Psychodynamic supportive psychotherapy

Domain I · Psychodynamic & depth psychology · Winston, Rosenthal, Pinsker · 1988 · New York

What it is

Supportive psychotherapy is a dyadic treatment that uses "direct techniques to ameliorate symptoms" and to maintain, restore or improve self-esteem, ego functions and adaptive skills. It is psychodynamically informed: the therapist thinks in terms of conflict, defense, ego function, transference…

Format

• Format
• Face-to-face and conversational. Frequency and length are flexible: from a single session to lifelong, and less than weekly is acceptable for stable chronic patients.

Who practises it, and how they are trained or regulated

• Assess: symptoms (with rating scales); history; relationship capacity; trauma and stressors; previous treatment and why it stopped; ego functions (reality testing, affect and impulse regulation, defenses, thinking, synthesis); self-esteem; adaptive skills before and after onset; collateral information with consent.
• How change happens. (a) A safe, positive alliance, the best single predictor of outcome, lowers anxiety and lets the patient borrow the therapist's ego functions (reality testing, problem-solving, affect regulation). (b) Adaptive defenses are strengthened and maladaptive ones are discouraged, without interpreting their unconscious roots. (c) Self-esteem rises through honest praise and real mastery, and adaptive…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• the patient sees a pattern for themselves.
• the patient begins making links independently.
• the patient arrives having already solved a problem.
• doing for the patient what they could do themselves.
• lasting dependence. The lending is meant to be temporary.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.