Living in the current climate of evidence-based treatment, a multitude of psychotherapies have gained credibility because of positive findings in research studies, such as Cognitive Behavioural Therapy (CBT), Interpersonal Psychotherapy (IPT) and Dialectic behavioural therapy (DBT), just to name a few. It is not uncommon for clients to request for a specific modality of therapy that they had read on the internet. But rarely do clients come requesting specifically for Supportive Psychotherapy, one that is most frequently used in the real world of everyday clinical practice.
What is Supportive Psychotherapy?
Supportive Psychotherapy was once described by Jeremy Holmes (1995) as “the poor relation of the psychotherapies, a Cinderella stuck at home doing the routine psychiatric chores while her more glamorous psychotherapeutic sisters are away at the ball”. It is a misconception that supportive psychotherapy requires no special training or abilities beyond common sense, interpersonal skills, and a capacity for empathy. Experienced therapists use a mix of supportiveness and expressiveness matched to the particular needs of the individual client at specific moments in the treatment. The most effective therapists are those who are able to improvise and switch strategies flexibly in the immediate clinical moment, which mostly requires tincture of time, clinical experience, and personal maturation.
The main priority in supportive psychotherapy is to build a “holding environment” and foster an atmosphere of emotional safety and trust. This involves respecting and responding to the client with compassion, empathy and commitment, even if the therapist does not agree or endorse the client’s behaviours or thoughts. One of the goals in supportive therapy is to balance appropriate “containment” of the client’s negative emotions while promoting autonomy and independence. The supportive therapist works with the client to recognise, acknowledge and express one’s inner life through clarification of vague speech; and to tolerate and regulate a broader range of emotions. The therapist may use suggestions, advice or teaching to guide the client to see things from different perspectives but it is never imposed. Decisions are never made on behalf of the client. Instead, the therapist enlists the client’s input to clarify and develop shared goals, including the search for positive meaning, on their journey together. Existing adaptive coping skills are encouraged by the therapist, who also models more effective ways of coping to limit self-destructiveness and impulsivity. Beyond supporting a sense of safety, self-esteem, or hope, the supportive therapist also helps the client to improve on their interactions with others. This involves helping them to strengthen control over socially unacceptable behaviours, and to build healthier connections with others, both in and outside of therapy.
The supportive therapist treats the client the way they would want to be treated. Beyond active listening, the supportive therapist brings attunement, patience, effort, and an open and inquisitive mind into the therapeutic space.
MClinPsych, BA (Hons)
J. Holmes (1995). Supportive Therapy. The Search for Positive Meaning. The British Journal of Psychiatry, 167, 439-435.