From switch-words to stitch-words

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.