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With child psychotherapy as the point of departure, meaning making in therapy may be described in light of the patient's relationship to the psychotherapist as “a meaning bearing other”—that is, someone who allows the possibility of meaningful thoughts and feelings, either through his or her actual communicative presence or as an unconsciously imagined communication partner. Within the theoretical framework of this article, being with a meaning bearing other is regarded as a prerequisite for development of both immediate, playful and reflective understanding of needs, wishes, and affect in self and other. The term meaning bearing other refers to three distinct but often synchronic modes of relatedness. These may be seen as developmental imperatives in both parenting and psychotherapy. The present article is a theoretical and clinical inquiry into the prerequisites for change in relationally oriented psychoanalytic psychotherapy. The article discusses what might be seen as basic forms of relatedness and interaction in light of Winnicott's developmental approach, relational and neo-Kleinian approaches within psychoanalysis, and also Heidegger and Gadamer's philosophy of meaning and interaction. The theoretical points of view are illuminated and illustrated through an excerpt from the first session from a twice-a-week psychotherapy with a 5-year old boy.