8 Psychotherapy8.1 Psychodynamic psychotherapy
8.1.3 Supportive psychotherapy
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Written by Resident Doctor Committee · Published
What it is
Supportive psychotherapy maintains current functioning by strengthening the coping the patient already has.
Its methods are encouragement, reassurance, advice, praise and bolstering of existing coping.
It does not uncover conflict, use structured cognitive work or work to a time-limited focus.
Its aims are to maintain or raise self-esteem and coping, working in the present and keeping anxiety low.
It works mainly through a stable therapeutic alliance, built with the patient's psychological and practical obstacles to engagement in mind.
Supportive versus exploratory therapy
Dimension | Exploratory therapy | Supportive therapy |
|---|---|---|
Defences | Confronted and dismantled | Adaptive ones preserved and strengthened |
Transference | Interpreted systematically, as in psychodynamic therapy | Managed to protect the alliance, rarely interpreted |
Anxiety | Provoked | Kept low |
Focus | The past | The present |
Therapist | Neutral, withholds guidance | Active and warm, advises by agreement |
Goal | Insight and structural change | Stable functioning and preserved coping |
Judge a defence by its effect in context. Intellectualising about cancer treatment is supported if it lets the patient attend appointments, but denial is gently challenged if it makes them miss essential treatment.
Choosing the patient
Supportive work suits poor ego strength and a high potential for decompensation, as in acute crisis.
Exploratory work suits a strong ego, psychological mindedness and a wish for insight.
Supportive work also helps in severe or chronic mental illness, physical illness, bereavement and advancing dementia.
It is no substitute for urgent treatment, crisis intervention or admission.
Core techniques
Technique | What it does | Limit |
|---|---|---|
Clarification | Asks the patient to say more so both share an accurate picture | Proposes no unconscious meaning |
Validation | Tells the patient a response is understandable | Does not agree it is the best response |
Encouragement and praise | Reinforces a specific step | Only when true, or credibility is lost |
Advice and problem solving | Builds a concrete plan in a crisis | Offered by agreement, never imposed |
Environmental intervention | Liaises over respite, housing or benefits | Part of the therapy, not outside it |
Psychoeducation | Explains the illness, its course and early warning signs | Uses terms the patient can use |
Pitfalls
Dependency is contact with the therapist replacing the patient's own coping without progress.
Repeated reassurance can feed reassurance seeking, particularly in health anxiety, so keep it specific, realistic and tied to self-management.
Suicide and self-harm risk need active monitoring, however informal the treatment seems.