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Chapter 32. Supportive Psychotherapy

Arnold Winston, M.D.
DOI: 10.1176/appi.books.9781585623402.302396

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Supportive psychotherapy is a broadly defined approach with wide applicability and is the most extensively practiced form of individual psychotherapy. In fact, research studies agree with clinical observations that supportive psychotherapy is effective for a broad range of conditions and may be as efficacious as expressive psychotherapy (Conte 1994; Hellerstein et al. 1998; Winston and Winston 2002).

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FIGURE 32–1. The psychopathology–psychotherapy continuum.
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TABLE 32–1. Theoretical approaches
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TABLE 32–2. Traditional selection criteria for impaired patients
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TABLE 32–3. Traditional selection criteria for patients in crisis
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TABLE 32–4. Strategies
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TABLE 32–5. Types of case formulation
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TABLE 32–6. Components of the structural approach
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TABLE 32–7. Goals
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TABLE 32–8. Interventions
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TABLE 32–9. The patient–therapist relationship
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TABLE 32–10. Crisis interventions
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Supportive therapy can be defined as a treatment that uses direct measures to ameliorate symptoms and to maintain, restore, or improve self-esteem, ego functions, and adaptive skills.

Psychoanalytic theory is generally viewed as the basis for supportive psychotherapy.

Matching psychotherapy technique to patient locus on the psychopathology continuum is of crucial importance.

There are few circumstances in which supportive psychotherapy is contraindicated. In general, supportive psychotherapy is contraindicated only when psychotherapy itself is contraindicated (e.g., in deliria, drug intoxication, late stages of dementia, malingering, or psychopathy).

Major strategies include strengthening defenses, maintaining and repairing the therapeutic alliance, enhancing self-esteem, and using therapeutic modeling and self-disclosure.

Major interventions include use of a conversational communication style, praise, reassurance, encouragement, advice, rationalizing, reframing, rehearsal, clarification, and confrontation.

Supportive psychotherapy focuses on the real relationship and less so on transference.

A supportive relationship is not supportive psychotherapy.

Clinical trials indicate that supportive psychotherapy is efficacious for many psychiatric disorders.

References

Alstrom JE, Nordlund CL, Persson G, et al: Effects of four treatment methods on social phobia patients not suitable for insight-oriented psychotherapy. Acta Psychiatr Scand 70:1–17, 1984
[PubMed]
 
Alter CL: Palliative and supportive care of patients with pancreatic cancer. Semin Oncol 23:229–240, 1996
[PubMed]
 
Barlow D, Craske M: Mastery of Your Anxiety and Panic. Albany, NY, Center for Stress and Anxiety Disorders, State University of New York, 1989
 
Beck AT, Sokol K, Clark DA, et al: A crossover study of focused cognitive therapy for panic disorders. Am J Psychiatry 149:778–783, 1992
[PubMed]
 
Bellak L: The schizophrenic syndrome: a further elaboration of the unified theory of schizophrenia, in Schizophrenia: A Review of the Syndrome. Edited by Bellak L. New York, Logos, 1958, pp 3–63
 
Benton MK, Schroeder HE: Social skills training with schizophrenics: a meta-analytic evaluation. J Consult Clin Psychol 58:741–747, 1990
[PubMed]
 
Beres D: Ego deviation and the concept of schizophrenia, in The Psychoanalytic Study of the Child, Vol 11. New York, International Universities Press, 1956, pp 164–235
 
Bond M, Banon E, Grenier M: Differential effects of interventions on the therapeutic alliance with patients with personality disorders. J Psychother Pract Res 7:301–318, 1998
[PubMed]
 
Bordin ES: The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research, and Practice 16:252–260, 1979
 
Bowlby J: Attachment and Loss, Vol 1: Attachment. New York, Basic Books, 1969
 
Bowlby J: A Secure Base. New York, Basic Books, 1988
 
Bronheim HE, Fulop G, Kunkel EJ, et al: The Academy of Psychosomatic Medicine practice guidelines for psychiatric consultation in the general medical setting. The Academy of Psychosomatic Medicine. Psychosomatics 39:S8–S30, 1998
 
