Chapter 32. Supportive Psychotherapy

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



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.


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Sample questions:
Which of the following statements concerning supportive therapy is false?
Several influential psychoanalytic theories form the basis for supportive psychotherapy. In this regard, Kohut is most often associated with which of the following?
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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