycho-

analytic Quarterly 47:363–385.
B LATT, S.J., & B LASS , R.B. (1996). Interpersonal relatedness and self-
definition: Two basic dimensions in personality: Development and psycho-
pathology. In Development and Vulnerabilities in Close Relationships,
ed. G.G. Noam & K.W. Fischer. Hillsdale, NJ: Erlbaum, pp. 309–338.
D AVIS , J.T. (2001). Revising psychoanalytic interpretations of the past: An
examination of declarative and non-declarative memory processes.
International Journal of Psychoanalysis 82:449–462.

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