Academic journal article American Journal of Psychotherapy

Support and Psychotherapy

Academic journal article American Journal of Psychotherapy

Support and Psychotherapy

Article excerpt

In recent years the psychiatric and psychoanalytical literature has expressed increasing interest in supportive therapy, which has long been considered rather disparagingly as a "lesser form" of psychotherapy. At the same time there has been much reflection on the significance and role of support in various therapeutic settings, outside the formal psychotherapeutic context. A review of updated literature shows, on the one hand, a general appreciation of the idea of support, as an acknowledged component of any therapeutic action. On the other, in the area of psychoanalytic-oriented therapies, there is still debate on the status of supportive psychotherapy, and particularly on the relations between supportive and explorative variants. The eclecticism of supportive therapy and the lack of consensus on its theoretical bases are reviewed in an attempt to develop theoretical/clinical models as the foundation for supportive measures. These potential models would greatly facilitate the transmission and technical application of supportive measures in clinical work. Further research is needed to define the theoretical underpinnings of supportive therapy, establish its origins, the pattern it should take in different therapeutic settings, its potential and limits.

INTRODUCTION

What strikes one first on looking through the literature on psychoanalytic psychotherapy is how much more numerous, explicit and "technical" the publications are that deal with the explorative or expressive variants of psychotherapy than are those about supportive therapy. This is because the former are much more like psychoanalysis itself. It is in fact in relation to psychoanalytical therapy and its goal to understand in depth that one should perhaps view the frequently disparaging attitude taken by many authors who dismiss supportive therapy as a "lesser art" which requires little technical ability and achieves limited therapeutic results.

In the last decades, however, there has been some shift in this still widely held opinion (1,2).

Various reasons are given for the growing interest in supportive therapies. There is a broad spectrum of clinical indications, including some serious pathologies where psychoanalysis and the more exploratory approaches might even be contraindicated, beside a more general consideration of economy (3). Attempts to define "the informal psychotherapeutic content of their contact with patients" (4) have certainly contributed to an examination of the utility of supportive therapy, which is now an acknowledged presence in a wide range of therapeutic and assistance settings.

We made a critical study of the literature based on a Medline search, on supportive approaches and the psychotherapy that is largely inspired by them. This literature, though not large, is recent and offers numerous points of interest despite its contradictoriness and incompleteness.

Support as a Gtoundstone of Psychotherapeutic Practice

The literature contains many statements that psychotherapies-whatever their theoretical-technical slant-contain significant, fundamental supportive elements (1-6), but these statements are not always developed as rigorously as they deserve.

Using an evocative image, Winston et al. (1) state that "a supportive relationship is the necessary cement for any therapeutic work, whether expressive or otherwise." Holmes (4), more recently, described support as "an implicit component of all psychotherapies," comprising "the regularity, reliability, and attentiveness of the therapist towards the patient, and the working alliance between them."

Therefore virtually a dual treatment pathway is present, illustrated clearly by the distinction made by De Jonghe et al. (6) between "supportive attitude" and "supportive technique." Further on we shall return to some technical questions. Here we want to underline that the idea of "a supportive attitude refers to aspects of the therapist's behavior that are present implicitly. …

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