Buckley P: Supportive therapy: a neglected treatment. Psychiatr Ann 16:515–521, 1986
 
Caplan G: An Approach to Community Mental Health. New York, Grune & Stratton, 1961
 
Classen C, Butler LD, Koopman, C, et al: Supportive expressive group therapy and distress in patients with metastatic breast cancer: a randomized clinical intervention trial. Arch Gen Psychiatry 58:494–501, 2001
[PubMed]
 
Conte HR: Review of research in supportive psychotherapy: an update. Am J Psychother 48:495–504, 1994
 
Dewald PA: Psychotherapy: A Dynamic Approach (1964). New York, Basic Books, 1971
 
Dewald PA: Principles of supportive psychotherapy. Am J Psychother 48:505–518, 1994
[PubMed]
 
Elkin I: The NIMH Treatment of Depression Collaborative Research Program: where we began and where we are, in Handbook of Psychotherapy and Behavioral Change. Edited by Bergin AE, Garfield SL. New York, Wiley, 1994, pp 114–139
 
Elkin I, Shea MT, Watkins JT, et al: National Institute of Mental Health Treatment of Depression Collaborative Research Program: general effectiveness of treatments. Arch Gen Psychiatry 46:971–982, 1989
[PubMed]
 
Erikson EH: Childhood and Society. New York, WW Norton, 1950
 
Evans S, Fishman B, Spielman L, et al: Randomized trial of cognitive behavior therapy versus supportive psychotherapy for HIV-related peripheral neuropathic pain. Psychosomatics 44:44–50, 2003
[PubMed]
 
Everly GS Jr, Mitchell JT: Critical Incident Stress Management (CISM): A New Era and Standard of Care in Crisis Intervention, 2nd Edition. Ellicott City, MD, Chevron Publishing, 1999
 
Fairbairn WRD: An Object-Relations Theory of the Personality. New York, Basic Books, 1952
 
Foa EB: Trauma and women: course, predictors, and treatment. J Clin Psychiatry 58:25–28, 1997
[PubMed]
 
Foa EB, Franklin ME: Psychotherapies for obsessive compulsive disorder: a review, in Obsessive Compulsive Disorder, 2nd Edition. Edited by Maj M, Sartorius N, Okasha A, et al. Chichester, England, Wiley, 2002, pp 93–115
 
Frank JD: General psychotherapy: the restoration of morale, in American Handbook of Psychiatry, 2nd Edition, Vol 5: Treatment. Edited by Freedman DX, Dyrud JE. New York, Basic Books, 1975, pp 117–132
 
Freud S: Lines of advance in psycho-analytic therapy (1919), in The Standard Edition of the Complete Psychological Works of Sigmund Freud, Vol 17. Edited by Strachey J. London, England, Hogarth Press, 1955, pp 157–168
 
Freud S: The ego and the id (1923), in The Standard Edition of the Complete Psychological Works of Sigmund Freud. Vol 19. Edited by Strachey J. London, England, Hogarth Press, 1961, pp 12–66
 
Gabbard GO: A contemporary psychoanalytic model of countertransference. J Clin Psychol 57:983–991, 2001
[PubMed]
 
Gaston L: The concept of the alliance and its role in psychotherapy: theoretical and empirical considerations. Psychotherapy 27:143–153, 1990
 
Gill M: Ego psychology and psychotherapy. Psychoanalytic Q 20:62–71, 1951
[PubMed]
 
Glass A: Psychotherapy in the combat zone. Am J Psychiatry 110:725–731, 1954
 
Glover E: The therapeutic effect of inexact interpretation: a contributing to the theory of suggestion. Int J Psychoanal 12:397–411, 1931
 
