Supportive Psychotherapy

Insight psychotherapy is an expensive, prestigious treatment conducted by a relatively few highly trained professionals. Supportive psychotherapy, on the other hand, is conducted, in a skilled fashion or naively, by everyone who cares about the patient and is willing to care for him/her. The methods of these psychotherapies are-different. The techniques of insight therapy include the interpretation of resistances, dreams, defense mechanisms, and transference reactions to the therapist, and, nowadays, may include specific prescriptions for particular anxiety states. The process is relatively prolonged.

The supportive therapist deals more superficially, perhaps, but more immediately with the daily events of his patient’s life. He appeals to the patient’s conscious mind, rather than interpreting his unconscious. Also he is interested not only in what his patient tells him, which is the exclusive interest of the psychoanalyst, for example, but in whatever else he can find out from the patient’s family and friends, and from everyone else. Treatment may continue as long or longer than insight psychotherapy, at infrequent and irregular intervals; or it may be very intensive over only a short period of time.

The indications for both treatments are also somewhat different. The patient deemed suitable for insight therapy is usually intelligent, motivated, relatively intact emotionally, and relatively well off financially, that is, able to afford the cost in time and money of treatment. Also such an ideal patient begins treatment, ideally, already inclined to thinking of himself or herself in psychological terms. The patient for whom supportive therapy is recommended is likely to be poorer, less capable, and sicker, perhaps psychotic—less able to tolerate the anxiety of looking at himself/herself objectively; but this need not be true.

In order to benefit from a supportive psychotherapy, someone need not he sick to any particular degree, nor does he need to have any special kind of illness. He can be depressed or schizophrenic or sexually disturbed—or neurotic. He may be in crisis, or he may be chronically ill. He need have no special social or intellectual qualification, or impairment. He can be anyone.

Finally, the therapist himself behaves differently, depending on whether he regards himself as doing insight or supportive psychotherapy. In insight therapy he thinks twice before saying anything, and certainly before giving advice. In order not to prejudice the patient’s remarks and attitudes, he tries to
introduce as little of his own attitudes as possible. He strives toward anonymity. When he is doing supportive therapy, on the other hand, he is active and involved. Since his patient may be too disturbed to cope effectively with day-to-day problems, the therapist will give advice. He speaks openly. He may describe his own feelings toward the patient, if his purpose is to reassure. He may speak of his own life in order to demonstrate a point. In short, he can be himself.

As is usual in psychiatry, however, these distinctions blur in practice. There are times when a patient in insight psychotherapy requires active intervention and support from the therapist—and there are times when a very sick patient can and will accept certain insights into himself. No treatment of the emotionally disturbed can be applied as a formula. The distinction between these two idealized forms of psychotherapy is drawn here only to underline the fact that supportive therapy, at least, as it has been described here, is not exclusively in the hands of psychiatrists or psychologists but is conducted by others also. Someone who lives with, or works with, an emotionally disturbed person is cast inevitably in the role of therapist. If he actively cares for that person, he is conducting a supportive psychotherapy.