The author focuses on the importance of the body in the analysis of patients with a defect of thinking. In many cases this defect is not fully evident until concrete and bodily aspects begin to emerge in sessions. In the absence of awareness of the body, the patient's personality is deprived of the main source of emotional stimulus, and mental growth is consequently paralysed. Hence the body is considered the starting point of mental processes and a progressive source of experience requiring the exercise of responsibility and thought. To indicate the theoretical background to this essentially clinical paper, some hypotheses about the body-mind link are very briefly considered. Specific emphasis is given to the development of Freud-Klein-Bionian theories about this subject and to some of Ferrari 's recent proposals. The author discusses four clinical cases, emphasizing the encounter with the body in analysis and its integration in emotional and thinking processes. The analyst's function in such cases is conceived mainly as that of midwife for a dialogue between the analysand 's body and mind.

Time is an important source of containment vis-à-vis the pressure of affects and the nondimensional immensity of mental space experienced by difficult patients. A more articulated spatiotemporal integration can be facilitated by the analyst's musical "reverie" during intense emotional exchanges in analytic sessions. This reverie can be visual, olfactory, kinaesthetic, etc., no less than auditory or musical. Music is indeed connected with both the concrete world of bodily sensations and the symbolic expressions of culture, and may be an important transitional phenomenon in analytic communication on both unconscious and conscious levels. Two clinical cases are presented in which the patient's awareness of the passage of time, associated with the analyst's internal musical experiences, made it possible in one case to reduce intense panic attacks and, in the other, to overcome the patient's rigid obsessive defenses, giving him access to fluid and unforeseen emotions. In these two instances of working through, the perception of time helped establish confidence in the creative contribution of the "unheard melodies" (Keats) of affects to the functioning of thought.

The author suggests that the use of mental models and language registers may help an analysis to proceed, especially in psychosis, when the patient has not yet developed a mental space that will allow him/her the functions of knowledge and containment of emotions. Models, according to Bion, are a primitive approach to abstraction and a manifestation of the analyst's reverie that enables him/her to transform sense data into alpha‐elements. Ferrari, in a further development of Bion's theories, hypothesises a relationship between the transference and the internal level of body‐mind communication, and proposes the use of language registers to sustain the psychoanalytic process. The author presents several clinical examples from a thirteen‐year, four‐session‐a‐week analysis of a psychotic analysand who was initially confused, paranoid and altogether unable to bring self‐reflective thought to bear on her overwhelming emotions and had, by the end of the analysis, completely recovered from her psychotic symptoms. The clinical material shows how the technical tools of mental models and language registers helped in the construction of a mental space and spatio‐temporal parameters, permitting the patient to tolerate overwhelming concrete emotions and finally to recognise and work through the emotions of an intense transference.

The author explores some psychoanalytic hypotheses about primitive mental states and their implications for a direct focus on body experience in clinical work. Some aspects of current clinical research about the patient's difficulty in achieving awareness of his emotional life as it emerges from object relations are presented, and this problem is viewed in connection with the relation of the analysand to his own body and to his capacity to pass through the different levels of mental elaboration, from motor discharge to abstraction. Ferrari's theories on the body-mind relationship are discussed and compared with the work of other authors. Ferrari calls the body the Concrete Original Object to indicate that it is the first source, differing from person to person, from which mental phenomena are generated and against which they are constantly measured. A clinical case serves as an illustration of the importance of the perception of the body for the birth of genuine, non-imitative mental activity.

The author presents the analysis of a 23-year-old, obese, psychotic man who was dominated by sensations and unable to work through the different levels of psychic elaboration. He could not discriminate between words and concrete objects or between the perceptual functions of sense organs and the oral-cannibalistic level of instinct. Following the working through of these inabilities, it became possible to understand the patient's use of sensation and to make him aware of his emotions and conflicts. The author's discussion of this material emphasizes the role of the body-mind conflict and how this can be confronted in the analytic relationship. Possible links with neuroscience are also indicated.