Psychoanalysis is often taught as if it were a single language—one grammar (drive), one engine (conflict), one royal road (interpretation). But contemporary applied psychoanalytic practice is defined by a different reality: we work with multiple metapsychologies at once. Not because theory is fashionable, but because patients arrive with different kinds of suffering—different forms of psychic organization—and the clinic forces us to choose, moment by moment, what counts as an intervention, what counts as data, and what we mean by change.
Psychoanalysis' centers of gravity
A useful map begins with four major “centers of gravity” that structure applied work today: conflict, deficit, trauma, and relational field. These are not schools to pledge allegiance to; they are lenses that alter what we see, what we privilege, and what we risk missing.
In a conflict metapsychology, symptoms are compromises: desire collides with prohibition, love with hatred, autonomy with dependence. The therapist listens for latent meaning, defensive operations, and the return of the repressed. Technique favors interpretation—especially of defenses and transference—timed to loosen rigid compromise formations. Change is often conceived as increased insight, affect tolerance, and a reorganization of defensive and superego economies.
In a deficit (or structural) metapsychology, pathology is less a battle than a lack: failures in psychic structure, symbolization, or self-cohesion. The clinic emphasizes functions—regulation, self-soothing, capacity for play—rather than the uncovering of forbidden wishes. Here “neutrality” can become a misattunement if the patient’s core struggle is disintegration rather than guilt. Technique leans toward provision: reliable holding, empathic attunement, and carefully dosed frustration that builds structure rather than breaks it. Change looks like sturdier self-experience and expanded capacity for relatedness and meaning.
In trauma metapsychologies, the problem is not primarily repression but excess—experience that could not be metabolized and returns as intrusion, dissociation, or somaticized affect. The analytic task becomes pacing and containment so that symbolization can occur without retraumatization. Interpretation still matters, but often later; early work may involve stabilizing arousal, tracking state shifts, and constructing dual awareness (living in the room while remembering what overwhelms). Change is measured by integration: a widening of the window of tolerance and a decrease in dissociative necessity.
Finally, relational metapsychology treats the analytic situation itself as the field where meaning is generated. The focus shifts from “what is inside” to “what happens between,” including enactment, mutual influence, and the ethics of recognition. The therapist’s subjectivity is not noise but instrument—handled with discipline. Change is not only insight but new relational experience: rupture and repair, the emergence of thirdness, the patient’s ability to sustain complexity without retreating into defensive certainty.
Applied psychoanalysis becomes contemporary when we stop asking “Which theory is true?” and start asking, clinically: What kind of suffering is this? What does my patient need from the frame right now—interpretation, holding, pacing, recognition? The art is not eclecticism. It is disciplined switching: holding multiple metapsychologies in mind while choosing one intervention that fits the psychic moment.
Back to: Contemporary Theories in Applied Psychoanalysis
