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Am J Psychother. 1994 Fall;48(4):505-18.

Principles of supportive psychotherapy.

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St. Louis University School of Medicine, MO.


I have attempted to survey and outline the conceptual differences between expressive and supportive forms of psychotherapy based on the construct of a spectrum with these forms of treatment at each end. As one moves toward the middle of the spectrum, the situation becomes more difficult to define and, to a certain extent, elements of each may be present in the other form of treatment. However, the more that the therapist can consistently maintain an understanding of the differences between these forms of therapy, and the more consistently he or she can apply them in terms of the tactics and the technical interventions used, the more likely is it that the goals of the treatment process will be achieved. If there is too much overlap or if too much confusion exists between the different strategic approaches (and the appropriate tactics involved), the therapist may inadvertently reinforce disturbed and regressive behavior; or the therapist may inadvertently keep the patient from benefiting optimally from the kind of treatment that has been undertaken. There is no way to catalog or describe all of the different available types of intervention, but it is possible to generalize and conceptually predict what the effects are likely to be given the nature of the treatment process being undertaken. The vast majority of psychiatric patients will probably make use primarily of supportive elements in the treatment experience and only a relatively small proportion of the total population will be optimally helped by an expressive treatment undertaking. It therefore becomes necessary to use creative and consistently organized ways of being supportive and to base the choice of tactics on the psychodynamic understanding of the strategy and technique of the therapeutic process.

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