The Psychodynamics and Psychotherapy of Depression: Contrasting the Self-Psychological and the Classical Psychoanalytic Approaches

Kohut's work, with its unique perspective on aggression and transference, laid the groundwork for the application of self psychology to the treatment of depression. In the classical analytic approach to the depressed patient, the expression of intense negative thoughts and feelings, especially those in relation to the therapist, were encouraged. They were seen as the result of a predictable collapse of depressed patients' idealizing transference tendencies, resultanting in experiences of rage and despair. Classical analysts felt that repetitive working through of these states of rage and despair would be therapeutic (Jacobson, 1954, 1971).

In contrast, Kohut advocated the reestablishment of patients' idealizing transference and found he could do so by empathically addressing a patient's inner experience of hurt and injury resulting from disappointment in either the therapy or the therapist's behavior (Hall, 1985; Goldberg, 1978). Despair and rage in treatment came to be seen as unwelcomed consequences of the rupture of idealizing transference.

In the traditional psychoanalytic approach, the main dynamic in depression is deemed to be rage at a lost object that has been withdrawn from that object and directed against the patient's ego (). Hence classical analytic treatment was geared toward mobilization and outward direction of this rage, toward the therapist.

However, Kohut saw the rages of depressed patients very differently; to him they were disintegration products resulting from fragmentations in the patient's sense of self. In contrast to the view that transference resulted solely from a revival of the feeling tone of past conflicted relationships, Kohut recognized that there was an aspect of transference which could, in itself, also serve the critically important function of activating internalized self-representations associated with feelings of cohesion and integration. The term self-object transference conveys the functional aspect of transference.