UNIT 2: SUPPORTIVE PSYCHOTHERAPY

ELABORATE: Why is supportive psychotherapy

a basic technique?

HISTORY OF SUPPORTIVE PSYCHOTHERAPY

Supportive therapy has emerged from the time of psychoanalysis. When psychoanalysis
and various psychodynamic therapies were the predominant forms of psychotherapy,
there were clients who were not “analyzeable” but still needed therapy. As a result,
clinicians helped these clients with support and suggestions. During this time,
supportive psychotherapy was, then, considered a form of therapy but did not require
clinicians any formal or special training. This is because it was thought that it was
nothing more but a “common sense” approach. At that time, the only requirement for
therapists are good interpersonal skills and the ability to empathize. However, through
the years, supportive therapy has evolved.

Supportive psychotherapy is rarely used as a “stand alone” kind of therapy. Its techniques
are basic and are used hand-in-hand with other forms of psychotherapy.

SUPPORTIVE PSYCHOTHERAPY

Supportive therapy is one of the commonly used therapy in practice, but is less researched
on. It has rarely been studied as a primary treatment for anything, unlike other therapies
such as psychoanalysis and cognitive-behavioral therapy. Nonetheless, supportive therapy
has been used hand-in-hand with other forms of psychotherapy.

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 The objective of this therapy is to bring about alleviation of the symptoms by strengthening
the existing defenses. In this way, it is hoped that the person will become symptom-free
and will be able to face his problems in the future.

The therapist takes a very directive role and attempts to modify patterns of behavior
by direct intervention. However, there may be instances when the therapist will take a
non- directive approach.

Supportive therapy may change maladjusted behaviors in a comparatively short period of

time when the conflicts are clear and on (or close to) the conscious surface of thought.
It deals with the “here and now” conflicts. It is inevitably a symptomatic treatment only. It
is ineffective when the presented conflict situation is only an expression of a much
deeper seated conflict.

The different processes called upon in supportive therapy are:

1. Ventilation or Verbal Catharsis

The man in the street may describe this merely as “talking it out” or “getting it off
your chest”. Catharsis is a way to achieve emotional relief. It is effective therapy
when the client is able to verbalize his /her feelings, to express his/her conflicts, to
describe life, to air grievances, and to find in the therapist a sympathetic audience.

There is something about the mere talking out of a problem which in itself is therapeutic,
and which tends to make the difficulty seem less significant. The conflict is brought
closer to possible control and mastery. Such verbal catharsis is generally experienced
through talking in a face-to-face interview.

When the individual who is ventilating his troubles truly re-experiences them, he
may identify with the difficult situation that he throws himself into full participation with
bodily, mental, and emotional revivification.

For example, a patient with anxiety who has been recently removed from a
battlefield situation may, with his therapist, relive the particular experience,
accompanied by the same tremendous fear, anxiety, and horror which he was
unable to master, and which caused his breakdown. This process is termed
“abreaction”. It involves revivification and re-experiencing within the constructive and
supportive relationship offered by the therapist. The patient is enabled to master the
situation by the release of his repressed anxiety and emotion. The therapeutic
effectiveness of this procedure is sometimes directly proportional to the violence and
intensity with which the emotion is released. Abreactive therapy has been most effective
with acute, traumatic neuroses.

2. Suggestion

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 Suggestion is a process by which one person directly induces another to think, feel or act
in a given way. However, keep in mind, that we do not force, command or coerce
our client to do what we have suggested.

Suggestions are ordinarily presented in a tentative form such as

 Have you thought of the possibility –
 Could it be that –
 Another way of approaching the problem might perhaps be-

Notice the structure of each statement. When providing suggestions, it is best to state it in
this way because it gives the client room to decide. The client is invited and permitted
to share in the decision process.

However, the effectiveness of a suggestion depends on two factors:

A. Condition of readiness (or “set”) for the acceptance of a suggestion within the client.
Suggestions may be more effectively built upon simpler, earlier suggestions. When
they are presented directly to the client without prior presentation, they are less
effective.

