What Is Supportive Psychotherapy?

The narrow definition of supportive psychotherapy is a method based on psychodynamic theory that uses methods such as advice, counselling and encouragement to treat patients with severe psychological impairment. The therapist's goal is to maintain or enhance the client's self-esteem, minimize or place recurrence of symptoms, and maximize the client's adaptability. The goal of the client is to maintain or reconstruct the highest possible level based on his innate personality, talents and living environment ^[1] . Its broad definition is a widely applicable treatment method, and it is the most commonly used individual psychotherapy.

Yu Honghua	(Attending physician)	Department of Clinical Psychology, Beijing Huilongguan Hospital
Liu Huaqing	(Chief physician)	Department of Clinical Psychology, Beijing Huilongguan Hospital

Supportive psychotherapy originated in the early 20th century. It is a treatment method that has more limited treatment goals than psychoanalysis. Its goal is to help learn to cope with symptoms and prevent more severe mental illness. For relatively healthy people, supportive psychotherapists help them deal with some temporary difficulties. Psychoanalysis aims to help counselors to grow and make them aware of the symptoms of subconscious conflict, which can be eliminated through cultivation.

Basic introduction to supportive psychotherapy

Basic principles of supportive psychotherapy

The basic principle of supportive psychotherapy is dual therapy, which directly improves symptoms on the one hand; in addition, maintains and rebuilds self-esteem or improves self-confidence, self-function, and adaptive skills. To achieve the goal, the therapist needs to examine the client's actual or empathic relationships, as well as past and current patterns of emotion or behavior. Support the patient's defense through the direct observation of the patient (usually coping with difficult situations), reduce the patient's anxiety, and increase the patient's ability to adapt.

The psychological impairment of the client is usually divided into severe impairment, moderate impairment and mild impairment. The corresponding psychological treatment methods are supportive, support-expression, expression-support and expressive psychotherapy. .

An important difference between supportive and expressive psychotherapy is that supportive psychotherapy generally does not discuss empathy, and treats empathy as a relationship; the therapist will encourage patients to express positive feelings, if the client expresses a positive Feelings, the therapist will accept without trying to help the patient understand why he has this feeling. In expressive psychotherapy, empathy analysis is one of the main ways to understand the inner world of counselors.

Supportive psychotherapy case

Interviewer: Your thinking about things is always clear. I always get in trouble, and you always know where the problem is and how to fix it.

Therapist: Thank you. Everyone is always easy to say but hard to do. (Supportive psychotherapy)

Consultant: I think it's getting harder and harder to get here on time. Something always comes up at the last minute. I'm sorry I'm late.

Therapist: We can change your treatment time to make it easier for you to come here on time, but I think the reason why it may be more and more difficult to get here on time is that you start to hesitate to continue to receive treatment. (Expressive psychotherapy)

In supportive psychotherapy, therapist can comfort, soothe, encourage, nurture, tolerate, restrict settings, and self-destructive behaviors like "good parents." Therapeutic alliances (the relationship between the patient and the therapist) are considered to be very effective elements of treatment, but they need to be discussed only if there is a problem with the therapeutic relationship and the treatment may be disrupted.

Goals and Basic Models of Supportive Psychotherapy

Dialogues in supportive psychotherapy are interactive, and the therapist needs to listen or wait for what the client will say next, but not too long. The therapist must not only care and accept the client, but also give the client something by responding to the client. A wise, opinionated person gives the counselor satisfaction and reassurance.

The basic principle of dialogue talks is to use the interactive relationship between the client and the therapist as one of the treatment tools. In supportive psychotherapy, the relationship between the client and the therapist is a relationship that two adults have a common goal. The therapist as a professional must have respect for the client and full attention and integrity. And hard work, the therapist uses professional knowledge and skills to achieve the set goals. The positive therapeutic relationship and the therapist make the client feel that the therapist is guiding the client to improve, which will directly reduce the client's sense of helplessness. In supportive psychotherapy, defenses that serve subconscious goals are often supported or ignored to protect clients who are anxious or have other unpleasant emotions. Unlike expressive therapy, the therapist will not adapt to the counselor's adaptive defense style. Supportive psychotherapy helps clients achieve treatment goals that improve self-function and adaptive skills through education, encouragement, counselling, demonstration, and anticipatory guidance.

Psychodynamic theory refers to the interaction between the conscious and subconscious parts of a person's mental life, and is an explanation of the meaning of human behavior. Therapists usually understand patients from symptoms and dysfunction. For example: A healthy, freshman student in college, for the first time returned home from college to celebrate Mother's Day for her mother. When she left home, there was a big dispute with her parents because of a small matter, and she was very angry before leaving. He didn't realize that part of him actually wanted to stay at home (depending on his family). By leaving home with anger, I protected the part I wanted to stay at home from feeling sad because I had to leave home.

