The basic strategy of expressive therapies is the creation of a treatment situation that highlights the patient’s transference wishes and fears. The basic strategy of supportive therapy is to create an atmosphere of safety within which the patient can work with the therapist to overcome the internal and external obstacles that prevent achievement of the patient’s goals. The methods of supportive and expressive psychotherapy differ consonant with their differing goals. Behavioral change for the better is seen as a consequence of developing such insight. Verbalized insight, as well as adaptation, is a criterion of therapeutic success in expressive therapy, where the overall goal can be described as a general expansion of patients’ awareness of their inner life and of its manifestations in current feelings and fantasies. In expressive therapy, the therapist’s goal does not include maintenance of functioning, because patients referred for expressive treatment are usually seen as able to function on their own with only brief regressions during treatment. The latter is often referred to as “adaptation,” a somewhat confusing term that often arouses the question, “adaptation to what?” The answer to this question is adaptation to whatever is irremediably limited by the patient’s circumstances. ![]() ![]() The goals of supportive therapy can vary from restoration and maintenance of functioning to fulfillment of whatever may be the individual’s capacities for happiness and healthy living. Granting that in everyday practice the distinction between the two therapy approaches is less sharp than it is in theory and that skillful therapists typically mix the two methods as indicated, it may be helpful to sketch out the theoretical differences between the two approaches as they are applied to the treatment of patients with personality disorders. Psychoanalytically informed supportive therapy is defined by its goals, its method, and its techniques because these differentiate it from expressive therapy. From the point of view of an outside observer (e.g., consultant, supervisor, researcher), a therapist is seen as providing supportive psychodynamic psychotherapy when he or she acts according to accepted practice principles by applying some specific techniques and avoiding others. The concepts that guide the therapist are those of current psychoanalytic theory as it has been enriched by theories of object relations, attachment, ego psychology, self psychology, and developmental observation.Īlthough patients may experience as supportive any measure that relieves anxiety, dynamic supportive psychotherapy is defined by psychoanalytic principles and certain techniques employed to implement them. Psychoanalytically informed therapists provide reassurance, encouragement, active teaching, comforting, and a host of other interventions that they regard as “appropriate” on the basis of a dynamic understanding of the unconscious processes underlying the patient’s distress and the therapist’s reactions. ![]() Yet even the most mature people lose their ability to provide support from within when they are excessively scared or in pain, and the treater must assess the level of distress and respond to it appropriately. They can forgive the grossest rudeness (or at least accept it) by making excuses for the doctor (“He is so important and busy that he can’t be expected to conform to ordinary courtesy”). Basically healthy patients provide their own support by assuming the treater they have sought out is competent and has their best interests at heart. Failure to provide this support spells failure of the attempt at treatment. Anyone seeking to help a patient with psychotherapy must provide support of the kind and in the amount the patient needs.
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