Addiction A-Z

Supportive psychotherapy

When it comes to psychotherapy, the argument could easily be made that all types of psychotherapy are supportive in nature – at least to a fair degree. After all, if you go to a therapist and don’t feel supported in any way, the odds that you’ll continue with that therapist – regardless of his or her therapeutic orientation – are about zero. Unless, of course, you’ve been referred to therapy to work on your masochistic tendencies and feel that you deserve an unsupportive therapist.

Humor aside, supportive psychotherapy is a distinct form of therapy, although it’s sometimes combined with cognitive behavioral techniques. In outpatient mental health clinics, psychiatric facilities, and even many psychiatrists who provide therapy in addition to medication, a high number of the patients seen are treated with supportive psychotherapy. That sounds rather bold when you consider just how many different types of psychotherapy there actually are, such as psychodynamic psychotherapy, Jungian analysis, existential therapy, Gestalt therapy, and countless others.

What is Supportive Psychotherapy?

As the name suggests, supportive psychotherapy aims to support therapy clients in a variety of ways. Rather than attempt to provide elegant interpretations to previously unconscious conflicts, explore the impact of childhood wounds, or change deeply-ingrained maladaptive beliefs about yourself or the world, supportive psychotherapy is geared towards more basic and straightforward therapeutic goals.

Essentially, one of the primary goals of supportive psychotherapy is to strengthen their clients’ ability to cope effectively with various life stressors. Therapists accomplish this in several different ways, which include:

  • Listening closely and actively
  • Showing genuine empathy
  • Helping clients have a better understanding of their current situation
  • Helping them explore the options available to them
  • Helping them find hope despite difficult circumstances
  • Reinforcing and strengthening their resilience to the challenges they face
  • Maintaining or building up their self-esteem
  • Encouraging them to share their feelings and thought

Supportive psychotherapy is also intended to help clients increase their ability to adapt to various situations. Being inflexible and incapable of adapting to change or other common life challenges is a trait that doesn’t bode well for anyone. It’s one that becomes even more problematic when faced with a difficult situation or mental health issues. Like most forms of psychotherapy, supportive psychotherapy is also geared towards reducing or alleviating symptoms of depression, anxiety, and other disorders.

In order to better understand supportive psychotherapy, it’s helpful to look at the various therapies on a continuum. If you can imagine psychodynamic therapy or expressive psychotherapy – which stresses the importance of insight and exploring underlying issues – on one end of the continuum, then supportive psychotherapy is on the other end, with the vast majority of other types of psychotherapy somewhere in between these two polar opposites. In fact, many – if not most – other types of psychotherapy are actually comprised of tenets of both supportive and insight-oriented psychotherapy

Depending on the client’s specific needs, as well as the degree of severity or complexity of the issues at hand, supportive psychotherapy may be a short-term intervention or a longer-term, ongoing form of treatment.

Who can Benefit from Supportive Psychotherapy?

Supportive psychotherapy can be helpful to a wide range of clients. However, it is especially ideal for the following types of individuals:

  • Those who are focused on surviving as opposed to self-actualizing (e.g. individuals with a chronic physical or mental illness and limited financial resources who are just trying to get through each day)
  • Individuals who are going through an acute crisis in their lives and doing their best to simply get through it
  • Individuals who currently lack a solid support system and are struggling to cope with a challenging situation
  • Individuals who would not respond well (e.g. it would cause more problems than it would be beneficial) to therapy designed to bring about any type of fundamental change

Underlying Principles

Over the years, supportive psychotherapy has come a long way and proven itself to be a truly potent, beneficial, and effective form of therapy in its own right. Early on, it was regarded by more traditional clinicians as an inferior approach to treatment. Therapists who provided this form of therapy were believed to offer little more than a warm smile and friendly demeanor to their clients. As a result, it was criticized as being too simplistic at its core.

However, that derogatory perception has changed significantly over the years. There’s much more to supportive psychotherapy than a warm, friendly therapist. Following are four ways in which the current practice of supportive psychotherapy differs vastly from expressive therapy:

  • Therapist style – In supportive psychotherapy, therapists are warm, genuine, empathetic, and conversational in their approach. In expressive psychotherapy, therapists are non-transparent and sometimes perceived (and experienced) as distant or aloof. (In all fairness, expressive therapists are generally supportive in the sense that they genuinely desire to help their clients, but it’s being supportive is not a primary goal).
  • Treatment goals – In supportive psychotherapy the primary treatment goals are to reduce suffering and improve the client’s coping skills; in expressive psychotherapy the primary treatment goal is insight into things such as the client’s internal conflicts and underlying motivations.
  • Unconscious issues – In supportive psychotherapy, only conscious issues are addressed, whereas in expressive psychotherapy, the unconscious provides a vast treasure trove of issues that needs to be explored.
  • Transference – Transference is a Freudian term that essentially refers to the feelings the client projects onto the therapist. In supportive psychotherapy, the goal is to nurture and reinforce positive transference. Transference is discussed only if it is negative. In expressive psychotherapy, however, transference must be thoroughly investigated and discussed.

