For Santostefano the first 2 years of life are critical in terms of how the relationship between infant and caregiver (mothering object) affects organizational issues of self. In this vein he integrates the approaches of Jean Piaget, Daniel Stern, Louis Sander, Beatrice Beebe, and Frank Lachmann and places "at the center meanings (representations) in infant constructs from experiences." As these "embodied schemas are gradually translated into symbolic forms" they are extended into and influence schemas that develop in childhood and beyond. The toddler’s schemata eventually become "life metaphors" for the developing self. Therapy is directed at revising a child’s rigid life metaphors, rigid cognitive functions, and rigid modalities "so that what a child does, imagines, and says become interrelated." The main catalysts of change are identified as cycles of dialectical interactions, enactments, idealization, and internalization. "Promoting flexibility in meanings, cognitive functioning, and modes of expression, then, is the focus of the treatment process." Verbalization is not the primary vehicle for change because many of the meanings a child gives to experience are preverbal and embedded in the process of interaction. In this sense the therapist becomes an "active participant" in the therapy in much the same way that adult theorists talk about the bipersonal field and the intersubjectivity of the transference.