Supportive Psychotherapy Versus Interpersonal Psychotherapy Essay

Supportive Psychotherapy Versus Interpersonal Psychotherapy Essay

Although supportive psychotherapy and interpersonal psychotherapy share some similarities, these therapeutic approaches have many differences. When assessing clients and selecting therapies, it is important to recognize these differences and how they may impact your clients. For this Assignment, as you compare supportive and interpersonal psychotherapy, consider which therapeutic approach you might use with your clients.Supportive Psychotherapy Versus Interpersonal Psychotherapy Essay

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Learning Objectives
Students will:
Compare supportive psychotherapy and interpersonal psychotherapy
Recommend therapeutic approaches for clients presenting for psychotherapy
To prepare:

Review the media in this week’s Learning Resources.
Reflect on supportive and interpersonal psychotherapeutic approaches.
The Assignment
In a 1- to 2-page paper, address the following:

Briefly describe how supportive and interpersonal psychotherapies are similar.
Explain at least three differences between these therapies. Include how these differences might impact your practice as a mental health counselor.
Explain which therapeutic approach you might use with clients and why. Support your approach with evidence-based literature.

Infertility is strongly associated with depression, yet treatment research for depressed infertile women is sparse. This study tested for the first time the feasibility and preliminary efficacy of interpersonal psychotherapy (IPT), the evidence-based antidepressant intervention with the greatest peripartum research support, as treatment for depressed women facing fertility problems. Patients who met DSM-IV criteria for major depressive disorder of at least moderate severity were randomized to either 12 sessions of IPT (n = 15) or brief supportive psychotherapy (BSP; n = 16), our control intervention. Eighty percent of IPT and 63 % of BSP patients completed the 12 sessions of therapy. Patients in both treatments improved. IPT produced a greater response rate than BSP, with more than two-thirds of women achieving a >50 % reduction in scores on the Montgomery-Åsberg Depression Rating Scale (MADRS). IPT also tended to have lower posttreatment scores on the Beck Depression Inventory, Clinical Global Impression-Severity Scale, and anxiety subscale of the Hamilton Depression Rating Scale, with between-group effect sizes ranging from 0.61 to 0.76. Gains persisted at 6-month follow-up. This pilot trial suggests that IPT is a promising treatment for depression in the context of infertility and that it may fare better than a rigorous active control condition. Should subsequent randomized controlled trials support these findings, this will inform clinical practice and take an important step in assuring optimal care for depressed women struggling with infertility.Supportive Psychotherapy Versus Interpersonal Psychotherapy Essay

These findings are important as they suggest that patients with depression should discuss different forms of non-drug therapy with their doctors and explore which type of psychotherapy best suits them.

The researchers, led by Jürgen Barth from the University of Bern in Switzerland, reached these conclusions by reviewing 198 published studies involving over 15,000 patients receiving one of seven types of psychotherapeutic intervention: Interpersonal psychotherapy, behavioural activation, cognitive behavioural therapy, problem solving therapy, psychodynamic therapy, social skills training and supportive counselling.* The authors compared each of the therapies with each other and with a control — patients on a waiting list or continuing usual case — and combined the results.

The authors found that all seven therapies were better at reducing symptoms of depression than waiting list and usual care and that there were no significant differences between the different types of therapy. They also found that the therapies worked equally well for different patient groups with depression, such as for younger and older patients and for mothers who had depression after having given birth. Furthermore, the authors found no substantial differences when comparing individual with group therapy or with face-to-face therapy compared with internet-based interactions between therapist and patient.

The authors say: “We found evidence that most of the seven psychotherapeutic interventions under investigation have comparable effects on depressive symptoms and achieve moderate to large effects vis-à-vis waitlist.”Supportive Psychotherapy Versus Interpersonal Psychotherapy Essay

They continue: “All seven psychotherapeutic interventions achieved a small to moderate effect compared to usual care.”

The authors add: “Overall, we found that different psychotherapeutic interventions for depression have comparable, moderate-to-large effects.”