Importance of the Therapeutic Alliance

The client’s rapport with the therapist is generally regarded as an important element in almost all forms of therapy. Without a sense of genuine connection and trust, the odds of therapy being successful are low. One of the reasons for this is because without that rapport and trust, clients are inclined to be resistant to the therapy process and ultimately drop out prematurely. After all, clients are expected to open up about deeply private and personal manners – things which they may not even share with their significant other or closest friend. Without a strong therapeutic alliance, it’s very difficult for many people to allow themselves to be that vulnerable. In fact, research has shown time and again that one of the most important predictors of the outcome of therapy is the therapeutic alliance.

In supportive psychotherapy, a very strong emphasis is placed on the relationship between therapist and client. Therapists strive to make their clients feel supported, understood, and safe. This particular form of therapy is about as non-threatening as they come. Therapists don’t “poke and prod” their clients for deeply personal information, or challenge or confront them as part of therapy. Instead, they work towards nurturing a warm, positive relationship with their clients. This, in turn, helps clients feel more inclined and comfortable working towards their treatment goals in collaboration with the therapist.

How Supportive Psychotherapy Works

Supportive psychotherapy works by helping clients make the necessary changes and tough decisions that will enable them to effectively cope with whatever challenging they’re facing. Challenges can include a wide range of things, such as the death of a loved one, a difficult life transition (e.g. getting divorced or changing jobs), dealing with a major setback, or learning to live with and manage a chronic physical or mental health condition.

As with many other types of therapy, the process starts by encouraging the client to talk freely and openly about how he or she feels about and views the situation. A strong sense of trust in the therapist, including his or her ability to genuinely understand what the client is feeling, helps facilitate this process. That being said, it’s also important that therapy clients trust that the therapist believes in them.

In many situations, clients must let go of some important aspect of their life – whether they want to or not – and adapt accordingly as they move on with their life. Supportive therapists help them through this difficult process. This is another reason why the therapeutic alliance is so crucial to supportive psychotherapy.

Five Crucial Elements of Supportive Psychotherapy

The reason that supportive psychotherapy is effective can be boiled down to five crucial elements:

Talking to the client in a conversational manner – In some forms of therapy, the therapist’s manner is anything but conversational. In fact, it may even come across as stilted, dry, or academic. Some clients have a difficult time relating to this type of therapist. When a conversational tone is used, it helps clients feel more comfortable with the therapist – as if they’re talking to a friend rather than a “doctor”, per se. This type of tone reinforces the therapeutic relationship.

Nurturing positive transference in the therapeutic relationship – As mentioned previously, a strong positive alliance between therapist and client is crucial in supportive therapy. Because of the empathetic and non-threatening style of supportive psychotherapy, it’s easy for most clients to have warm, positive feelings towards the therapist as time goes on. However, occasionally negative feelings (negative transference), like anger or frustration, develops for some reason or another.

When this occurs, it’s not the therapist’s job or goal to interpret them or dig deep into the client’s psyche to determine what triggered them. Rather, the therapist’s goal is to acknowledge and try to understand the client’s feelings, while striving to help the client work through them. Ideally, the negative feelings will dissipate, and positive ones will emerge.

Reduce suffering and anxiety – Although supportive therapists encourage their clients to talk about things that are painful or distressing, they don’t push them beyond a reasonably uncomfortable point. They do, however, strive to make it as comfortable as possible for their clients to open up about difficult topics. They also know they can always come back to it at a later time if needed.

Boost the client’s self-esteem – Low self-esteem is a fairly common problem in the general population, and even more so in therapy clients. Supportive therapists strive to build up their client’s self-esteem. Not only does this help them feel better in general, it also enhances their ability to handle stress and cope with difficult situations. Therapists work with clients to help them recognize and change negative and distorted self-perceptions, teach them to self-soothe, and use positive comments and compliments to enhance their clients’ self-esteem.

Reinforce and fortify healthy coping skills – The development and reinforcement of good coping skills is one of the primary goals of supportive psychotherapy. Therapists offer suggestions and help clients discover and practice strategies that work. Homework assignments may also be used to assist the client.

