Supportive psychotherapy

Supportive psychotherapy is a type of psychotherapy common in most physician-patient interactions and is the method provided to most patients who seek psychiatric help. Physicians use it to determine and improve symptoms and to aid the patient by boosting self-care. In formal therapy, supportive psychotherapy may involve examining actions, emotional response patterns, and relationships. Supportive psychotherapy’s sole purpose is to meet the patient’s needs. However, it only addresses issues that the patient is aware of.

A central element of supportive psychotherapy is the therapeutic alliance. This is the connection the patient feels with the practitioner. It includes the patient’s certainty that the practitioner respects the patient and is helping the patient to meet his or her goals. The practitioner must develop strategies to build this connection. This may entail asking about the patient’s family, discussing changes in the individual’s life, and helping the patient identify and find ways around obstacles to wellness, among other issues and concerns. A good therapeutic alliance is a strong predictor of success in treating many conditions.

Background

Awareness of mental illness is as old as history. The ancient Greeks were the first culture to recognize it as a medical issue. Although they did advocate for treating individuals with mental illness, their medical knowledge was far from accurate and led to treatments such as bloodletting.

The first use of the term psycho-therapeia is attributed to English psychiatrist Walter Cooper Dendy in 1853. About half a century later, Sigmund Freud developed psychoanalysis. His research revealed a great deal about the human mind, including descriptions of the unconscious. Freud believed keeping memories or thoughts in the unconscious resulted in mental illness. He also believed in treating the patient by listening and interpreting the patient’s words. His methods dominated clinical psychology for half a century.

Carl Rogers developed interpersonal therapy during the 1940s. His method involved developing a therapeutic alliance with the patient. He advocated for developing a warm relationship with the patient.

American psychology brought new ideas about treatment to the field in the 1950s. Behavioral psychologists used research from animal psychology in devising treatments. Cognitive-behavioral therapy included a focus on the patient’s feelings and thoughts.

Other types of therapy also were developed. These included guided imagery, which uses mental images and narratives, and psychodrama. By the late 1960s, more than sixty types of psychotherapy were in use. However, traditional psychotherapy was a long process involving many sessions. As managed care insurance plans were introduced, coverage for mental health issues was often limited. Financial concerns drove practitioners to develop shorter forms of psychotherapy that would be effective and offer aid to more people. Supportive psychotherapy fulfilled these requirements.

Overview

One model of supportive psychotherapy is commonly known as the good parent. It was developed by Donald Misch, who outlined the basic strategies of supportive therapy in 2000. In this type of psychotherapy, case formulation, or case conceptualization, is the therapist’s understanding of what is wrong with the client, or more specifically, what needs to be fixed. This allows the therapist to continue to monitor progress and stay on track toward the goal. It also gives the therapist a starting point for seeking more information from the patient. Case conceptualization can change as the therapist learns more about the patient.

To be a good parent, the therapist must understand the parent-child relationship. The therapist does not take on the role of parent, but recognizes that the patient may not be functioning as a mature individual in some areas. These areas may include interpersonal relations, impulse control, or problem solving. To be a good parent, the therapist determines how the patient is functioning in these areas developmentally, evaluating strengths and shortcomings, and offers comfort when appropriate. The therapist may praise, nurture, and validate the patient at times. However, the therapist may also address behaviors in other ways as a parent would, by setting limits or helping the patient develop independence.

Fostering and protecting the therapeutic alliance may be difficult, especially with patients who enter therapy mistrustful or expect instant results. Some patients will quickly give up on a therapist. The good parent role is often beneficial in developing the therapeutic alliance. One effective strategy is to appeal to the healthy aspects of the patient’s personality, such as by agreeing on goals and setting up a plan together.

Transference refers to a patient transferring feelings from a parent or other important person to the therapist. The patient may attribute positive or negative feelings to the therapist. The therapist uses positive transference to help the patient reach the goal of addressing and overcoming the problem.

In holding the patient, the therapist learns when to intervene and when to hold back. These actions again are part of being a good parent. Containing the patient may involve medication or hospitalization, after discussing and explaining these treatments to the patient.

When lending psychic structure, the therapist encourages the patient to borrow the therapist’s ego. The ego is the rational part of the human mind. The therapist helps the patient to think like the therapist.

The therapist helps the patient develop or improve coping skills and defenses. Defense mechanisms include humor, rationalization, and altruism. Coping skills may include going for walks or trying relaxation techniques.

Alexithymia means “no words for mood.” The therapist works to increase a patient’s awareness to help the individual name feelings. Making connections means helping the patient see how events are related to thoughts and feelings.

Raising self-esteem involves helping the patient develop competency. This could include discussing a concern and encouraging the patient to take a step toward addressing it. Preparation may include practice or role playing. Encouraging employment or volunteer activities adds structure to the patient’s life and boosts self-esteem by helping the patient connect with others.

Hopelessness may be caused by inaccurate perceptions. The patient may believe that courses of action are closed to them. The therapist helps the patient see situations in a more positive light.

While classic psychoanalysis seeks the root of problems in the past, supportive psychotherapy is concerned with the present. The therapist wants to learn where the patient is now, in terms of happiness, coping skills, etc., and find ways to achieve the goal of therapy. This involves setting concrete goals, determining steps needed to reach them, and helping the patient take these steps.

Supportive psychotherapists may work with others in the patient’s environment, including working with the family. The therapist may also bring social service agencies aboard or communicate with employers or judicial agencies. This falls into the role of good parent, offering appropriate help when needed.

Bibliography

Battaglia, John. “5 Keys to Good Results with Supportive Psychotherapy.” Current Psychiatry, vol. 6, no. 6, June 2007, pp. 27–34, www.mdedge.com/psychiatry/article/62700/5-keys-good-results-supportive-psychotherapy. Accessed 5 Mar. 2020.

Haggerty, Jim. “History of Psychotherapy.” Psych Central, 14 Jan. 2020, psychcentral.com/lib/history-of-psychotherapy/. Accessed 5 Mar. 2020.

Misch, Donald A. “Basic Strategies of Dynamic Supportive Therapy.” The Journal of Psychotherapy Practice and Research, vol. 9, no. 4, Fall 2000, pp. 173–189, www.ncbi.nlm.nih.gov/pmc/articles/PMC3330607/. Accessed 5 Mar. 2020.

Neuman, Fredric. “Supportive Psychotherapy.” Psychology Today, 2 June 2013, www.psychologytoday.com/us/blog/fighting-fear/201306/supportive-psychotherapy. Accessed 5 Mar. 2020.

Rasmussen, Brian. “The Story of Lucy: Lessons Learned, Lessons Taught.” Smith College Studies in Social Work, vol. 88, no. 3, 2018, pp. 237–249, doi.org/10.1080/00377317.2018.1476642. Accessed 5 Mar. 2020.

Rasmussen, Brian, and David Kealy. “Reflections on Supportive Psychotherapy in the 21st Century.” Journal of Social Work Practice, 30 July 2019, doi.org/10.1080/02650533.2019.1648245. Accessed 5 Mar. 2020.

Rothe, Eugenio M. “Supportive Psychotherapy in Everyday Clinical Practice: It’s Like Riding a Bicycle.” Psychiatric Times, vol. 34, no. 5, 24 May 2017, www.psychiatrictimes.com/psychotherapy/supportive-psychotherapy-everyday-clinical-practice-its-riding-bicycle. Accessed 5 Mar. 2020.

“Supportive Psychotherapy for Medical Students.” University of Nevada, Reno, School of Medicine, med.unr.edu/psychiatry/education/resources/supportive-psychotherapy. Accessed 5 Mar. 2020.