B. Confidence of the client in the therapist. The credibility and prestige of the therapist
are important factors.

A special type of suggestion is the post-hypnotic suggestion. It is a suggestion given

during the hypnotic trance, but carried out in the normal state of consciousness
without knowledge by the patient that he is carrying out the suggestion. In a hypnotic
state, an individual is more sensitive to suggestions which are given to him because
of the heightened susceptibility. In this case, the suggestions are given in a straight-
forward, somewhat authoritative way. When a post-hypnotic suggestion is successfully
carried out, the individual’s confidence is built up and he may find that he can cope with
his problems with no further therapeutic help.

2. Reassurance

Reassurance is a procedure that aims to give the client confidence in a favorable

outcome. Reassurance strengthens positive attitudes within the client and is an antidote
for fear, worry, insecurity and uncertainty. It may be superficial and its effects may
be transient, but at times may be valuable to get over a difficult situation.

Types of Reassurance:

a. Direct Reassurance

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 In a direct way, the therapist reassures the client that he is not unusual in his difficulties,
that the nature of his condition is known and has a cause, that the symptoms may be
annoying but not too dangerous, that something can be done, that the condition
will not lead to insanity, that there may be relapse but it does not mean that the
condition is getting worse etc.
Direct reassurance may be generously used when its content is true, but too free and
too early use may give premature and superficial relief which may block further
progress. Let the client express his fears, and the therapist should recognize,
accept and clarify for himself the need for reassurance before reassurance is given.

Direct reassurance is most effective when it involves factual information, rather than
opinions. When a client raises questions about which he could be reassured, it is best
to do so. Not telling anything may increase his anxiety. If the prognosis is really
unfavorable, this should not be revealed at this early stage when the client’s Ego is
still shaky.

b. Indirect Reassurance

Sometimes, reassurance may be given without directly telling it to the client. The
personality of the therapist, his dignified, professional and unemotional mode of
speaking and acting, together with the surroundings may inspire confidence in
the client, so that he gets the reassurance that he is in good hands and that he is
receiving the best possible treatment.

Reassurance may be beneficial in the process. However, there are certain situations where
reassurance may not be helpful. These situations include:

⮚ When its content is not true and the client knows the truth or will find out sooner
or later. It is never a good idea to lie to the client. This may damage the
relationship, thus, affecting the therapeutic process.

⮚ When the reassurance induces the client to shift the responsibility entirely to
the therapist. Remember, the client and therapist must collaborate. In
providing reassurance, we must recognize the boundaries between the client
and the therapist. It’s true that we, as therapists, are there to help the client.
However, we still have to remind the client about his/her responsibilities.

⮚ When the reassurance may lead to overconfidence. Aside from reminding the client
of his/her responsibilities, we also have to ground him/her in reality. For instance, if a
client is willing to try out a solution to a problem, we have to help him prepare for
two possible outcomes - either the solution will work or not. If the client is fixated
on the belief that a solution is going to or will always work, it may lead to some
problems.

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 INDICATIONS FOR SUPPORTIVE PSYCHOTHERAPY

Supportive therapy can be used in cases like:

- Major Crises in Adjustment – if the client is in such a state that he cannot approach
his problems constructively because he is agitated, anxious, excited, supportive
therapy is indicated until other approaches can be used

- Minor Crises in Adjustment – periods of difficulty that resolve themselves

spontaneously (example, homesickness). Supportive therapy helps the client till the
difficult period has passed.

- Insoluble problems - Sometimes, there is no direct solution to a problem. For

instance, a client’s loved one is diagnosed with stage 4 cancer. In this scenario,
there is no direct solution to it. Hence, the best thing we can do is to provide
support to our client.

- Distressing Symptoms – it is necessary to help the client with his distressing symptoms
before dealing with the basic problems can get started.

- Dangerous Symptoms – symptoms of imminent uncontrollable behavior as for

instance, suicidal thoughts, very intense sexual impulses, panic, etc., ask for
immediate relief and action. Providing suggestions to our clients may be helpful
in cases like these.