Glynn SM, Marder SR, Liberman RP, et al: Supplementing clinic-based skills training and manual-based community support sessions: effects on social adjustment of patients with schizophrenia. Am J Psychiatry 159:829–837, 2002
[PubMed]
 
Goldman CR, Quinn FL: Effects of a patient education program in the treatment of schizophrenia. Hosp Community Psychiatry 39:282–286, 1988
[PubMed]
 
Greenson RR: The Technique and Practice of Psychoanalysis. New York, International Universities Press, 1967
 
Greenson RR: The real relationship between the patient and the psychoanalyst, in The Unconscious Today. Edited by Kanzer M. New York, International Universities Press, 1971, pp 213–232
 
Greist JH: Treatment of obsessive-compulsiveness disorder: psychotherapies, drugs, and other somatic treatments. J Clin Psychiatry 51 (suppl):44–50, 1990
 
Gunderson JG, Frank AF, Katz HM, et al: Effects of psychotherapy in schizophrenia, II: comparative outcome of two forms of treatment. Schizophr Bull 10:564–598, 1984
[PubMed]
 
Hartmann H: Ego Psychology and the Problem of Adaptation (1939). Translated by Rapaport D. New York, International Universities Press, 1958
 
Heinssen RK, Liberman RP, Kopelowicz A: Psychosocial skills training for schizophrenia: lessons from the laboratory. Schizophr Bull 26:21–46, 2000
[PubMed]
 
Hellerstein DJ, Pinsker H, Rosenthal RN, et al: Supportive psychotherapy as the treatment model of choice. J Psychother Pract Res 3:300–306, 1994
 
Hellerstein DJ, Rosenthal RN, Pinsker H, et al: A randomized prospective study comparing supportive and dynamic therapies: outcome and alliance. J Psychother Pract Res 7:261–271, 1998
[PubMed]
 
Henry WP, Schacht TE, Strupp HH: Structural analysis of social behavior: application to a study of interpersonal process in differential psychotherapeutic outcome. J Consult Clin Psychol 44:27–31, 1986
 
Henry WP, Schacht TE, Strupp HH: Patient and therapist introject, interpersonal process, and differential psychotherapy outcome. J Consult Clin Psychol 58:768–774, 1990
[PubMed]
 
Hogarty GE, Kornblith SJ, Greenwald D, et al: Three-year trials of personal therapy among schizophrenia patients living with or independent of family, I: description of study and effects on relapse rates. Am J Psychiatry 154:1504–1513, 1997
[PubMed]
 
Holmes J: Supportive psychotherapy: the search for positive meanings. Br J Psychiatry 167:439–445, 1995
[PubMed]
 
Horowitz MJ, Marmar C: The therapeutic alliance with difficult patients, in Psychiatry Update: The American Psychiatric Association Annual Review, Vol 4. Edited by Hales RE, Frances AJ. Washington, DC, American Psychiatric Press, 1985, pp 573–585
 
Horowitz MJ, Marmar C, Weiss DS, et al: Brief psychotherapy of bereavement reactions: the relationship of process to outcome. Arch Gen Psychiatry 41:438–448, 1984
[PubMed]
 
Horvath AO, Symonds BD: Relation between working alliance and outcome in psychotherapy: a meta-analysis. J Couns Psychol 38:139–149, 1991
 
Hunter J, Leszcz M, McLachlan SA, et al: Psychological stress response in breast cancer. Psychooncology 5:4–14, 1996
 
Imber SD, Pilkonis PA, Sotsky SM, et al: Mode-specific effects among three treatments for depression. J Consult Clin Psychol 58:352–359, 1990
[PubMed]
 
Jacobson E: The Self and the Object World. New York, International Universities Press, 1964
 
Kiesler HD: Therapist countertransference: in search of common themes and empirical referents. J Clin Psychol 57:1053–1063, 2001
[PubMed]
 
