AN INTRODUCTION TO SUPPORTIVE THERAPY (SI)

THE CONCEPT OF SUPPORTIVE PSYCHOTHERAPY

PRINCIPLES AND MODE OF ACTION ASSESSMENT,
CASE FORMULATION, AND GOAL SETTING

PRESENTER: EGLA WILLIAM FUGUSA

HD/MUH/T.239/2014
FA C I L I TAT O R : DR. HOGAN/ ISAAC

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 SHORT HISTORY OF SUPPORTIVE
PSYCHOTHERAPY
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The concept of supportive psychotherapy was
developed early in the 20th century to characterize
treatment approach with objectives more limited
than the objective of psychoanalysis.
The objective of supportive treatment as initially
defined, were not to change a patient’s personality
but rather to help a patient to cope with symptoms,
to prevent relapse of serious mental illness or to
help a relatively health person deal with a transient
problem

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In more recent years the domain of supportive
psychotherapy has become larger, reflecting changes
in the definition even more so, in practice of
psychotherapy.
Although customary explained in terms of its origin
in psychoanalysis, supportive psychotherapy is a
treatment approach that shares tactics and objectives
with medical management that is familiar to
physicians who are entering the specialty of
psychiatry.

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IDEAS PRESENT IN DEFINITION OF
SUPPORTIVE PSYCHOTHERAPY
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There are four ideas/themes. These are:

1) What the therapist hopes to achieve (objectives)
for example to maintain or improve the patient's
self esteem, to minimize or prevent recurrent of
symptoms and to maximize the patient’s adaptive
capacities, (Pinsker, et al, 1991)

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2) What the patient wants to achieve (goals). For

example to maintain or re-establish his/her best
possible level of functioning given the limitations of
his /her personality, native ability and life
circumstances (Ursano and Silberman, 1999)
3)What the therapist does (technique) for example
encouragement, reassurance, education and advise.
4) What is not – an exposition of elements of
expressive therapy that have been subtracted,
(Denald, 1964).

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In addressing the question of where supportive

psychotherapy fits among the many models of
psychotherapy, Rockland (1989) proposed the
acronym POST to signify “Psychodynamically
Oriented Supportive Therapy” explaining that all
psychotherapies involve both supportive and
exploratory interventions.

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Supportive Therapy is frequently used in non
psychiatric studies to denote the designation for an
approach that involves expression of interest,
attention to concrete services, encouragement and
optimism. This is supportive relationship or
supportive contact. Therefore
Supportive psychotherapy is defined as a dyadic
treatment that uses direct measures to ameliorate
symptoms and to maintain, restore or improve self
esteem, ego function and adaptive skills.

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Self esteem involves the patient’s sense of

efficacy , confidence, hope and self regard.
Ego functions include relation to reality, thinking,
defense formation, regulation of affect and
synthetic function.
Adaptive skills are actions associated with
effective functioning.

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 PRINCIPLES AND MODE OF ACTION
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PRICIPLES OF SUPPORTIVE PSYCHOTHERAPY

The professional relationship between patient and
therapist. This a the relationship between two adults
with common purpose. One provide a service that
the other needs, similar in most respect to all
professional relationship. The therapist owe the
patient or client respect, full attention, honestry and
vigorous effort to accomplish the stated purpose by
using the knowledge and skills of the profession.

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Staying within the boundary. In course of supportive

psychotherapy and supportive expression therapy the
therapist gives simple, direct answers to personal
questions, within the bounds of information that he/she is
willing to share with an acquaintance.
Disclosure of information that is ordinarily kept private is
often associated with violation of the boundary that must
separate the personal from the professional. When the
stance is primarily expressive the therapeutic strategy is
based on the assumption that the patient's thoughts about
the therapist will revel evidences of transference.

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Conversional style. Supportive Psychotherapy is
conducted in the conversational style. Because
conversation is the principle form of interaction
among adults, readers. Therapist task was not
listening silently to a patient who has been
instructed to “say whatever comes to the mind”.
To maintain supportive conversational style the
therapist must be responsive. In the act of
responding, therapist is giving something to the
patient.

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Maintaining and improving self -esteem. This is a

major concern of supportive psychotherapy.
Therapist helps to improve the self esteem of client
by conveying acceptance , approval, interest,
respect and admiration, this by communicate to
the patient by making it evident that he/she
remember their conversations, recalls what the
patient has said and is aware of the patient’s likes,
dislikes and attitudes.

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Defenses in the supportive approach defenses are
encouraged when they serve their unconscious
purpose –protecting the individual from anxiety or
other unpleasant affect. When therapy is primarily
expressive defenses are identified and examined to
discovering the underlying conflicts that made the
defenses necessary.

