Anna Freud’s recognition of the complex interactions between endowment and maturation, innate structuralization and environmental influences, have had a profound influence on the development of policies and programs in the United States that attempt to improve the adverse conditions, strengthen the tenuous maternal ties, and reduce the potential for behavioral problems and intrapsychic distress in certain high-risk families. This paper describes and provides a case illustration of the application of Ms. Freud’s psychoanalytic theories to the Yale Family Preservation and Support Programs. It reviews and comments on national policies regarding the risks and benefits of family preservation and child placement, identifies a paradigmatic shift in the provision of mental health care, and cautions against overconfidence in our ability to intervene effectively.