Klein DF, Zitrin CM, Woerner MG, et al: Treatment of phobias, II: behavior therapy and supportive psychotherapy: are there any specific ingredients? Arch Gen Psychiatry 40:139–145, 1983
[PubMed]
 
Kohut H: The Analysis of the Self. New York, International Universities Press, 1971
 
Lamberti JS, Herz MI: Psychotherapy, social skills training, and vocational rehabilitation in schizophrenia, in Contemporary Issues in the Treatment of Schizophrenia. Edited by Shriqui CL, Nasrallah HA. Washington, DC, American Psychiatric Press, 1995, pp 713–734
 
Lauriello J, Bustillo J, Keith SJ: A critical review of research on psychosocial treatment of schizophrenia. Biol Psychiatry 46:1409–1417, 1999
[PubMed]
 
Levenson E: The Ambiguity of Change: An Inquiry Into the Nature of Psychoanalytic Reality. New York, Basic Books, 1983
 
Lewis J: To Be a Therapist: The Teaching and Learning. New York, Brunner/Mazel, 1978
 
Liberman RP, Wallace CJ, Blackwell G, et al: Skills training versus psychosocial occupational therapy for persons with persistent schizophrenia. Am J Psychiatry 155:1087–1091, 1998
[PubMed]
 
Lindemann E: Symptomatology and management of acute grief. Am J Psychiatry 101:141–148, 1944
 
Luborsky L: Principles of Psychoanalytic Psychotherapy: A Manual for Supportive-Expressive Treatment. New York, Basic Books, 1984
 
Mahler MS, Pine F, Bergman A: The Psychological Birth of the Human Infant. New York, Basic Books, 1975
 
Maina G, Forner F, Bogetto F: Randomized controlled trial comparing brief dynamic and supportive therapy with waiting list condition in minor depressive disorders. Psychother Psychosom 74:43–50, 2005
[PubMed]
 
Markowitz JC, Klerman GL, Clougherty KE, et al: Individual psychotherapies for depressed HIV-positive patients. Am J Psychiatry 152:1504–1509, 1995
[PubMed]
 
Marlatt GA, Gordon JR: Relapse Prevention: Maintenance Strategies in the Treatment of Addictive Behaviors. New York, Guilford, 1985
 
Marmor J: Short-term dynamic psychotherapy. Am J Psychiatry 136:149–155, 1979
[PubMed]
 
Massie MJ, Holland JC: Depression and the cancer patient. J Clin Psychiatry 51 (suppl):12–19, 1990
 
McIntosh VW, Jordan J, Carter FA, et al: Three psychotherapies for anorexia nervosa: a randomized, controlled trial. Am J Psychiatry 162:741–747, 2005
[PubMed]
 
Misch DA: Basic strategies of dynamic supportive therapy. J Psychother Pract Res 9:173–189, 2000
[PubMed]
 
Mitchell S: Relational Concepts in Psychoanalysis: An Integration. Cambridge, MA, Harvard University Press, 1988
 
Mumford E, Schlesinger HJ, Glass CV: The effect of psychological intervention on recovery from surgery and heart attacks: an analysis of the literature. Am J Public Health 72:141–151, 1982
[PubMed]
 
Munich RL: Contemporary treatment of schizophrenia. Bull Menninger Clin 61:189–221, 1997
[PubMed]
 
Novalis PN, Rojcewicz SJ, Peele R: Clinical Manual of Supportive Psychotherapy. Washington, DC, American Psychiatric Press, 1993
 
O'Malley SS, Jaffe AJ, Chang G, et al: Naltrexone and coping skills therapy for alcohol dependence: a controlled study. Arch Gen Psychiatry 49:881–887, 1992
[PubMed]
 
Othmer E, Othmer S: The Clinical Interview Using DSM-IV, Vol 1. Washington, DC, American Psychiatric Press, 1994, pp 87–97
 
