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This paper explores the psychoanalytic thought of Eugenio Gaddini, one of the most original and influential figures in Italian psychoanalysis. A detailed analysis of his writings and the cultural context in which his thought developed reconstructs his reflections on the early phases of mental development, the mind–body relationship, and the clinical implications of his theories. Particular attention is devoted to the concepts of primitive imitation, fantasies in the body, basic mental organisation, and acting out, with which Gaddini contributed to the understanding of the genesis of the Self and the birth of the psyche from the soma. The paper also sheds light on the relationship of Gaddini’s thinking with the psychoanalytic tradition, in particular with Freud, Winnicott, and the anglophone schools, and his innovative approach to psychoanalytic theory and practice. Lastly, the relevance of his ideas to contemporary psychoanalysis is highlighted, especially in the treatment of pathologies characterised by non-represented mental states and psychosomatic disturbances.