In this case, an important hypothesis of psychodynamic therapy is that unconscious emotions cause current unpleasant feelings or unsuitable behaviors. These emotions are believed to help alleviate these unpleasant feelings and unsuitable behaviors, but Recognizing these hidden emotions is usually not enough. Decisions on how to respond more effectively need to be made at the conscious level, that is, the focus of supportive psychotherapy to help counselors acquire adaptive skills.

Supportive psychotherapy case

Consultant: I asked the guy who lives next to me to go to the mall with me, but he said there was no time. He doesn't want to do it more than I do.

Therapist: How do you feel?

Consultant: I can do it. He doesn't have to be so. (Refuses, denies his emotional response)

Therapist: You're right, he doesn't have to. You're right. (Commendation) But I asked you how you feel, and you gave me your analysis. (Face; implicitly ask questions)

Consultant: I don't feel anything.

Therapist: Many people will be disappointed or angry about what you said-although this feeling does not control others, it is important to understand how you feel, otherwise you cannot do things that affect yourself Make a good decision. (Teach, normalize)

Supportive psychotherapy interventions

When we support someone, we use a variety of strategies to help them avoid various dysfunctions, and we want them to get better. Purely supportive technologies, such as praise, assurance, and encouragement, are primarily designed to promote patients' self-esteem. The therapist expressed acceptance, respect and attention to the patient through his own attitude. At the same time, the therapist always demonstrates to the patient adaptive, reasonable and good behavior and thinking.

Supportive psychotherapy praise

Giving enough praise is a very good supporting technology in itself. It should be noted here that praise is a strengthening stimulus for adaptive behavior, provided that the patient agrees with the praise. For example, "Tell your mother that you always know that you are annoying. This is a good step. What do you think?" False praise is worse than saying nothing. Hypocrisy and deception are not good for good relationships.

Case:

Patient: As soon as she walked into my room this morning, she said, "Why are you still in bed?" She didn't respect me, and I knew my mother was abnormal at the age of 15.

Therapist 1: You explained very well.

Therapist 2: It's not easy for you to say these things. You did a lot of hard work.

Praising something that a patient feels bad will do the opposite.

Case:

Patient: I feel terrible. Did nothing at home.

Therapist: Did you do anything other than sitting at home last week? (See details)

Patient: Oh, watch a movie ...

Therapist: Very good! (The therapist does not understand what this behavior means to the patient and should seek further feedback to understand the thoughts and feelings that accompany this behavior)

Supportive Psychotherapy Guarantee

The guarantee is a sincere attitude, and the patient must feel that the therapist understands his or her particular situation. And make sure that the therapist's professional competence. "Normalization" is an appropriate assurance technique for most people.

Case:

Patient: I was very sad when my grandmother died, but I didn't even cry.

Therapist: This is normal. This state is also a sad reaction.

In addition, proverbs and maxims are another form of "normalization", such as "don't do anything to others you don't want."

Supportive psychotherapy encouragement

People always expect hard work to be rewarded and encouragement to evoke memories. Advice is another type of encouragement.

Case:

Patient: I have a good appetite and I can sleep well, but there is no way to do things.

Therapist: A frustrated person always feels that hard work is futile, so he doesn't want to try to do things. To get rid of this feeling is to force yourself to do things, even if you don't like it. Taking the first step is not easy. Once you take the first step, it is not far from success.

Another meaning of encouragement is "give hope."

Case:

Patient: Last week I only watered my potted plants and weeded them. My mood is terrible.

Therapist: One of D's most serious manifestations is making people pessimistic and hopeless. Those good things in the past are just used to prove how bad you are now. This is the symptom of the disease itself. For you now, just do what you can. Making a little change, a small improvement is good enough.

Rationalization and reconstruction of supportive psychotherapy

Rationalization and reconstruction is to help the client to see things from different perspectives. In rationalization and reconstruction, attention should be paid to avoid sudden feelings, and at the same time to avoid disputes or contradictions.

Case:

Patient: My son's room is always a mess. It's terrible.

Therapist: You know this is the case for 15-year-old boys. What causes you to know this clearly but cannot accept it?

Supportive psychotherapy recommendations

Therapist advises patients to satisfy dependent patients, but may deprive them of opportunities for growth. In the following example, the therapist 2's recommendation is more effective than the therapist 1's:

Therapist: You should exercise regularly.

Patient: Why?

Therapist 1: Everyone should. Obesity is harmful to health.

Therapist 2: Many studies have shown that exercise can improve symptoms of depression. It can reduce the dosage of the medicine. Even if you do it without effect, nothing will be lost.

It only makes sense if the patient thinks that the therapist's advice is relevant to their needs. For patients with severely impaired functions, appropriate advice should be given on daily life:

Case: When getting up in the morning, you should get dressed and make the bed. It is important to form a regular life.