Benefits of Supportive Psychotherapy

Supportive psychotherapy offers many potential benefits for those who receive it. They include:

  • Greater flexibility
  • Improved coping skills
  • Increased adaptability to difficult events or situations
  • Improved self-esteem
  • Greater resilience
  • Increased emotional wellbeing and stability
  • Better relationships with others

It’s important to note that this is far from a comprehensive list. Rather, it’s just a few of the most salient benefits that can be gained from supportive psychotherapy.

Effectiveness

Supportive psychotherapy has been found to be effective in various studies. One prominent study that scanned a 25-year period looked at the results of over 40 individuals who were in one of three types of psychotherapy – supportive psychotherapy, psychodynamic (or expressive) psychotherapy, and psychoanalysis. The researchers found that the individuals who received supportive psychotherapy improved as much as those in the other two types of treatment.

Techniques Used in Supportive Psychotherapy

Following are several examples of techniques used by supportive psychotherapists. The specific techniques used with an individual will depend – as with other therapies – on the particular needs and goals of that individual. These techniques fall into four main categories:

  • Providing support
  • Skills building
  • Expanding awareness
  • Reducing anxiety
  • Esteem building

Supportive techniques include the following:

  • Building a strong rapport or alliance (this includes things like adopting a conversational style, showing genuine interest in the client, and being empathetic)

Skills building techniques include:

  • Giving advice to clients
  • Educating clients
  • Anticipatory guidance

Techniques that help expand clients’ awareness include:

  • Clarification
  • Confrontation
  • Providing interpretation – this, of course, is used in a very limited manner

Esteem building techniques include:

  • Encouraging clients
  • Offering reassurance
  • Normalizing situations and experiences

Techniques used to reduce anxiety include:

  • Reframing
  • Normalizing feelings and experiences
  • Encouraging rational thinking

Supportive Psychotherapy and CBT

Many therapists who offer supportive therapy utilize aspects of cognitive behavioral therapy into their treatment approach. CBT is one of the most widely studied and consistently effective treatments for a variety of disorders and problems. By essentially combining the two, the benefits of supportive psychotherapy are enhanced and increased. Some of the techniques listed above, such as normalizing and reframing, are commonly used by cognitive behavioral therapists. Additional techniques that come from CBT include:

  • Helping clients identify and understand the impact of their automatic thoughts
  • Gradual exposure to things that cause anxiety
  • Helping clients learn to become more assertive
  • The use of relaxation techniques such as progressive muscle relaxation, creative visualization,
  • mindfulness exercises, and slow deep breathing

Combining cognitive behavioral techniques with supportive psychotherapy can be especially effective.

Brief History of Supportive Psychotherapy

Supportive psychotherapy when expressive forms of psychotherapy were the most commonly used. It developed out of the need for a treatment approach that was suitable for individuals who weren’t appropriate for expressive therapy, or who failed to get better from that treatment approach. Many of these individuals included patients suffering from severe forms of mental illness, such as schizophrenia.

Instead of expressive therapy, they were merely offered supportive treatment. This basically consisted of efforts to encourage them and alleviate their anxiety. Unlike expressive therapists, who had extensive training in psychoanalysis and other types of expressive therapies, the clinicians who provided the supportive treatment typically didn’t have any particular training. They also had very low expectations for bringing about any real change in their patients. However, their patients often did improve – despite the therapists’ lack of training and formal structure or guidelines to the supportive treatment they provided.

Over the years, trained therapists have developed supportive psychotherapy to make it the widely used and effective form of treatment it is today. In fact, not long ago, education in supportive psychotherapy became a required part of a psychiatrist’s education.

Disorders and other Issues that can Benefit from Supportive Psychotherapy

Supportive therapy can be a very beneficial treatment for a wide range of psychiatric disorders, other condition and problems, and challenges in life that cause distress. Following are just a few of the disorders that can really benefit from supportive psychotherapy:

Psychotic Disorders – Psychotic disorders are often the most challenging and serious of all the psychiatric disorders. They include disorders such as schizophrenia, schizoaffective disorder, and delusional disorder. It’s not uncommon to think that psychotherapy wouldn’t be of much value in the treatment of psychotic disorders. And this may be true with certain types of types of psychotherapy. However, supportive psychotherapy can be very helpful for schizophrenic individuals as well as those who suffer from similar disorders.

With psychotic disorders, supportive psychotherapy is especially valuable in helping clients deal with the challenges of life that frequently accompany this type of illness. For example, it’s not uncommon for these individuals to struggle with the painful stigma of their mental illness, find it difficult or impossible to hold down a job, become isolated and lonely due to feeling disconnected from family and friends, and lose their ability to live independently.

