Jefferson Journal of Psychiatry


Think of 1896, the year Jacob Freud died, kindling a depression in his son Sigmund which led to The Interpretation of Dreams. To a raucous convention in Chicago, William Jennings Bryan declaimed against the gold monetary standard: "You shall not press down upon the brow of labor this crown of thorns, you shall not crucify mankind upon a cross of gold" (I). Years later the monetary gold standard was abandoned during the New Deal, but Freud's newly mined "pure gold of analysis" continued to be an object of adulation and emulation, despite Freud's prediction that its exoteric application would require alloys "with the copper of direct suggestion" (2).

One such alloy is supportive psychotherapy. Wallerstein (3) defines it as an ego-strengthening therapy which uses means other than interpretation or insight to help the patient suppress mental conflict and its attendant symptoms. Bloch deems it a form of treatment for patients with "chronic psychiatric conditions for whom basic change is not seen as a realistic goal," and its aim is to sustain a patient who can not independently manage his or her own life (4). Werman describes it as a substitutive form of treatment, one that supplies the patient with those psychological functions that he or she either lacks entirely or possesses insufficiently (5).

Until recently, however, supportive therapy was like a neglected patient who had been coming to clinic for many years, but never received the courtesy of a psychodynamic formulation. Only in this decade has it been appreciated as a distinct type of therapy with its particular patients, goals, and techniques, defined by its own ground rules and theory of psychopathology. This paper presents the rationale which underlies supportive psychotherapy and the basis on which it constitutes a distinct type of treatment.

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