Psychoanalytic Theory & Approaches

History of American Psychoanalytic Theory

Psychoanalysis became established in America 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, "modern Freudians", 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. Many psychoanalysts believe that the human experience can be best accounted for by an integration of these perspectives.

Whatever theoretical perspective a psychoanalyst employs, the fundamentals of psychoanalysis are always present—an understanding of transference, an interest in the unconscious, and the centrality of the psychoanalyst-patient relationship in the healing process.

Attachment Theory

The term "attachment" is used to describe the affective (feeling-based) bond that develops between an infant and a primary caregiver. The quality of attachment evolves over time as the infant interacts with his caregiver and 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:

  •  Proximity Maintenance: wanting to be physically close to the caregiver
  •  Separation Distress: more widely known as "separation anxiety"
  • Safe Haven: retreating to the caregiver when the infant senses danger or feels anxious
  • 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 the brain is developing at exponential rates informs the quality of relationships throughout 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.


Transference is a concept that refers to our natural tendency to respond to certain situations in unique, predetermined ways--predetermined by much earlier, formative experiences usually within the context of the primary attachment relationship. These patterns, deeply ingrained, arise sometimes unexpectedly and unhelpfully--in psychoanalysis, we would say that old reactions constitute the core of a person's problem, and that he or she needs to understand them well in order to be able to make more useful choices. Transference is what is transferred to new situations from previous situations.

As a result, a person’s relationship to lovers and friends, as well as any other relationship, including his psychoanalyst, includes elements from his or her earliest relationships. Freud coined the word "transference" to refer to this ubiquitous psychological phenomenon, and it remains one of the most powerful explanatory tools in psychoanalysis today—both in the clinical setting and when psychoanalysts use their theory to explain human behavior.

Transference describes the tendency for a person to base some perceptions and expectations in present day relationships on his or her earlier attachments, especially to parents, siblings, and significant others. Because of transference, we do not see others entirely objectively but rather "transfer" onto them qualities of other important figures from our earlier life. Thus transference leads to distortions in interpersonal relationships, as well as nuances of intensity and fantasy.

The psychoanalytic treatment setting is designed to magnify transference phenomena so that they can be examined and untangled from present day relationships. In a sense, the psychoanalyst and patient create a relationship where all the patient’s transference experiences are brought into the psychoanalytic setting and can be understood. These experiences can range from a fear of abandonment to anger at not being given to fear of being smothered and feelings of  

One common type of transference is the idealizing transference.  We have the tendency to look towards doctors, priests, rabbis, and politicians in a particular way—we elevate them but expect more of them than mere humans.  Psychoanalysts have a theory to explain why we become so enraged when admired figures let us down.

The concept of transference has become as ubiquitous in our culture as it is in our psyches.  Often, references to transference phenomenon don’t acknowledge their foundation in psychoanalysis.  But this explanatory concept is constantly in use. 

For example, in season three of the television series Madmen, one of the female leads is romantically drawn to a significantly older man just after her father dies. She sees him as extraordinarily competent and steady.

Some types of coaching and self-help techniques use transference in a manipulative way, though not necessarily negatively.  Instead of self-understanding, which is the goal of psychoanalysis, many short term treatments achieve powerful reactions in clients by making use of the leader as a powerful, charismatic “transference" figure—a guru who readily accepts the elevation transference provides, and uses it to prescribe or influence behavior.  Essentially, this person accepts the transference as omnipotent parent and uses this power to tell the client what to do.  Often the results obtained are short lived.


Along with transference, resistance is one of the two cornerstones of psychoanalysis. As uncomfortable thoughts and feelings begin to get close to the surface--that is, become conscious--a patient will automatically resist the self-exploration that would bring them fully into the open, because of the discomfort associated with these powerful emotional states that are not registered as memories, but experienced as fully contemporary—transferences. The patient is thus experiencing life at too great an intensity because he or she is burdened by transferences or painful emotions derived from another source, and must use various defenses (resistances) to avoid their full emotional intensity.

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 threatening 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.

Psychoanalysts consider resistance to be one of their most powerful tools, as it acts like a metal detector, signaling the presence of buried material.


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.

Fortunately, the need for trauma survivors to have treatment is now well understood in the broader mental health community.  Certain medications are helpful in the treatment of trauma, but there should always be a psychological component to the treatment, and it must be understood that treatment can be needed years after the trauma is experienced.

Psychoanalysts did much of the early work in treating trauma, from shell shock of WWI, War Neurosis of WWII, Post Vietnam Syndrome of the Viet Nam war, and now Post Traumatic Stress Disorder (PTSD).  Treatment of PTSD still contains elements that harken back to psychoanalysis—trauma patients need a witness to their pain, who helps them, bit by bit, incorporate the traumatic experience with the rest of the story of their lives in some way that can make sense.  Facing unbearable feelings with another human being, and supporting and employing the ego-the part of the mind responsible for decision making, understanding cause and effect, and discrimination—all these techniques owe their roots to psychoanalysis.