Supportive psychotherapy

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Supportive psychotherapy is a collective term for psychotherapeutic forms of treatment with the aim of helping people with a (chronic) mental illness to cope with their symptoms and / or their everyday problems caused by illness. The primary target groups of supportive psychotherapy are patients with severe personality disorders and chronic psychoses . Supportive psychotherapy is also indicated for people suffering from an acute crisis situation .

Supportive psychotherapy is carried out under a variety of names: supportive psychotherapy, general psychotherapy, supportive medical consultation, adaptive psychotherapy, basic psychiatric therapy, psychotherapy for psychiatric diseases and the like. a. m.

Development of supportive psychotherapy

Supportive psychotherapies are predominantly modifications of the so-called conflict-uncovering, psychodynamic or insight-oriented psychotherapies, i. H. the analytic or psychodynamic psychotherapy . They can be used to "treat patients with persistent and severe defects in their ego structure who are either not accessible through conflict-uncovering forms of therapy or would be destabilized under their influence." psychotherapeutic treatment would be excluded. In addition to psychoanalytic and depth psychological treatment techniques, supportive psychotherapies also use elements of behavioral therapy , client-centered psychotherapy , stress management , relaxation procedures and the like. a. (often so-called eclectic approach).

Supportive psychotherapy on a psychoanalytic basis

On the psychoanalytical side, Kernberg (1999) advocates a strict distinction between “psychoanalysis” , “psychoanalytic psychotherapy” and supportive psychotherapy. In the case of severe personality disorders, supportive psychotherapy should be used for patients who would be overwhelmed by psychoanalytic psychotherapy, e.g. B. because of insufficient introspection .

In psychoanalysis and psychoanalytic psychotherapy, unconscious internal conflicts and impulses are interpreted by the psychoanalyst at the appropriate time. The unconscious processes are to a certain extent uncovered. No interpretations are given in supportive psychotherapy, only precursors are used: e.g. B. Clarification and "confrontation", cognitive support, emotional support and encouragement as well as direct intervention in the patient's environment, e.g. B. Discussion with relatives. Since supportive psychotherapy does not “reveal” unconscious conflicts, it is also referred to as “masking psychotherapy”. The aim of therapy is to control (possibly unconscious) problematic impulses and conflicts while largely maintaining the existing defense structure .

According to Sigmund Freud's psychoanalytic theory, the so-called resistance stands in the way of becoming conscious of unconscious processes, which, according to the interpretation, has to be overcome by persistent work. “As is well known, the overcoming of the resistance is initiated by the physician discovering the resistance never recognized by the person being analyzed and communicating it to the patient. ... Naming the resistance [cannot] result in its immediate cessation. You have to give the patient the time to immerse himself in the unknown resistance, to work through it (emphasis in the original), to overcome it by continuing to work according to the basic analytical rule in spite of it. ”What happens in supportive psychotherapy can be understood as working through without explicit interpretation. - Supportive psychotherapy is carried out while sitting. The hourly frequency is variable between several sessions per week up to one session at intervals of several months. Supportive psychotherapy can accompany a patient for a very long time.

Supportive psychotherapy in psychiatry

Rössler (2004) conceives supportive psychotherapy as psychotherapy for chronically mentally ill people . It must be based on the treatment needs of these people. Essential therapy contents are: life plans in the partnership and professional area; personal development in terms of self-awareness and identity; Coping with everyday problems; Attitude towards and handling of the illness (also medication); Dealing with personal vulnerability (relapse prevention); Problems with closeness and distance to family of origin; Dependence on and dealing with professional support.

For patients with schizophrenic psychosis who are long-term delusional experiences (content- related thinking disorder) and hallucinations , Klingberg et al. a. (2008) developed a supportive psychotherapeutic program based on behavioral therapy. The aim is to reduce these symptoms by reducing stress in everyday life and at work, and increasing their resilience to stress. The "lifestyle of the patient" is discussed primarily, i. H. both the problems that arise in everyday life as a result of the symptoms, as well as unproblematic areas of life. Delusions and hallucinations are not treated directly, neither with drugs nor with cognitive-behavioral therapy . The following treatment strategies are used: Empathetic listening by the therapist; Self-esteem promotion, positive feedback; Activation of personal resources; Activation of external resources and social support; Advice, guidance, daily structuring; Implicit problem solving (the therapist flexibly follows a problem-solving scheme when dealing with the problem with the patient, but does not present the scheme as such).

Supportive psychotherapy is often carried out at the same time as drug treatment. In acute schizophrenic psychosis and severe depression , drug treatment is given priority and (supportive) psychotherapeutic treatment is usually only possible after the symptoms have improved.