Notes:

*”Interpersonal psychotherapy” is short and highly structured, using a manual to focus on interpersonal issues in depression.

“Behavioral activation” raises the awareness of pleasant activities and seeks to increase positive interactions between the patient and his or her environment.

“Cognitive behavioural therapy” focuses on a patient’s current negative beliefs, evaluates how they affect current and future behaviour, and attempts to restructure the beliefs and change the outlook. “Problem solving therapy” aims to define a patient’s problems, propose multiple solutions for each problem, and then select, implement, and evaluate the best solution.

“Psychodynamic therapy” focuses on past unresolved conflicts and relationships and the impact they have on a patient’s current situation.Supportive Psychotherapy Versus Interpersonal Psychotherapy Essay

In “social skills therapy,” patients are taught skills that help to build and maintain healthy relationships based on honesty and respect.

“Supportive counselling” is a more general therapy that aims to get patients to talk about their experiences and emotions and to offer empathy without suggesting solutions or teaching new skills.

Therapists use different types of techniques during a psychotherapy session. These can be divided into “specific and “non-specific” psychotherapy components.

Specific components are unique techniques based on the theoretical orientation of a particular treatment — for example, weighing the evidence for and against automatic thoughts in cognitive behavior therapy.

Non-specific components are techniques that are shared across many psychotherapies — for example, developing a therapeutic alliance and providing opportunity for emotional catharsis.

In their recently published article in the Journal of Psychotherapy Integration, authors Marlissa Amole, Jill Cyranowski, Laren Conklin, John Markowitz, Stacy Martin, and Holly Swartz (2017) demonstrated the successful use of an established measure, the Collaborative Study Psychotherapy Rating Scale (CSPRS), to evaluate therapists’ use of specific and non-specific components in two affect-focused treatments for depression — interpersonal psychotherapy (IPT) and brief supportive psychotherapy (BSP).

IPT is a structured, time-limited treatment focused on the reciprocal relationship between mood states and interpersonal problems that commonly trigger or exacerbate depressive episodes. BSP is also time-limited and affect-focused; however, it is non-directive except to explore patients’ affective responses. BSP rests primarily on non-specific components and has often been used as an active psychotherapy comparator condition to control for common non-specific components in psychotherapy trials.Supportive Psychotherapy Versus Interpersonal Psychotherapy Essay

Raters who were blind to the type of treatment delivered listened to 180 audio-recorded psychotherapy sessions. Using the CSPRS, raters discriminated between therapies with 97% accuracy.

Ratings on component subscales showed that both IPT and BSP therapists used similarly high levels of non-specific components, such as warmth and empathy. As expected, IPT therapists were more directive and used more IPT-specific strategies, while BSP therapists utilized more non-directive, supportive strategies.

BSP therapists displayed a greater focus on feelings (i.e., encouraging the identification, acceptance, and exploration of affect) than IPT therapists. This likely reflects the fact that BSP therapists had a limited number of alternative techniques available, whereas IPT therapists have at their disposal multiple specific interpersonal strategies that vie for session time.

Amole and colleagues were interested in the relative use of specific vs non-specific components over the course of treatment.

In exploratory analyses, the authors found that therapists typically use more specific strategies earlier in treatment and more non-specific strategies toward the end of treatment. They also found that a greater focus on feelings, a non-specific strategy, during early sessions (i.e., sessions 2–4) was associated with greater depressive symptom reduction in the first eight weeks of treatment.Supportive Psychotherapy Versus Interpersonal Psychotherapy Essay

Greater use of specific strategies was unrelated to symptom change. This suggests that identification and exploration of emotions are crucial to any successful therapy, especially early in treatment. Premature introduction of directive techniques, which is common among early therapists who are less comfortable with patient negative affect, may not allow enough time to build an alliance or experience relevant emotions.

The results of this study highlight the possibility of using measures like the CSPRS to assess the components of psychotherapy and their effect on outcomes within empirically supported treatments without the need for dismantling the treatments.