Parad HJ, Parad LG: Crisis Intervention, Book 2: The Practitioner's Sourcebook for Brief Therapy. Milwaukee, WI, Family Service America, 1990
 
Parloff MB: Goals in psychotherapy: mediating and ultimate, in Goals of Psychotherapy. Edited by Mahrer AR. New York, Appleton-Century-Crofts, 1967, pp 5–19
 
Pinsker H: A Primer of Supportive Psychotherapy. Hillsdale, NJ, Analytic Press, 1997
 
Pinsker H, Rosenthal RN, McCullough L: Dynamic supportive psychotherapy, in Handbook of Short-Term Dynamic Psychotherapy. Edited by Crits-Christoph P, Barber JP. New York, Basic Books, 1991, pp 220–247
 
Pinsker H, Hellerstein DJ, Rosenthal RN, et al: Supportive therapy, common factors and eclecticism. Paper presented at the annual meeting of the American Psychiatric Association, New York, May 1996
 
Piper WE, Joyce AS, McCallum M, et al: Interpretive and supportive forms of psychotherapy and patient personality variables. J Consult Clin Psychol 66:558–567, 1998
[PubMed]
 
Pollack J, Flegenheimer W, Winston A: Brief adaptive psychotherapy, in Handbook of Short-Term Dynamic Psychotherapy. Edited by Crits-Christoph P, Barber JP. New York, Basic Books, 1991, pp 199–219
 
Quality Assurance Project: Treatment outlines for the management of the somatoform disorders. Aust N Z J Psychiatry 19:397–407, 1985
 
Rea MM, Strachan AM, Goldstein MJ, et al: Changes in coping style following individual and family treatment for schizophrenia. Br J Psychiatry 158:642–647, 1991
[PubMed]
 
Renaud J, Brent DA, Baugher M, et al: Rapid response to psychosocial treatment for adolescent depression: a two-year follow-up. J Am Acad Child Adolesc Psychiatry 37:1184–1190, 1998
[PubMed]
 
Rollnick S, Miller WR: What is motivational interviewing? Behavioral and Cognitive Psychotherapy 23:325–334, 1995
 
Rosenbaum B, Valbak K, Harder S, et al: The Danish National Schizophrenia Project: prospective, comparative longitudinal treatment study of first-episode psychosis. Br J Psychiatry 186:394–399, 2005
[PubMed]
 
Rosenthal RN: Identification of dual diagnoses in drug abusers, in NIDA National Conference on Drug Abuse Research and Practice: An Alliance for the 21st Century (January 12–15, 1991): Conference Highlights. Washington, DC, National Institute on Drug Abuse, 1991, pp 63–64
 
Rosenthal RN, Muran JC, Pinsker H, et al: Interpersonal change in brief supportive psychotherapy. J Psychother Pract Res 8:55–63, 1999
[PubMed]
 
Safran JD, Segal ZV: Interpersonal Process in Cognitive Therapy. New York, Basic Books, 1990
 
Safran JD, Muran JC, Samstag LW: Resolving therapeutic alliance ruptures: a task analytic investigation, in The Working Alliance: Theory, Research and Practice. Edited by Horvath AO, Greenberg LS. New York, Wiley, 1994, pp 225–255
 
Shear KM, Houck P, Greeno C, et al: Emotion-focused psychotherapy for patients with panic disorder. Am J Psychiatry 158:1993–1998, 2001
[PubMed]
 
Sifneos PE: The prevalence of "alexithymic" characteristics in psychosomatic patients. Psychother Psychosom 22:255–262, 1973
[PubMed]
 
Sifneos PE: Problems of psychotherapy of patients with alexithymic characteristics and physical disease. Psychother Psychosom 26:65–70, 1975
[PubMed]
 
Simon JC: Criteria for therapist self-disclosure. Am J Psychother 42:404–415, 1988
[PubMed]
 
Stanton AH, Gunderson JG, Knapp PH, et al: Effects of psychotherapy in schizophrenia, I: design and implementation of a controlled study. Schizophr Bull 10:520–563, 1984
[PubMed]
 
