Supportive

Psychotherapy
Dr. Bidita Bhattacharya
Associate Professor
Dept. of Clinical Psychology, IOP
 Definition
A dyadic treatment that uses direct measures to ameliorate symptoms &
maintain, restore, or improve self esteem, ego function, & adaptive skills
(Pinsker et al., 1991)

Self esteem – involves sense of efficacy, confidence, hope & self regards
Ego function – include relation to reality, thinking, defense formation,
regulation of affect, synthetic function
Adaptive skills – actions associated with effective functioning

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 Overview
• Originally believed by psychoanalytically oriented psychotherapist – to
benefit only less intelligent & less motivated patients
• It has proved to be effective in a variety of settings
• Any effective therapy is necessarily supportive (Miller, 1969)
• Supporting patients to enable them to return to normal functioning

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 Focus of therapy
• Symptom removal Essential goal
• Emotional equilibrium
• Reduce detrimental external control (that act as sources of stress)
• Strengthen existing defenses
• No intent to change personality structure although constructive characterological
alterations may take place
• May be utilized as the principal treatment or as adjunct to reeducative or
reconstructive psychotherapy
• Defenses are questioned only when they are maladaptive
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 Techniques (Woolberg)
Providing active help
•Fact giving • Relaxation &
•Interpretation several other
•Directing authority relevant
techniques
•Specific disturbing Tension
problems Guidance control
•Instruction
•Courses of action
recommendation
Environm
ental Externaliz
manipulati ation of
on interest
Env.al adjustment • Diverting interests
•Home treatment, Distraction from
hospitalization, etc. the neurotic
•Half way home, Day concerns, leisure
Hospital, etc.
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 Therapists variables
Therapists’ Warmth,
empathy,
interpersonal Congruence,
skills genuineness

Relevant &
Therapeutic appropriate
approaches techniques
selection

Quality of pt Good
– therapist therapeutic
alliance
interaction
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 Therapists variables

By conveying
Improving acceptance,
approval, interest,
self esteem respect or
admiration

Conveying By avoiding arguing,

acceptance criticizing, etc.

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 Specific Techniques

Can be reinforcement of
accomplishments or of more adaptive
Praise behaviours,
(pt is likely to agree that praise is
deserved)

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 • Must be honest
• Pt must believe that the reassurance is based on an
understanding of his or her unique situation
• Must limit reassurance to areas in which he or she
has expert knowledge or dependable common
information
• It is never acceptable to offer reassurance that is
Reassurance simply what the pt (or family) wants to hear
• Normalizing for most people is a palatable form
of reassurance
• Reassurance & normalizing must not extend to
pathological or nonadoptive behaviour, nor to
opportunistic, holistic interactions with others.
• Couple reassurance with enunciation of a principle
or a rule.

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 • Looking at something in a different light or from a
Rationalizing different perspective
& Reframing • Avoid sounding fatuous in this process
• Avoid arguments as well

• Advice is meaningful when the pt sees it as pertinent

to his/ her needs
Advice & • Advice & teaching are appropriate in areas in which
Teaching the therapist is professionally expert (e.g., areas like
mental illness, normal human behaviour,
interpersonal transactions, etc.)
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 • To consider in advance what obstacles there might be
to a proposed course of action, and then to prepare
Anticipatory
strategies for dealing with them
Guidance • This can be helpful & supportive in contexts other
than rehab.

Reducing & • Every effort to avoid interrogative style

Preventing • To minimize anxiety – therapist shares his agenda
Anxiety with the pt

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 • Pt’s sense of control may be enhanced & thus anxiety
Naming minimized
Problem • Need for control is one reason why human beings
find pleasure in counting & classifying

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 Clarification
Ø Summarizing
Ø Paraphrasing
Ø Organizing

Confrontation
Expanding Bringing pt’s attention to a
the pt’s pattern of beh, ideas, or feelings
Awareness he/ she has not recognized or has
avoided

Interpretation
Ø Meaning of the pt’s thoughts,
intents
Ø Linking of current feelings
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with the past or the 13
relationship with the therapist
 Phases of Therapy
Beginning Phase:
üSpecific attention to therapeutic alliance – will increase the compliance in
therapy
üTherapist to come to a reasonable understanding about the target complaints
& presenting symptoms
üFormulation & the hypothesis of the problem
üFine tuning of understanding & addressing ego functioning
üHospitalizing issues
üEstablishing a rational & collaborative process
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 Phases of Therapy
Middle Phase:
üTherapist continues to monitor alliance (to keep equal attention like
beginning)
üCorrective emotional experience
üPositive transference & regard for the therapist are allowed without
interpretation
üNew intermediate goals may arise & that can be addressed depending on the
situation & condition of the client
üWell structured psychoeducational & skill building interventions as well as pt
driven processes
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 Phases of Therapy
Termination Phase:
üA formal termination process is not a part of supportive psychotherapy
üTherapy ends when the goals of treatment have been reached or when the pt
elects not to continue
üIf there are other issues to stop – like ego function disturbance, faulty
adaptive skills, etc., - these issues can be taken up & addressed separately
üAt the end of formal treatment, gains are summarized & an future agenda is
articulated
üPts to reflect important milestones & achievements
üTherapist also reflect the changes from his/ her part
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 Conclusion
• No such time limit for supportive psychotherapy
• Brief therapy is typically indicated when the psychopathology is expected to
be time limited
• Treatment is complete, not when core conflicts have been resolved but rather
when symptoms have been reduced to comfortable levels or have been more
competent coping strategies have been developed

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 Thank you

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