Ecological supportive psychotherapy

Jürg Willi (2005) starts from the anthropological concept of "answered action": "The person strives to make something happen in his environment and to be answered in these effects," that is, "to experience himself as effective in the environment". The relationship environment created by a person is called a "personal niche". The personal niche includes their caregivers and their relevant material environment (workplace, home, property). "Through the action that is answered, the person continuously restores their mental health and develops their abilities and psychological structures, in particular their ego functions, their reality check, their self-esteem and their identity." People with mental disorders are impaired in their ability to develop a rich To create relationship niches. Accordingly, they only receive limited responses and attention from their caregivers. The more severely a person is mentally ill, the more likely they are to be overwhelmed to find their way around in free living conditions and to build a satisfying personal niche.

As an example, the relationship possibilities are presented that people with severe schizoid-paranoid personality disorder are able to enter into (in increasing difficulty): mere participation in environmental events without direct interaction; Relationships with the inanimate environment or with animate objects without reciprocity; fleeting interpersonal contacts without commitment; Contacts to family of origin and therapist; mutual relationships with predictable answers, relationships without formulated personal closeness and self-disclosure (helper relationships, role relationships, group contacts); short-term work and partner relationships; permanent working and partner relationships with firm commitments and commitments. The latter type of relationship is rarely achieved in this group of patients.

The goal of therapy for personality disorders is not seen as “a fundamental change in personality structure”. The aim of supportive psychotherapy is that the patient learns and executes behaviors that lead to positive responses. The patient is supported to create a personal niche despite his relationship difficulties and to create the necessary but not overwhelming relationship space for his psychological survival. It's about independent living and an autonomous lifestyle. "So the focus of interest is not on early childhood, but ... on the period that led to the current situation." The therapeutic interest is more focused on what the patient does and can do, and less on his deficits. It is not uncommon for patients to "create relationships that are challenging but not overwhelming, but also relationships that offer resistance to their own regressive and destructive tendencies."

Special non-revealing psychotherapies

Specific therapy programs have been developed for different patient groups that combine supportive psychotherapeutic and behavioral elements. These are structured in terms of content and process, some manualized and limited in time. Mention should be made: for patients with schizophrenic psychosis the above. Klingberg u. a. (2008) and Integrated Psychological Therapy Program for Schizophrenic Patients IPT; for depressed patients interpersonal psychotherapy ; for patients with borderline disorder dialectical behavioral therapy . The designation of special non-investigative psychotherapies has been suggested for these programs .

Supportive psychotherapy for crisis intervention

Crisis intervention is marked u. a. through: temporal limitation of the intervention, therapeutic reference to a specific crisis-triggering factor, limitation of the treatment goals to mastering them while centering on available resources, reality orientation. Crisis intervention is assigned to supportive psychotherapy.

Indications for supportive psychotherapy

The indication for supportive psychotherapy can be made in people with the following diseases:

  1. severe personality disorder, borderline disorder
  2. schizophrenic psychosis in remission
  3. chronic neuroses, anxiety and obsessive-compulsive disorders, chronic depression
  4. Acute conflict, crisis and stress reactions; post-traumatic stress disorder
  5. psychosomatic illnesses, severe or chronic physical illnesses, cancer
  6. Addictions with stable abstinence
  7. Motivation or preparation for psychotherapy
  8. limited purpose, limited resources

The following contraindications are listed: secondary gain from illness , strongly dependent-seeking relationship building, heavy ego-syntonic behavior , antisocial personality disorder as well as good response to conflict-uncovering psychotherapy.

Klaus Grawe has formulated four "therapeutic factors" that are more or less effective in all effective psychotherapeutic methods: (1) resource activation and therapeutic relationship, (2) updating the problem, (3) active help in overcoming problems; (4) Clarification of motives and meanings. In supportive psychotherapy, the main focus is on the factors resource activation and problem solving. With regard to problem updating, the therapist never exceeds the problem intensity presented by the patient. Clarification is z. B. indicated on the question of realistic goals in life. Supportive psychotherapy includes all four factors. It is to be seen as an independent psychotherapy method.

Supportive psychotherapy is probably the most widely practiced method of psychotherapy. However, their prestige is low. Willis ecological model (2005) is one of the few theoretical foundations. Edgar Heim , Director of the Psychiatric Polyclinic at the University of Bern, writes regretfully: “We all practice these [supportive] techniques to a greater or lesser extent; but we hardly talk about it with our colleagues, we do not organize any congresses on this topic, we hardly find any textbooks with this content - we keep silent, we are a little ashamed of helping that part of our patients so straightforwardly that actually needs it. "

