Saturday, June 23, 2012

Supportive Psychotherapy 101

An article in Psychiatric News on June 15 by Arnold Winston [his book] offers a quick review about the elements of supportive psychotherapy and why it has become the most widely used form of psychotherapy.
Definition of supportive psychotherapy: designed to reduce symptoms, improve self-esteem, and maximize adaptive capacities.
  • alliance building (expressions of interest, empathy, conversational style)
  • esteem building (reassurance, normalizing, encouragement)
  • skills building (advice, teaching, anticipatory guidance)
  • reducing and preventing anxiety (normalizing, reframing, rationalizing)
  • expanding awareness (clarification, confrontation, interpretation)
  • strengthening defenses (as opposed to challenging them)
  • other cognitive-behavioral (identification and examination of automatic thoughts, relaxation exercises, assertiveness training, exposure treatment)
  • supportive
  • empathic
  • nonthreatening
  • affectionate bond between patient and therapist
  • agreement on the task and goals of the therapy
  • patient's capacity to perform therapeutic work
  • therapist's empathic relatedness and involvement


Dinah said...

Look, it's Roy writing about psychotherapy. Wow!

Anonymous said...

Kinda hurl for me. "expression of interest" from someone who is interested on by the 50 minute hour for pay, is not interest, except maybe their own. How people fall for that and develop an "affectionate bond" that goes one way is beyond my ability to understand.

Anonymous said...

Sounds interesting, I'll read it. I am a year into psychodynamic therapy and it's going well overall, but my therapist rarely reveals anything, that I can tell. Recently he has had some reactions to some of my accounts of abuse where I know it's stirring something in him, not just in me. I can't tell you how validating that was. Otherwise, I just think it mustn't be that big of a deal, my feelings are once again not validated, so it must just be me, get over it already! I totally support some rules and space to allow for transference, but seriously, I need a little humanity in my sessions, too...

Anonymous said...

From what I can tell, when something is said that stirs some emotion in the therapist, it is either about their own stuff or very good acting job.Doesn't make me feel validated one bit.

Anonymous said...

Hey, whatever gets the job done, anonymous. If my therapist can fake it, and not actually suffer along with me, but I get what I need, then I'm cool with that.

Anonymous said...

Not sure why I didn't remember this sooner, but I dated a therapist before I new much about therapy or had ever been in therapy myself. She was very affected by her sessions, it was obvious, and did seem to genuinely care for her clients (as well as her own therapist which she described as being in a very "loving" relationship with, without the sex of course). Not every therapist is the same, and now that I'm in therapy I wonder if my therapist fakes it from time to time, but I won't forget how my ex really did care about people and loved her work -- and often brought home the emotions of the day with her. (Of course she never shared details about clients.)

Anonymous said...

Faking it is not okay with me. I also don't want a therapist who suffers along with me since that renders them useless.Real empathy does not mean suffering along with and cannot be faked.

Anonymous said...

Maybe the point is, therapists can genuinely care for (and feel for) their clients, no matter their discipline, no matter how much they reveal that. I'm in sales, and I have clients that I genuinely care about within the frame of our business relationship (and some I'd be personal friends with if the business relationship stopped). I spend a lot of time with these people and I serve them to help them be successful because that's what most people on the planet tend to do (paid or not). We care. Sure, some you relate to some folks more than others, but suggesting that because you're in a business relationship with a therapists somehow makes them inhuman and not genuinely caring for you or your condition seems like a pretty simplistic (perhaps a little jaded?) view of human dynamics. You, as the client, don't have to forget the business relationship, and you can be as close (open) or distant (closed) as you wish within that framework, and you're not burdened with the professional ethics and therapeutic rationals for managing the relationship in very certain ways -- which means by design therapists can't always be genuine in a session. You can, they can't. At the same time, they aren't robots. On getting paid for this trade, therapists have to make a living, and they earn it. So do priests, school teachers, and other professions of service for our hearts and minds.

Sarebear said...

I felt a bit of mild distress upon reading this post, as I thought, "So there's a formulaic way of doing what they do, they are countering x with y, z with l, etcetera?"

But then, how could you teach someone to be a therapist if ways to help people hadn't been figured out, if techniqus, types of responses, and all that hadn't been studies and figured out?

