Contributions of Psychoanalysis

Psychoanalysis has made many contributions to the development of other psychotherapies, but in particular its understanding of attachment theory, transference, resistance and trauma have been studied by many other mental health professionals and incorporated in their own theories and practices.

Attachment Theory
The term “attachment” is used to describe the affective bond that develops between an infant and a primary caregiver. The quality of attachment evolves over time as the infant interacts with his caregiver. The attachment status is determined partly by the caregiver’s state-of-mind toward the infant and his needs. The father of attachment theory, John Bowlby, M.D., believed that attachment bonds between infants and caregivers have four defining features:

1. Proximity Maintenance: wanting to be physically close to the caregiver

2. Separation Distress: more widely known as “separation anxiety”

3. Safe Haven: retreating to the caregiver when the infant senses danger or feels anxious

4. Secure Base: exploration of the world knowing that the caregiver will protect the infant from danger.

The quality of a child’s attachment during the formative years when her brain is developing at exponential rates informs the quality of her relationships throughout her life. It is important to note that attachment is not a one-way street. As the caregiver affects the child, the child also affects the caregiver. In a psychoanalytic treatment setting, the patient’s journey towards self-discovery can mimic the attachment theory features presented by infants, with the analyst representing the caregiver.

"Attachment theory is critically important to understanding what happens to people, what their issues are, and why some people seem unreachable psychologically while others are accessible. With the goal of enabling attachment for the children of young mothers, we developed the Cradles to Classroom project, which provided childcare, healthcare, tutoring, and mentoring to every pregnant teen and teen mother in the Chicago School District. Attachment theory could be used as the scientific backbone of significant public policy advancements in providing maternal and child mental health support in the United States.”
Carl C. Bell, M.D., President/C.E.O. Community Mental Health Council and Professor of Psychiatry and Public Health, University of Illinois at Chicago.

Transference
Transference is a universal psychological phenomenon in which a person’s relation to another person has elements which are similar to and/or are based on his or her earlier attachments, especially to parents, siblings, and significant others. In other words, a patient’s relationship to lovers and friends, as well as any other relationship, including analyst, includes elements from his or her earliest relationships.

As in any other relationship, the patient sees the analyst not only objectively but imputes qualities to the analyst which are based on qualities of other important figures in his or her earlier life. In real relationships, the other person gratifies or rejects, demands gratification or provokes rejection; both parties may mutually gratify or mutually reject. In the analytic relationship, the analyst attempts to be “neutral.” The analyst attempts to limit gratifications of the patient’s desires and attempts to control his or her own counter-reactions (and tries to understand his or her own countertransferences) to the patient’s attempts to provoke gratification or rejection.

In a typical analytic situation, the analyst does not react in kind when a patient disparages him, for example, nor counter-reject the patient when the patient leaves him for a long hiatus. Instead the analyst tries to help the patient understand why the patient disparages and attempts to reject the analyst (as well as demonstrating to the patient the similarity between his reactions to the analyst and to other situations, where such a pattern occurred). The analyst’s neutrality allows the patient to observe the parallels between the reactions to the analyst with the reactions to others in his or her life. Subsequently patient and analyst are able to understand the origins of the difficulties in the earliest experiences in childhood.

Resistance
Resistance is one of the two cornerstones of psychoanalysis. (See also transference.) As uncomfortable thoughts and feelings begin to get close to the surface--that is, become conscious--a patient may resist the self-exploration that would bring them fully into the open.

These resistances can take the form of suddenly changing the topic, falling into silence, or trying to discontinue the treatment altogether. To the analyst, such behaviors would signal the possibility that a patient is unconsciously trying to avoid theatening thoughts and feelings, and the analyst would then encourage the patient to consider what these thoughts and feelings might be and how they continue to exert an important influence on the patient’s psychological life.

As the analysis progresses, patients may begin to feel less threatened and more capable of facing the painful things that first led them to analysis. In other words, they may begin to overcome their resistance.

Trauma
Trauma is a severe shock to the system. Sometimes the system that’s shocked is physical; the trauma is a bodily injury. Sometimes the system is psychical; the trauma is a deep emotional blow or wound (which itself might be connected to a physical trauma). It’s the aftereffects of the psychical trauma that psychoanalysis can attempt to counteract.

While many emotional wounds take a while to resolve, a psychic trauma may continue to linger. When the stimulus is powerful enough--a death, for instance, or an accident--the psyche isn’t able to respond sufficiently through regular emotional channels such as mourning or anger.

Often this lack of resolution can foster a repetition compulsion--a chronic re-visiting of the trauma through rumination or dreams, or an impulse to place oneself in other traumatic situations. Psychoanalysis can help the victim to develop emotional and behavioral strategies to deal with the trauma.

History of American Psychoanalytic Theory
Psychoanalysis became established in America sometime between World War I and World War II, when Americans traveled to Europe to take advantage of psychoanalytic training opportunities there. The single major therapeutic perspective that was transplanted to the United States was ego psychology, based centrally on Sigmund Freud’s The Ego and the Id (1923) and The Problem of Anxiety (1936), followed by Anna Freud’s Ego and the Mechanisms of Defense (1936) and Heinz Hartmann’s Psychoanalysis and the Problem of Adaptation (1939). This perspective of psychoanalysis was dominant in America for approximately a 50-year span until the 1970s. Meanwhile, in Europe, various theoretical approaches had been developed.

In 1971, Heinz Kohut’s book, The Psychology of the Self, inaugurated a new theoretical perspective in American psychoanalysis. Soon after, Margaret Mahler’s developmental approach was espoused by some, and a growing diversification in therapeutic approaches in the American schools of psychoanalysis began.

Current Psychoanalytic Treatment Approaches
Today, the ego psychology that was dominant in American psychoanalytic thought for so many years has been significantly modified and is also currently strongly influenced by the developing relational point of view. The diverse schools of therapeutic approach currently operative in America include influences from British object relationists, the theories of Klein and Bion, self-psychology, the Lacanians, and more. Truly, a kaleidoscope of approaches is now available at psychoanalytic institutions in the United States. Some psychoanalysts believe that the human experience can be best accounted for by an integration of these perspectives.