5 key components
Although all psychotherapies have some elements of support, effective supportive psychotherapy has 5 key components (Table 2).
- asking directive questions
- allowing inflection in your voice
- making gestures
- discussing opinions.
Table 2
5 components of supportive psychotherapy
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CASE CONTINUED: Learning to cope
Mrs. S’ new psychiatrist starts her on an antidepressant and once-weekly supportive psychotherapy. For the initial sessions, the psychiatrist helps Mrs. S explore options for her highly conflicted marriage and strategies for coping with panic symptoms.
Mrs. S develops a strong feeling of attachment to the psychiatrist, sometimes projecting anger onto him by declaring that he does not care enough. Instead of interpreting this transference, the psychiatrist uses it as an opportunity to explore coping options Mrs. S can try when she feels unloved or rejected.
Nurture positive transference. A positive relationship is essential for the therapeutic alliance. In most instances, a patient naturally develops good feelings toward the therapist over time as a result of repeated empathic interchange. In supportive psychotherapy, you may acknowledge these good feelings but do not interpret them for unconscious underpinnings.
Address transference only if it is negative. If the patient develops hostility or anger toward you, use techniques to improve the relationship, such as:
- acknowledging the validity of the patient’s angry feelings
- gaining an understanding of your role in the conflict and apologizing if sincere
- offering solutions to improve the conflict
- providing reassurance that working through the conflict will strengthen the therapeutic relationship.
Reduce anxiety. In supportive psychotherapy, the primary goal is to lessen the patient’s suffering. Although the patient often must talk about stressful or painful topics, you can help him or her do so in a tolerable manner. Focus on making it easier for the patient to talk.
Reducing anxiety means not only helping the patient talk about painful matters but also allowing him or her to avoid topics that are too uncomfortable to endure. You can always “earmark” areas of concern for later discussion. This modulation of anxiety is consistent with the object relations approach proposed by Kohut,10 in which emotional pain is addressed in “small, psychologically manageable portions.”
Enhance self-esteem. Virtually all patients in supportive psychotherapy suffer from low self-esteem, so it is beneficial to help them feel better about themselves. Take an active role by using positive comments and acknowledgements (“plussing”) as well as compliments when appropriate.
Most patients with low self-esteem have defects in the ability to nurture or forgive themselves (“self-soothe”). Work with patients to enhance this ability by:
- plussing where appropriate
- correcting negative self-distortions or self-reproach
- educating patients on how to both placate and reward themselves.
Strengthen coping mechanisms. In supportive psychotherapy the therapist acts as a coach, giving the patient suggestions on how to cope with difficult matters. As part of treatment, you might assign the patient homework and instruct him to practice specific coping strategies.
CASE CONTINUED: Feeling stronger
Eventually Mrs. S is able to talk in a limited fashion about childhood sexual abuse. With her psychiatrist’s encouragement, she begins to write about her feelings in a journal and exercising to help her “feel strong.” The psychiatrist often acknowledges her struggle and compliments her attempts at coping in healthy ways. After a year of supportive psychotherapy Mrs. S is better able to modulate her feelings and make decisions without feeling overwhelmed.