This article examines the analytic environment in which psychoanalytic work occurs when patients struggle with complex somatic experiences, such as disease or physiological dysfunction. Patients express fantasies and beliefs about the etiology of their somatic experiences; they elaborate theories about why infertility, irritable bowel disease, or some other disease, syndrome, or crisis is happening to them. I consider these to be patients' multiply determined, fantasy-saturated psychosomatic theories, and suggest that the analyst's understanding of patients' ideas about their somatic experiences is organized by the analyst's both articulated and not articulated psychosomatic theories. Using brief clinical vignettes, I highlight the potentially constricting effect of clinicians' theories on their analyses of patients' psychosomatic theories. I examine psychoanalytic theories of psychosomatics, suggesting that adherence to the theories we have, which often posit linear psychogenesis of somatic phenomena, can result in collusion with, rather than analysis of, the psychic stances reflected by patients' theories. To address the problematic adherence to our theories, and characterize a less constricting clinical and theoretical stance, I critique aspects of the theories and suggest directions for replenishing them.

It is well established that postnatally, maternal psychopathology greatly increases a child's risk for emotional disorders. This article addresses the formative phase that precedes the mother–infant mutually regulating dyad. Biopsychological data presented here suggest that women's affective states during pregnancy—specifically depression, anxiety, and elevated life‐stress—are associated with subtle alterations in the neurobiological substrate of the fetus' emerging affect regulation system. The article moves to a general discussion of the emotional experience of pregnancy, and to the use of psychodynamic psychotherapy when problematic aspects of women's representational world lead to negative or dysregulated affect. Two case vignettes are presented: one described in brief and the other in greater detail. This kind of therapeutic intervention aims to achieve mood improvement, address women's emerging relationship with her baby, and potentially, influence the course of fetal development. Winnicott (1960) said there is no such thing as a baby alone; all the more so during pregnancy.

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