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Psychodynamic assumption. Psychodynamic is

the interactive between conscious and unconscious
element of mental life. It is an explanation of the
meaning of behavior.
One of the task of the psychotherapy is to create
order out of symptoms and dysfunctions.
To accomplish this task the patient and therapist
join in developing a history or narrative in which
these symptoms and dysfunctions make sense .
Cause and effect connection are established.

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In psychodynamic assumption there are
Unrecognized emotion. An assumption
of psychodynamically oriented therapies is that
unrecognized emotion are often responsible for
current unpleasant feelings or maladaptive
behavior. At times simply becoming aware of the
emotions may provide relief.
Maladaptive behavior, another tenet of
psychodynamically oriented therapy is that people
often follow patterns of behavior that were
appropriate when established but have become
maladaptive.
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Psychogenetics and early life experiences.
Psychodynamic explanation tell about the interplay of
factors in current life ; they do not explain the origin of
the of the forces, emotions or assumptions that affect
behavior. Psychogenetics is the search for these
origins.
The interpersonal and emotional experiences of early
life are important in the development of the individual
and his/her problems. Creating a meaningful
autobiography is in itself useful, because during the
process , what may have appeared to be random
events become connected into a meaningful story.
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 MODE OF ACTION
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Attempts to achieve the supportive psychotherapy

objectives of the improved ego function and
adaptive skills involves teaching, modeling and
anticipatory guidance.
People in general, not only patients respond to
teaching and instruction if they want to learn, if they
want to improve their a lot, and if they trust the
teacher.

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Education and instruction are potent agents for
bringing about chance in people’s lives. Advice
and instruction are most likely to be followed
when given by a person the individual trust and
respects.
The skillful therapists or teacher gives instruction
that is needed at the time when it can be absorbed
and used. What to consider is therapeutic
relationship or therapeutic alliance

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 CASE FORMULATION
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Case Formulation depends on an accurate and thorough

assessment of the patient.
The case formulation is an explanation of the patient's
symptoms and psychosocial functioning. The therapist’s
formulation govern what interventions will be used as well
as which issues in the patient therapist dialogue will be
selected for attention.
Having a sense of underlying issues at the start enhances the
therapists ability to respond empathetically. At the same
time, empathy for patient helps the therapist to guide and
plan therapy effectively and must be modified as more is
learned about the patient during the course of psychotherapy
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 Case Formulation Approaches.
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These are
 Structural,
 genetic,
 dynamic and
 cognitive behavioral.
Supportive psychotherapy uses elements of all these
approaches but differ in how these elements are used.
Example a patient’s conflict may be clearly
understood and formulated by the therapist but never
or only partially explored in psychotherapy.
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Structural Approach. This concentrates on fixed

aspect of individual’s personality within a functional
context; asses strength and weakness and overall level
of psychopathology.
Structural approach have several components which
deals with ego functions and superego functions.

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In ego functions there are
 relation to reality,
 object relations,
 affects,
 impulse control,
 defenses,
 thought processes,
 autonomous function(perception, intention,
intelligence, language and motor development) and
 synthetic function ( ability to form cohesive whole
or gestalt.
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Superego functions involves
 conscience,
 morals and
 ideals.
Genetic approach. This explores early development
and life events that may explain the patients current
situation.
Dynamic approach. It highlight the content of an
individual’s current conflicts and relates it to a
primary lifelong or core conflict; examines mental
and / emotional tensions that may be conscious or
unconscious. 02/13/2023
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Cognitive behavioral. This attends to individual’s

automatic thought (based on the persons core beliefs
or negative schemas) and how they can be addressed
to change thoughts, behaviors and moods.

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Behavioral case formulation model has the
following components:
 Problem list( including automatic thought)
 Core beliefs
 Origins
 Precipitants and activating situations
 Predicted obstacles to treatment and
 treatment plan

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 GOAL SETTING
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For patients requiring supportive psychotherapy,

organizing goals should be as follows
 Amelioration of symptoms,
 Improvement of adaptation,
 Enhancement of self esteem and
 Improvement of overall functioning

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Clear outlined goals helps motivate patients and

promote the therapeutic alliance as a patient and
therapist work toward a common end. The goal of
treatment should be derived from the patent’s
problem area so that motivate to change will be
enhanced and will promote therapeutic clarity.

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 Conclusion
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Assessment of the patient's problems symptoms and

character structure is critical for arriving at a
complete diagnosis, case formulation and treatment
plan. Case formulation should be comprehensive
encompassing structural, genetic, dynamic and
cognitive and behavioral approaches.

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 REFERENCES
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Winston. A, Rosenthal, R.N, Pinsker. H. (2012), Core

Compitencies in Psychotherapy: American

Psychiatric Publishing:Washington DC

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