Someone just applying these techniques as if they're going down a checklist, doesn't seem to me as if they'd be near as good as someone who . . . applies these things with a caring, empathic point of view, with someone who sometimes pushes (a little more confrontation) or sometimes pulls back on the pushing, depending on how much stress you're under, how they assess your condition or stability at the time, etc. Just . . . how much care they take with what they do, and how they do it, and when and what they do.

Anyway, there are a variety of reasons why I feel my therapist cares, some "proofs" I can think of. I still have trouble connecting to his empathy at times, because I have difficulty connecting to anyone, emotionally. I'm very isolated that way. Still, we've discussed this and anything he can do or is doing or is not doing that may affect how I connect to him. He never says or indicates it's me, he just says when I say maybe it's my problems connecting to people, he'll say that's an interesting theory.

He's been so extraordinarily kind, in a variety of ways, that in thinking about those it makes it easier to connect, although part of me distances from it by saying but how could I be worth that, I'm not . . .and so there's another wall between me and connecting.

Anyway . . . one example I do connect with is, after each of my knee replacements, about 4-5 weeks out when I was ready to start leaving the house (it wasn't painless though, let me assure you) he had worked on getting access to the conference room downstairs of the lawyer firm in the building. It took some time and effort to arrange this with them. The building he's in is oldk, and grandfathered out of disabled access laws and stuff. It's a steepish curving staircase up to his office.

So, after my surgeries we met downstairs in this conference room, about 3-4 times after each surgery, until I was ready to slowly tackle the stairs (going down was more of a concern than going up, but that was daunting too early on). He would be very solicitious of my pain, and my comfort, helping arrange chairs in the conference room so I could put my legs up, and stuff. Small things, but all very kind and caring. Meeting elsewhere than his office, maybe not such a small thing. Some therapists mighta made me wait til I could tackle the stairs before coming back to therapy.

Back to the post, my therapist does all of this with me (and other things, he's eclectically oriented) except he confronts rationalization, as well as dealing with defenses, not strengthening them.

Anonymous said...

Wow, somebody must have been talking to my therapist. A lot of this stuff describes her. Sometimes she's in my face and she always expects me to do my homework and work with her as a "team." That being said, she works like a dog. I know she's pulling for me.
She has gone above and beyond the call of duty for me. Gave me a cell phone number for the day I first saw my abusive ex-husband after twenty years. Didn't use it, didn't record it, and ripped it up. But she was there if I needed her.
She's done a therapy session with me in my parents' home after I had open heart surgery and came to my home once after I had major kidney surgery. I needed to talk!!
And oh, by the way, this therapist's name is Dr. Alycia Chambers. She immediately reported in 1998 her suspicions that Jerry Sandusky was a pedophile to all legally required authorities and urged the mother of survivor #6 to immediately go to the police, which she did.
There are some really good people providing mental health care.

George Dawson, MD, DFAPA said...

Disagree with at least part of the definition of the therapeutic alliance as: "Affectionate bond between patient and therapist." I thought that my old psychotherapy supervisors asking the question: "Do you like the patient?" occurred when they had run out of things to say.

Much more important to maintain neutrality and relate in ways that are not typically experienced by the patient. People develop a unique relationship when they are hearing empathic and unique information from a person who they are not emotionally involved with.

joey said...

Meeting elsewhere than his office

Medical Business

Simple Citizen said...

Supportive psychotherapy should be the most commonly used.

It is the easiest to do without much training, it can be done in a 5 minute visit or a 90 minute visit, and it works with nearly all patients with any problem.

However, if you never move beyond supportive, you're really missing out. Patients should advance, so that supportive is not needed much anymore, and expressive psychotherapy takes over.

EastCoaster said...

I just read an article by Sid Blatt comparing intensive supportive therapy with more insight-oriented psychoanalysis in different types of patients.

He makes a distinction between anaclitic patients who fear abandonment and want to build a relationship with or even merge with the therapist, and introjective patients who may be obsessed with self criticism and tend to be more dismissive of the possibility of becoming attached to someone. Neither are terribly adaptive nor functioning in a great way, but the introjective patients seem to do better with the interpretations rather than the supportive ones. They improve through the changes in their thinking first and only then can they work on the interpretive dimension.

The picture seems a lot more complicated than what's normally presented.

EastCoaster said...

Just curious what the shrinks here think about mentalization based therapy?