See also

literature

  • B. Genser: Supportive Psychotherapy. In: ders .: People in psychiatry. Books on Demand, Norderstedt 2006, pp. 9-29.
  • OF Kernberg: Psychoanalysis, psychoanalytic psychotherapy and supportive psychotherapy: Current controversies. In: Psychotherapy, Psychosomatics and Medical Psychology. 49, 1999, pp. 90-99.
  • S. Klingberg, A. Wittorf, U. Jakobi, S. Sickinger: Supportive therapy for the treatment of patients with persistent psychotic symptoms. Treatment manual. Version of 3rd University Hospital, Tübingen 2008.
  • W. Rössler: Supportive Psychotherapy. In: ders. (Ed.): Psychiatric Rehabilitation. Springer, Berlin 2004, pp. 134-145.
  • K. Schonauer: Supportive psychotherapy and medical conversation. In: HJ Möller, G. Laux, HP Kapfhammer (Hrsg.): Psychiatrie und Psychotherapie. 3. Edition. Springer, Berlin 2008, pp. 691–702.
  • G. Stotz-Ingenlath, H. Kind: Supportive medical discussion. In: HJ Möller (Hrsg.): Therapy of mental illnesses. 3. Edition. Thieme, Stuttgart 2006, pp. 15-23.
  • J. Willi: Ecological Psychotherapy. Rowohlt, Reinbek 2005.
  • W. Wöller, J. Kruse, L. Alberti: What is supportive psychotherapy? In: Neurologist. 67, 1996, pp. 249-252.

Individual evidence

  1. ↑ G. Stotz-Ingenlath, H. Kind: Supportive medical discussion. In: HJ Möller (Hrsg.): Therapy of mental illnesses. 3. Edition. Thieme, Stuttgart 2006, pp. 15-23.
  2. ^ W. Wöller, J. Kruse, L. Alberti: What is supportive psychotherapy? In: Neurologist. 67, 1996, pp. 249-252.
  3. ^ W. Rössler: Supportive Psychotherapy. In: ders .: Psychiatric rehabilitation. Springer, Berlin 2004, pp. 134-145.
  4. ↑ OF Kernberg: Psychoanalysis, psychoanalytic psychotherapy and supportive psychotherapy: Current controversies. In: Psychotherapy, Psychosomatics and Medical Psychology. 49, 1999, pp. 90-99.
  5. ↑ S. Freud: Remembering, repeating, working through. In: Ges. Works. XII, Fischer, Frankfurt am Main 1946, pp. 183-194. (first 1914)
  6. ↑ B. Genser: Supportive Psychotherapy. In: ders .: People in psychiatry. Books on Demand, Norderstedt 2006, pp. 9-29.
  7. ↑ Rössler 2004, 135.
  8. ↑ S. Klingberg et al.: Supportive therapy for the treatment of patients with persistent psychotic symptoms. Treatment manual. Version of 3rd University Hospital, Tübingen 2008.
  9. ^ E. Rahn, A. Mahnkopf: textbook psychiatry for study and work. 3. Edition. Psychiatrie-Verlag, Bonn 2005, p. 320, 368.
  10. ↑ J. Willi: Ecological Psychotherapy. Rowohlt, Reinbek 2005, p. 48 ff., 101 ff.
  11. ↑ J. Willi: Ecological Psychotherapy. 2005, p. 217 ff.
  12. ↑ J. Willi: Ecological Psychotherapy. 2005, pp. 31, 231 ff.
  13. ↑ J. Willi: Ecological Psychotherapy. 2005, p. 217 ff., 223 ff.
  14. ↑ G. Stotz-Ingenlath, H. Kind: Supportive medical discussion. 2006, p. 20.
  15. ↑ V. Roder, HD Brenner and others: Integrated psychological therapy program for schizophrenic patients (IPT). Psychologie Verlags-Union, Weinheim 1997.
  16. ^ E. Schramm: Interpersonal Psychotherapy. 3. Edition. Schattauer, Stuttgart 2010.
  17. ^ MM Linehan: Dialectical-behavioral psychotherapy for borderline disorder. CIP-Medien, Munich 1996.
  18. ↑ B. Genser: Supportive Psychotherapy. 2006, p. 14.
  19. ↑ T. Simmich, C. Reimer: Psychotherapeutic aspects of crisis intervention. In: The Psychotherapist. 43, 1998, pp. 143-156.
  20. ↑ G. Stotz-Ingenlath, H. Kind: Supportive medical discussion. 2006, p. 18; K. Schonauer: Supportive psychotherapy and medical conversation. In: HJ Möller, G. Laux, HP Kapfhammer (Hrsg.): Psychiatrie und Psychotherapie. 3. Edition. Springer, Berlin 2008, p. 698.
  21. ^ W. Wöller, J. Kruse, L. Alberti: What is supportive psychotherapy? 1996, p. 250; OF Kernberg: Psychoanalysis, psychoanalytic psychotherapy and supportive psychotherapy: Current controversies. 1999, p. 96; K. Schonauer: Supportive psychotherapy and medical conversation. 2008, p. 699.
  22. ^ K. Grawe: Outline of a general psychotherapy. In: Psychotherapist. 40, 1995, pp. 130-145.
  23. ↑ J. Willi: Ecological Psychotherapy. 2005, p. 213.
  24. ↑ E. Heim: "Support Therapy" - rediscovered? A plea for adaptive psychotherapies. Psychotherapy and Medical Psychology 30, 1980, pp. 261-273.