A supportive therapist can help them find ways to cope with these challenges more effectively. The warm, caring, empathetic support from the therapist also gives clients someone to reach out to and trust, especially when psychotic symptoms – particularly paranoia, which makes trust extremely challenging – start to reappear. The strong therapeutic alliance that’s been developed enables the client to accept help that he or she might otherwise refuse.

One of the reasons this is so crucial for these individuals is because paranoia, delusions, and auditory hallucinations often lead clients to stop taking medication and going to treatment. Keeping them on their medication and in treatment can help offset the need for hospitalization, keep them out of harm’s way when they’re the most impaired, and help reduce the risk and severity of future episodes.

Bipolar Disorder – Bipolar, like schizophrenia, is often a lifelong disorder once the first symptoms appear. People with bipolar disorder can be significantly impaired, struggling with recurring bouts of depression and manic or hypomanic episodes. This often leads to many of the same challenges that individuals with psychotic disorders face – stigma, isolation, inability to maintain employment, and in severe cases, the inability to live on their own.

Supportive psychotherapy can help individuals with bipolar disorder benefit from the empathy and caring support that they may not get from others. They are able to talk openly and honestly about their disorder without feeling as if they’re burdening anyone. A supportive therapist can provide much needed guidance, help them develop effective coping strategies, and help them adapt as best they can to a challenging life situation.

Panic Disorder – Supportive psychotherapy can help individuals who struggle with panic attacks as well as panic disorder. Rather than offer solutions for eliminating the panic, supportive therapists help them work on decreasing stress in their lives that is triggering or contributing to the feelings of panic. Learning to cope and adapt are two ways that clients are better able to reduce their stress.

Specific Phobias – Specific phobias consist of things like an intense fear of dogs, heights, or flying. Sometimes individuals who experience phobias have more than one. Supportive therapy can help individuals overcome phobias by encouraging them to express their emotions related to the phobia and talk about the ways it interferes with their life. They allow the clients to lead the process as they assume a non-directive stance. This supportive and non-directive approach has been shown to help over 70% of clients with varying types of phobias, including mixed phobias.

Borderline Personality Disorder – Individuals with borderline personality disorder typically struggle with a multitude of challenges, including rocky or broken relationships, feelings of depression and anxiety, the consequences of anger outbursts as well as self-destructive and impulsive behaviors, frequent suicidal thoughts and behaviors, and a deeply-ingrained belief that they are a bad person.

Supportive psychotherapy can help these individuals by reducing their anxiety, providing a nurturing, positive relationship, improving and reinforcing their coping skills, boosting their self-esteem, providing reassurance when appropriate, confronting inappropriate behavior when necessary, and giving them guidance and advice as needed.

Several other disorders that can greatly benefit from supportive psychotherapy include:

  • Depression
  • Other personality disorders
  • Substance use disorders and relapse prevention
  • Dual diagnosis (individuals with a mental health condition and a substance use disorder)
  • Developmental disorders
  • Learning disabilities
  • Grief and loss / bereavement
  • Acute stress disorder
  • Post-traumatic stress disorder
  • Psychosomatic disorders
  • Anxiety disorders
  • Trauma recovery
  • Acute crisis intervention
  • Adjustment disorders
  • Stress related to chronic illness

Finding a Supportive Psychotherapist

It should be noted that many therapists describe themselves or their practice as “supportive.” However, that doesn’t automatically mean they offer the specific supportive psychotherapy discussed in this article. This can make it a little more challenging if you’re seeking this type of therapist. If you’re searching online for “supportive psychotherapy,” pay close attention to the descriptions provided by various therapists who show up in the results. In many cases, you’ll be able to distinguish those who use the term “supportive” as merely an adjective, and those who use it to describe this form of therapy.

Supportive psychotherapy can be beneficial in a variety of ways. Whether you’re suffering from a specific psychiatric disorder, going through an acute crisis, or on the journey of recovering from an addiction, supportive psychotherapy can help you navigate the challenges you’re facing. If you have any questions or concerns about the process, a consultation with a therapist who practices supportive psychotherapy can usually quickly address and alleviate them.

You really have nothing to lose with supportive psychotherapy. Granted, you won’t be attempting to resolve deep wounds from childhood or uncover unconscious conflicts that may be lurking in your psyche. But you will feel supported, cared for, and understood. Your self-esteem will likely improve, and your ability to cope with stress and other challenges will improve, and any anxiety you’re experiencing will likely decrease. And those are just some of the potential benefits of supportive psychotherapy!

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