Stewart RL: Psychoanalysis and psychoanalytic psychotherapy, in Comprehensive Textbook of Psychiatry, 4th Edition. Edited by Kaplan HI, Sadock BJ. Baltimore, MD, Williams & Wilkins, 1985
 
Sullivan HS: Conception of Modern Psychiatry. New York, WW Norton, 1953
 
Sullivan PR: Learning theories and supportive psychotherapy. Am J Psychiatry 128:119–122, 1971
 
Thomas EM, Weiss SM: Nonpharmacological interventions with chronic cancer pain in adults. Cancer Control 7:157–164, 2000
[PubMed]
 
Thompson LW, Gallagher D: Depression and its treatment. Aging (Milano) 348:14–18, 1985
 
Tomkins MA: Cognitive-behavioral case formulation: the case of Jim. Journal of Psychotherapy Integration 6:97–105, 1996
 
Wallerstein RS: Forty-two Lives in Treatment: A Study of Psychoanalysis and Psychotherapy. New York, Guilford, 1986
 
Wallerstein RS: The psychotherapy research project of the Menninger Foundation: an overview. J Consult Clin Psychol 57:195–205, 1989
[PubMed]
 
Walsh BJ, Wilson GT, Terence G, et al: Medication and psychotherapy in the treatment of bulimia nervosa. Am J Psychiatry 154:523–531, 1997
[PubMed]
 
Werman DS: The Practice of Supportive Psychotherapy. New York, Brunner/Mazel, 1984
 
Westerman MA, Foote JP, Winston A: Change in coordination across phases of psychotherapy and outcome: two mechanisms for the role played by patients' contribution to the alliance. J Consult Clin Psychol 24:190–195, 1995
 
Winnicott DW: The Maturational Process and the Facilitating Environment: Studies in the Theory of Emotional Development. London, England, Hogarth Press, 1965
 
Winston A, Muran JC: Common factors in the time-limited psychotherapies, in The American Psychiatric Press Review of Psychiatry, Vol 15. Edited by Dickstein LJ, Riba MB, Oldham JM. Washington, DC, American Psychiatric Press, 1996, pp 43–68
 
Winston A, Winston B: Handbook of Integrated Short-Term Psychotherapy. Arlington, VA, American Psychiatric Publishing, 2002
 
Winston A, Pinsker H, McCullough L: A review of supportive psychotherapy. Hosp Community Psychiatry 37:1105–1114, 1986
[PubMed]
 
Winston A, Rosenthal RN, Muran JC: Supportive psychotherapy, in Handbook of Personality Disorders: Theory, Research, and Treatment. Edited by Livesley WJ. New York, Guilford, 2001, pp 344–358
 
Winston A, Rosenthal RN, Pinsker H: Introduction to Supportive Psychotherapy. Arlington, VA, American Psychiatric Publishing, 2004
 
Wolf ES: Empathy and countertransference, in The Future of Psychoanalysis. Edited by Goldberg A. New York, International Universities Press, 1983, pp 309–326
 
Zetzel E: Current concepts of transference. International Journal of Psychoanalysis 37:369–375, 1956
[PubMed]
 
Zitrin CM, Klein DF, Woerner MG, et al: Behavior therapy, supportive psychotherapy, imipramine, and phobias. Arch Gen Psychiatry 35:307–316, 1978
[PubMed]
 
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Which of the following statements concerning supportive therapy is false?
2.
Several influential psychoanalytic theories form the basis for supportive psychotherapy. In this regard, Kohut is most often associated with which of the following?
3.
The sickness–health continuum is a useful way of conceptualizing relative levels of psychopathology versus healthy functioning in patients and matching these to appropriate interventions. Under this model, psychotherapists would use more primarily supportive approaches with patients on the left (greater impairment) side. Which of the following diagnoses would be likely placed on the left side?
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