Supportive Psychoanalytic Psychotherapy

Supportive Psychoanalytic Psychotherapy

Although only recently systematized, this form of psychotherapy provides psychological stabilization to the patient through the vehicle of a consistent and predictable caring therapist–patient relationship (Werman, 1984; Rockland, 1989; Novalis et al., 1993; Hellerstein et al., 1994; Misch, 2000). Supportive psycho-therapy attempts to shore up the patient’s psychological defenses and enhance his or her ability to cope with the trials of illness or psychological deficits and the challenges they impose on the patient’s daily activities (Table 66.10). Not unexpectedly, it also strives to prevent decompensation and regression. As such, psy-choanalytic supportive psychotherapy employs a psychodynamic understanding of the patient’s difficulties but does not emphasize

interpretation of the patient’s internal world. Rather, supportive psychotherapy focuses on assisting the patient to address inter-personal and environmental challenges in the here and now.

Despite its noninterpretive emphasis, supportive psycho-therapy can have a substantial impact in the lives of patients with significant ego deficits and those with major mental illness. These patients may include those with high levels of aggressivity, poor impulse control, overreliance on action rather than verbal expression of emotions, compromised reality testing and limited psychological mindedness. It is also highly effective with higher functioning patients who have experienced recent psychic trauma (e.g., through natural disasters, illness, physical or sexual assault, and unexpected devastating losses).

Supportive psychotherapy techniques consist predominantly of empathically listening to the patient’s feelings and experiences; giving advice and reassurance; offering suggestion and helpful coping techniques; and for some patients with severe and chronic maladaptations, gently revealing their misperceptions and how they interfere in daily functioning. Although often unexpressed, the patient’s identification with the therapist’s values, ideals and approaches to problems is exceptionally therapeutic. Environmen-tal interventions through helping agencies and the patient’s sig-nificant others are also effective supportive techniques. Although nonspecific to some degree, these interventions are nevertheless based on a comprehensive understanding of the patient’s strengths and weaknesses, and are frequently instrumental in curbing self-destructive and self-defeating behaviors. Transference is appreci-ated but the therapist rarely interprets it in supportive psychoana-lytic psychotherapy, choosing rather to foster a positive working relationship through other means (Pinsker et al., 1992).

Although frequently disparaged, effective supportive psy-choanalytic psychotherapy is often more challenging to provide than some forms of expressive psychotherapy. Appreciating the psychological forces that are impinging on a marginally func-tioning patient whose communicative abilities are suboptimal re-quires a sophisticated clinical approach. Moreover, in supportive psychotherapy, the therapist must assist the patient to modulate intense affective states that are often frightening to the patient and to those in his or her environment. Needless to say, such af-fects can be directed at the therapist as well. The establishment with the patient of the requisite safe and caring relationship, which may be frequently disrupted by both internal and external forces, is often a significant clinical challenge.

Supportive psychotherapy can produce significant and lasting behavioral change through the reinforcement of health-promoting behaviors; increased capacity for self-reflection; anxiety reduction; and development of new defenses such as intellectualization that enable the patient to acquire a cognitive, anxiety-reducing conceptualization of her or his difficulties.