Consider the example below to illustrate how supportive psychotherapy is used:

Client is a 35year old woman, married with four children, teacher by profession. She has
been in therapy at regular intervals for the last 2 years. This is an excerpt of a clinical
session after a period of several months that she was functioning relatively well

Legends: C - Client; T: Therapist

C: I cannot go on like this… Some time ago, everything was fine. I really thought that I
would not have to come back anymore. Of course, I would still come back to tell you
that I was fine, but not anymore for that… It’s terrible (starts crying)

T: You felt you were on the right track, but now, it is as if you are as miserable as before. If
not, worse.

C: Yes, you said it. It’s worse. Nothing seems to work anymore. My husband simply does
not care what’s happening to me. He says that I am crazy or overreacting … that I
think too much… that I “blow things up”… Last night, do you know what he said to me?
He said that I have to grow up… That I have to stop acting like a child. Imagine? He
said that to me! (Goes on talking about her difficulties at home with the children, in
school with her co- workers)… It’s just.. It’s all a big mess

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 T: It really seems to be… But in the meantime, you were able to go on with your teaching,
weren’t you?

C: Yes… That’s true. With the children in school, there are no real difficulties. Of course,
there are some problems...minor problems… But… But then I go home, I have been
teaching for the entire day and then I get it… Last week, the maid was sick, had to attend
to my kids, and my husband would say that I am crazy (cries)

T: I see. It is never pleasant to hear these things, but when the tension runs high, it is
quite understandable that words are used, which should not have been said in the first
place. Is it not possible that your husband didn’t mean that?

C: Yes, perhaps he didn’t mean it because… Hmm… Now that I think of it… Afterwards, he
really tried to be nice to me…But I didn’t like it anymore. I was fed up.. I got so mad that…
(stops)

T: So mad that..

C: That I really said… crazy things… I said so many things and then… later, I felt so bad
about myself

T: Do you mean to say that “your feeling bad” was more about yourself than about
your husband and others?

C: I think so… Hmm.. Yes, it is really that… But I didn’t see it like that before… I was like a small
child who had tantrums… Is that the way you call it?

T: Mm-m… Yes

C: He is mad and angry for simply being mad… My God, I was really like a child… Perhaps,
my husband was right when he said that I still have to grow up. But isn’t that horrible?! To
be a married woman, a mother of four children, and a teacher… and to find out that you’re
still a child

T: To act at times in a less mature way doesn’t mean that we have to compare
ourselves with a child. Who can claim that he was fully matured in all aspects of what we
are?

REFERENCES:

Clinical Psychology Manual (Psych 25) and Faculty Notes. Saint Louis University.

Grover, S., Avasthi, A. & Jagiwala, M. (2020). Clinical Practice Guidelines for Practice
of Supportive Psychotherapy. Indian Journal of Psychology, 62(2), S173-
S182. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7001359/

Trull, T. & Prinstein, M. (2013). Clinical Psychology (8th Edition). Belmont, CA: Cengage
Learning.

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 Images:

All images were obtained from various sources, but are under Creative common license.

✔ Image 1 (“Psychotherapy”)
Link: https://thenounproject.com/term/psychotherapy/1250223/
✔ Image 2 (“Jumping from old to new”)
Link: https://commons.wikimedia.org/wiki/File:Career_Change_Jump_Cartoon.svg
✔ Image 3 (“Two women talking”)
Link: https://creazilla.com/nodes/33891-women-are-talking-clipart
✔ Image 4 (“Ball of emotions”)
Link: https://www.pxfuel.com/en/free-photo-oozws
✔ Image 5 (“Puzzled”)
Link: https://commons.wikimedia.org/wiki/File:Puzzly_puzzled.svg
✔ Image 6 (“Change”)
Link: https://www.needpix.com/photo/511040/change-list-pin-arrows-transformation-
novelty-reordering-refactoring-innovation
✔ Image 7 (“Support”)
Link: https://pixabay.com/photos/search/support/

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