Only recommendations based on the facts given to the patient's report or statement are appropriate and effective.

Anticipatory guidance in supportive psychotherapy

Advance drills or anticipatory guidance techniques are also effective in supportive psychotherapy. The purpose is to study the corresponding coping strategies by considering in advance what problems or obstacles may be encountered in future practical actions. Anticipatory guidance technology is especially important for patients with chronic schizophrenia, because these patients are more likely to worry in new situations, lack confidence in some social cues and their own behavioral responses, fear of being rejected, and have difficulty sticking to it.

Supportive psychotherapy reduces and prevents anxiety

Care should be taken to avoid asking questions in an interrogative manner. You can first tell the patient about the purpose of the inquiry or examination to minimize patient anxiety:

Therapist 1: I want to ask some questions to check your memory and attention.

Therapist 2: Do you say that you are mainly worried about your relationship with your daughter, do you have any new problems?

Therapist 3: Did you feel sad when your father died? Some people don't respond very well, which is fine. Some people did not respond at the time, but in fact there was sadness deep in their hearts that could not be expressed.

Telling patients in advance what may cause anxiety during treatment is an effective technique to minimize the anxiety of patients during treatment.

Case: Just now you had to interrupt because the topic we were discussing upsets you. Now I want to go back to that topic again. I wonder what happened when your mother remarried and your stepfather's children moved into your house?

The therapist asks the patient's consent whether to continue to discuss topics that may cause anxiety, which can avoid aggravating the patient's anxiety. For example, you can ask the client "Do you think we can continue to discuss this topic?"

Supportive psychotherapy expands patient awareness

Expanding the patient's consciousness actually uses some techniques of expressive therapy, such as clarification, that is, summarizing, explaining or organizing what the patient says. Facial means to make the patient aware of behaviors, thoughts, and emotional patterns that he is not aware of or trying to avoid. Elaboration. Some researchers believe that the job of elaboration is to link the patient's current emotions, thoughts, and behaviors to past events or relationships with the therapist.

Supportive psychotherapy indications and contraindications

Supportive psychotherapy indications

Various states of crisis. People with normal function and adaptability, who have problems only when facing acute, great or unusual stress, are more suitable to receive supportive psychotherapy in crisis. Including acute crisis, adaptation disorder, physical illness, substance abuse disorder, sudden bereavement, and alexithymia ^[2] . Chronic disease is another indication for supportive psychotherapy.

Contraindications to supportive psychotherapy

There is no effect on delirium, other organic mental disorders, drug poisoning, and any psychological treatment in the late stages of dementia. For TOURETTE syndrome, acute adolescent depression, panic disorder, obsessive-compulsive disorder, and bulimia nervosa cognitive behavior therapy is more effective.

Supportive psychotherapy treatment relationship

In supportive psychotherapy, the basic principle of maintaining a good therapeutic relationship is to maintain the therapeutic alliance. In supportive psychotherapy, the positive emotions and positive empathy toward the therapist are generally not discussed. However, in order to be able to anticipate and avoid the destruction of treatment, you need to be alert to alienation and negative reactions during treatment. When the patient-therapist problem cannot be solved through clinical discussion, the topic of treatment should be shifted to the therapeutic relationship. During treatment, non-explanatory methods such as clarification and facial quality can be used to correct the distorted ideas and concepts of patients. If indirect methods still fail to resolve negative empathy or treat an impasse, the therapist should discuss the treatment relationship in a more direct and clear way. Only when dealing with negative empathy is it necessary for the therapist to use appropriate expressive techniques.

A good therapeutic alliance allows patients to listen to what the therapist is saying, and once someone else says so, the patient will not accept it. Sometimes when the therapist expresses opinions that make patients feel criticized, they must express them in a pleasant or supportive manner, or give advance guidance.

Expert opinion on supportive psychotherapy

Supportive psychotherapy has been considered for many years for patients who are not suitable for expressive psychotherapy, such as:

(1) Primitive defenses dominate (such as projection and denial);

(2) Lack of ability to establish mutual relations and reciprocity;

(3) No introspection ability;

(4) The self cannot be separated from the object due to severe narcissism or autism;

(5) Insufficient emotional regulation ability, especially more aggressive;

(6) Physical form issues;

(7) Excessive anxiety related to separation and individualization problems, and separation anxiety.

But research shows that patients receiving supportive psychotherapy can achieve greater than expected gains and can produce lasting personality changes. Even for patients with better functions suitable for expressive therapy, supportive therapy can also reduce their complaints and improve their mental symptoms, and patients can develop differentiation and family differentiation through interaction with the therapist in supportive psychotherapy. Adaptive self. So in fact, the scope of supportive psychotherapy is very wide ^[3] .