Supportive Psychotherapy

Supportive vs. Exploratory Psychotherapy

Psychotherapy as a mode of treatment has gone through many phases and incarnations. Supportive psychotherapy is a body of techniques used to assist significantly distressed individuals in need of solid direct measures addressing their symptoms. This differs from expressive or exploratory psychotherapy which is usually reserved for “intact” clients, seeking to grow or enhance various aspects of their professional or personal lives. While these are very different approaches to counseling, they are often used in combination and should not be regarded as distinct or mutually exclusive.

Among the key differences between supportive and exploratory psychotherapy is their objective and underlying assumptions. Exploratory psychotherapy assumes unconscious conflicts while supportive psychotherapy is more reserved in these areas. Instead of trying to resolve past inner conflict, supportive psychotherapy focuses on the here and now, addressing specific symptoms and seeking measures that yield more adaptive behaviors.

Since most psychotherapy is geared toward the amelioration of specific symptoms, supportive psychotherapy (not exploratory) is more commonly used among today’s mental health professionals. It addresses the day-to-day hurdles of the psychologically impaired and uses systematic, evidence-based tools to address both personal and interpersonal issues. At its best, the framework of supportive psychotherapy through direct talk therapy offers individuals at various levels of impairment the opportunity and ability to learn, improve, and ultimately cultivate a more adaptive and productive lifestyle. The intervention methods utilized regularly by practitioners may seem simplistic, but in the therapeutic setting have consistently been shown to produce concrete measurable results.

Techniques

Offering praise to others can be tricky. If it is taken as a fake attempt at social gain it can easily backfire. When, however, it is genuine and grounded in the acknowledgment of real progress, praise can be very effective in reinforcing good behavior. Hence, the therapist’s use of praise must be measured and meaningful to have its desired effect.

A stunning example of ineffective praise can be derived from my current internship placement, where praise flows like water from the supervisors to the staff. It is exceedingly obvious that the words of praise are hollow and useless, almost a chore that needs to be done despite its failure to hit its target – every single time. After a long meeting of berating the staff for tedious crimes of commission and omission, Olivia (supervisor) will say something to the effect of “we know how hard you guys work and admire your dedication, it is truly appreciated…” One look around the room will tell you, this is not effective praise and probably should be avoided. Perhaps this kind of praise helps the staff know what not to do with their clients when it comes to praise…

Anticipatory guidance is something that I have seen many times effectively practiced throughout my internship. Simply put, this technique entails detailed conversations in advance about future, potentially distressing events or challenges. Anticipatory guidance comes in different forms. At our outpatient clinic during our high-risk assessment meetings a supervisor will help a social worker or doctor with anticipatory steps for upcoming interaction with clients. It is also seen when practitioners discuss how they plan to provide such guidance to their clients. This is a truly simple yet powerful tool that helps prevent disasters instead of trying to fix things after the fact. As noted in the text, this tool is particularly useful with substance abuse patients. I have seen anticipatory dialogue around substance abuse many times in meetings and recovery groups and would not be surprised if they have mitigated all sorts of undesirable occurrences. The example that comes to mind is when we discuss in our addiction recovery group what relapse looks like. The dreadful potential for the loss of self and the natural progression of events follow a relapse never fails to resonate. This kind of foreshadowing imbues the group participants with a keen motivation to maintain sobriety and healthy living.

Loosely based on:

Winston, Rosenthal, and Pinsker’s Introduction to Supportive Psychotherapy (2004) Chapters 1-3