Therapists' Responses to Training in Brief Supportive Psychotherapy
Markowitz, John C., Manber, Rachel, Rosen, Phyllis, American Journal of Psychotherapy
There is little research addressing supportive psychotherapy training. This article describes training clinicians in a form of brief supportive psychotherapy (BSP) for a multisite depression study, and reports on a survey of therapist attitudes toward BSP. We hypothesized that while most therapists would report acclimating to BSP, cognitive-behavioral therapy (CBT)-trained therapists would report greater frustration with BSP. Sixteen (89%) of 18 therapists completed a brief questionnaire. Therapists reported gaining comfort with supportive concepts and interventions. Therapists with cognitive behavior therapy orientations did not report significantly greater frustration with intervention restrictions. All practitioners indicated they were already using or were planning to use BSP outside the study, and that BSP training had altered their appreciation of psychotherapy. Most study therapists lacked prior supportive therapy training but reported adapting to BSP and appreciating its strengths and limitations.
Psychotherapy research requires training therapists to proficiency, or competence, in delivering relatively homogeneous, manual-based treatment. Although this training provides the foundation for the validity of psychotherapy studies, it has received relatively little attention in the literature. The few reports documenting the training of research psychotherapists have focused on training therapists in the preferred, specific, experimental treatment cell of a randomized trial (e.g., cognitive behavioral therapy [CBT], interpersonal psychotherapy [IPT], supportiveexpressive psychodynamic psychotherapy), rather than the control condition (Weissman, Rounsaville, & Chevron, 1982; Rounsaville, Chevron, Weissman, Prusoff, & Frank, 1986; Dobson & Shaw, 1988; Crits-Christoph et al., 1998).
To control for therapist contact and nonspecific elements of attending treatment, psychotherapy trials increasingly compare an experimental treatment to another form of psychotherapy, rather than to a waiting list. Among the more robust examples of a psychotherapy control condition is brief supportive psychotherapy (BSP), which has been used as a comparator in several randomized controlled outcome trials. Brief supportive psychotherapy involves the "common factors" of psychotherapy (Frank, 1971), which constitute the core of all therapies and have been credited with most of the outcome variance of efficacious specific therapies such as CBT and IPT (Wampold, 2001; Zuroff & Blatt, 2006). These common factors include emotional arousal, an understanding and empathie therapist, a structure and ritual to the treatment, success experiences, and provision of therapeutic hope and optimism. These factors are sufficiently active that BSP has at times worked "too well" as a control condition, keeping pace with more elaborate treatments (e.g., Markowitz, Kocsis, Bleiberg, Christos, & Sacks, 2005; Hellerstein, Rosenthal, Pinsker, Samstag, Muran, Sc Winston, 1998; Mclntosh et al, 2005). Hence, it has been proposed not only as a control condition, but also as a treatment of choice (Hellerstein, Rosenthal, & Pinsker, 1994).
Supportive psychotherapy has a long and somewhat checkered history, and it has meant different things to different therapists at different times. It was initially a descriptor for the lesser sort of psychodynamic psychotherapy used to treat patients who were not candidates for psychoanalysis. Several clinical models and research manuals for supportive therapy now exist (Novalis, Rojcewicz, & Peele, 1993; Pinsker, 1997; Rockland, 2003; Appelbaum, 2006). Yet treatments like BSP have received little attention in their own right, and training in such treatments has received still less. A recent issue of Psychotherapy Research (2006, Volume 3) devoted to training of psychotherapists largely ignored common factors treatments such as BSP, albeit "alliance-fostering psychotherapy" may be a related approach (Crits-Christoph, Gibbons, Crits-Cristoph, Narducci, Schamberger, & Gallop, 2006). …