5 Keys to Good Results with Supportive Psychotherapy: Evidence-Based Technique Gains New Respect as a Valuable Clinical Tool

Supportive psychotherapy began as a second-class whose only operating principle was being friendly with the patient (Box, page 28). (1) Critics called it simple-minded (2) and sniffed, it is supportive, it is not therapy ... if it is therapy, it is not supportive. (3) [ILLUSTRATION OMITTED] Since its lowly beginning, however, supportive psychotherapy has been proven highly effective, and clinicians have developed operating principles that distinguish it from expressive psychotherapy (Table 1, page 31). (4) To help you make good use of supportive psychotherapy, this article describes its evolution and: * evidence that demonstrates its effectiveness * 5 key components for clinical practice * how to use it when treating challenging patients. A proven Effective long-term therapy. Much research on supportive psychotherapy comes from studies in which supportive psychotherapy was included as a treatment as usual comparison. In an extensive longitudinal study, for example, the Meninger Psychotherapy Research Project examined 42 patients receiving psychoanalysis, psychodynamic psychotherapy, or supportive psychotherapy over 25 years. (5) Despite the institutional expertise in psychoanalysis and expressive psychotherapy, patients in supportive psychotherapy did just as well as those receiving the other treatments. Researchers found that each therapy carried more supportive elements than was intended, and supportive elements accounted for many of the observed changes. They concluded that: * thinking of change in terms of structural vs behavioral was not useful * change did not occur in proportion to resolving unconscious conflict. Combating phobias. A study of behavior therapy for treating phobias had similar results. (6) Patients with agoraphobia, mixed phobia, or simple phobias were treated with behavior therapy alone, behavior therapy plus imipramine, or supportive psychotherapy plus imipramine for 26 weekly sessions. Therapists in the behavior therapy group used a manualized, highly structured protocol that included in vivo desensitization and homework. Therapists who used supportive psychotherapy simply encouraged patients to ventilate their feelings and discuss problems. Supportive therapists were instructed to be nondirective and avoid confrontation unless the patient proposed it. Both therapies combined with imipramine produced similar rates of moderate to marked improvement in patients with agoraphobia (85% to 100% with supportive therapy, 76% to 100% with behavior therapy). For patients with mixed phobias, 71% to 100% improved moderately or markedly with supportive therapy compared with 88% to 100% with behavior therapy. Among patients with simple phobia, 72% to 86% experienced moderate to marked improvement with supportive therapy, compared with 87% to 93% with behavior therapy. Improving personality disorders. Several studies examined a form of supportive psychotherapy that used a manualized, structured protocol for treating higher functioning patients who traditionally have been treated with expressive psychotherapy. The protocol used a conversation-based, dyadic style to improve self-esteem and adaptive skills through data-based praise, advice, education, appropriate reassurance, anticipatory guidance, clarification, and confrontation. Under these reproducible conditions, supportive psychotherapy showed good efficacy compared with dynamic therapies for patients with depressive, anxiety, and personality disorders. A review of studies from 1986 to 1992 found that supportive psychotherapy was effective for a variety of psychiatric and medical conditions, including schizophrenia, bipolar disorder, depression, posttraumatic stress disorder, anxiety disorders, personality disorders, substance abuse, and stress associated with breast cancer and back pain. …