Future research should examine the reciprocal relationship between therapist use of strategies and patient symptom change over time and explore the optimal balance of specific vs non-specific components.

The authors believe that therapy is as much an art as it is a science and that an important part of successful treatment is the therapist’s ability to balance and creatively weave together the component parts.

Levels of psychological impairment
Figure. Levels of psychological impairment

Supportive psychotherapy occurs in almost every doctor-patient encounter and is the psychotherapy provided to the vast majority of patients who are seen in psychiatric clinics and mental health centers. Yet very few scholarly articles are written that help explain its principles or how it works.Supportive Psychotherapy Versus Interpersonal Psychotherapy Essay

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In the late 19th century, Freud began to develop the techniques of psychoanalysis, which served as a foundation for all the other psychotherapeutic modalities. Most of Freud’s patients were members of the upper classes of Viennese society and had significant ego strengths, and their problems were mainly intra-psychic. In contrast, many of the patients seen by psychiatrists and residents today suffer from extra-psychic problems, such as poverty, social and political oppression, and abuses of power in relationships that threaten to overwhelm their coping capacities. For these patients, supportive therapy is the treatment of choice.

Supportive psychotherapy is a dyadic treatment that uses direct measures to ameliorate symptoms and to maintain, restore, or improve self-esteem, ego functions, and adaptive skills. It was developed in the early 20th century, and its objectives are more limited than those of the psychodynamic therapies. This therapeutic modality focuses especially on developing adaptive capacities that take into account the patient’s limitations, including:Supportive Psychotherapy Versus Interpersonal Psychotherapy Essay

• Personality issues, such as deficits in character structure and defense mechanisms

• Native ability (eg, impaired reality testing, decreased cognitive functioning, lower IQ, learning disabilities)

• Problems associated with life circumstances (eg, lower levels of education, low socioeconomic status, limited social support systems, problems related to migration)

The connection between mental illness and poverty

There is a 2-way connection between mental illness and poverty. Poverty increases the risk of mental illness, and mental illness is often a person’s path into poverty. In 1965, the sociologist Oscar Lewis published the controversial document “The Culture of Poverty,” in which he argued that to adapt to their environment, people who live in poverty for a long time develop a series of coping mechanisms that become engrained and paralyzing and that affect the individual, the family, the slum community, and the community in relation to society.Supportive Psychotherapy Versus Interpersonal Psychotherapy Essay

Supportive therapy can serve as the first bridge out of social isolation and marginalization, since the 2 most important elements of supportive therapy are the therapeutic alliance, which allays anxiety, helps support the patient’s healthy defenses, and enhances adaptive skills; and conversational style. This style avoids analytic abstinence and engages the patient in a collaborative discussion that decreases the power differential.

Supportive therapy is also the treatment of choice in individuals with severe personality disorders, at least in the initial phases of treatment. Many individuals with personality disorders resent and fear the power differential that results from a more analytic stance, given that many of them have experienced abuses of power in early life. If the power differential is not addressed early in the treatment, it can destroy the therapeutic relationship.

Understanding supportive psychotherapy

Most psychotherapies rely on the therapeutic alliance, but in supportive psychotherapy it is considered the most important element. When practicing supportive psychotherapy, one must negotiate a therapeutic alliance that preserves the authority, voice, and agency of the patient and ensures that he or she is active in the treatment. In patients who have chronic disorders, unsatisfactory living conditions, and little hope for change in their lives, the therapist represents a figure of stability, a contact with the outside world, and a representative of the broader world. Supportive psychotherapy stands in contrast to expressive therapies that seek to accomplish personality change through analysis of the relationship; exploration of previously unrecognized feelings, thoughts, needs, and conflicts; and development of insight. Supportive therapy includes some of these elements, so the therapist must move through a “psychotherapeutic continuum” Supportive Psychotherapy Versus Interpersonal Psychotherapy Essay

The therapist takes into account the patient’s cognitive abilities, reality testing, thought process, capacity to organize behavior, affect regulation, and capacity to relate to others in order to determine the patient’s location on the continuum. Purely supportive interventions are chosen for patients with disorganized behavior, thought disorder or cognitive impairment, limited intelligence, and lower levels of education and socialization and for patients with personality disorders. With less impaired patients, expressive therapies are used. It is important for the therapist to be hopeful that the impaired patient can eventually move across to more psychodynamic supportive therapy and beyond.

Affect regulation is one of the most important goals of supportive psychotherapy. More regressed patients commonly have difficulties with affect regulation, which produces a state in which the patient cannot attend or think and which interferes with the capacity to self-reflect. The therapist must attend to the patient’s physical comfort in therapy and try to avoid interruptions and phone calls during the sessions; establish conditions of emotional safety, such as addressing issues of substance abuse, self-harm, and domestic abuse; and avoid an interrogation stance.Supportive Psychotherapy Versus Interpersonal Psychotherapy Essay

Supportive psychotherapy practice

In contrast to more psychodynamic-oriented therapies, one must be careful not to be incisive when practicing supportive therapy with more vulnerable or regressed patients. Clarifications, interpretations, and confrontations may embarrass the patient, increase the patient’s anxiety to a level that he or she is incapable of modulating, and may reawaken memories of abuse. These interventions are more appropriate for treating patients with neurotic defenses that are analyzed and examined and the conflicts underlying the defenses identified.

A strong therapeutic alliance is fostered by conveying to the patient acceptance, interest, respect, and admiration for his or her accomplishments, thus supporting the patient’s self-esteem. Conscious problems are addressed, and defenses are questioned only when they are maladaptive. The patient is treated with honesty and respect.

Other important techniques used in supportive psychotherapy include behavior goal setting, encouragement, positive reinforcement, shaping behavior, and modeling. Children respond to the influence of their parents by imitating them and gradually by internalizing aspects of the parents by the process of identification. They later identify with other important figures in their lives. Some key aspects of these identifications include the development of a stable sense of self; a capacity to modulate anxiety so that it does not lead to defensive distortions of reality; a benevolent conscience that allows for a reasonable pursuit of pleasure without unreasonable guilt; and a capacity to love without fearing a loss of the self in experiences of fusion, or of excessive anxiety in the face of separations. For change to take place in therapy, interpretive work needs to occur with the patient’s increasing capacity for self-reflection, but modeling by the therapist provides some of the first and most fundamental building blocks for change.Supportive Psychotherapy Versus Interpersonal Psychotherapy Essay

Supportive therapy may include educating the patient and family members about the illness and about the patient’s potential and limitations, establishing realistic goals, addressing issues in the life of the patient that will reduce stress and anxiety, and helping the patient and the family improve their adaptive skills. It may also include limit setting and appropriate reward and punishment with children, and helping the patient, the family, and others involved to understand the patient’s functional and cognitive limitations.

Conclusion

It is important to take into account barriers to treatment such as economic, geographic, cultural, and stigma-related issues; distrust; and past persecutory experiences. Idioms of distress are the characteristic way in which members of different cultures describe what is wrong and which may differ from the expressions found in mainstream American culture. It is also very important to explore the patient’s history for adverse life events and to listen to the metaphors or therapeutic stories for adverse previous personal and medical experiences. In many cases, the patient’s “life-meaning story” is closely related to previous traumas that account for treatment resistance. In some cases, the patient fears a repetition of these traumas, such as in the case of psychiatric hospitalization, which may elicit fears of oppression, abuse, and incarceration.Supportive Psychotherapy Versus Interpersonal Psychotherapy Essay

Acknowledgment-I am grateful to David Lopez, MD, and Jennifer Downey, MD, of the American Academy of Psychoanalysis and Dynamic Psychiatry (AAPDP) for their invitation to write this article and for their review of the article. The AAPDP is the affiliate society of the American Psychiatric Association dedicated to all aspects of psychodynamic psychiatry. Its mission is to promote psychodynamic understanding when evaluating and treating patients in clinical practice, medical education, and residency training.Supportive Psychotherapy Versus Interpersonal Psychotherapy Essay