Kaplan & Sadock’s Pocket Handbook of Clinical Psychiatry

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Supportive psychotherapy In supportive psychotherapy, the essential element is support rather than the de velopment of insight. This type of therapy often is the treatment of choice for patients with serious ego vulnerabilities, particularly patients with psychosis. Patients in a crisis situation, such as acute grief, also are suitable. This therapy can be continued on a long-term basis and last many years, especially in the case of patients with chronic problems. Support can take the form of limit setting, increasing reality testing, reassurance, advice, and help with developing social skills. Brief psychodynamic psychotherapy A short-term treatment that generally consists of 10 to 40 sessions over the course of less than 1 year, brief psychodynamic psychotherapy utilizes psycho dynamic theory to develop insight into underlying conflicts. These insights then lead to psychological and behavioral changes. This therapy is more confrontational than the other insight-oriented therapies in that the therapist is very active in repeatedly directing the patient’s associa tions and thoughts to conflictual areas. The number of hours is explicitly agreed on by the therapist and patient before the beginning of therapy, and a specific, circumscribed area of conflict is chosen to be the focus of treatment. More ex tensive change is not attempted. Patients suitable for this therapy must be able to define a specific central problem to be addressed and must be highly motivated, psychologically minded, and able to tolerate the temporary increase in anxiety or sadness that this type of therapy can evoke. Patients who are not suitable include those with fragile ego structures (eg, suicidal or patients with psychosis) and those with poor impulse control (eg, patients with borderline personality disor der, substance abusers, and antisocial personalities). There are several methods, each having its own treatment technique and spe cific criteria for selecting patients, but they are more similar than different. Some of the types of brief psychodynamic therapy are listed as follows. Brief focal psychotherapy (Tavistock—Malan) Therapists should formulate a circumscribed focus and set a termination date in advance. Patients should work through grief and anger about termination. Time-limited psychotherapy (Boston University—Mann) A psychotherapeutic model of exactly 12 interviews focusing on a specified cen tral issue, this technique helps determine a patient’s central conflict reasonably correctly. It is particularly effective when exploring young persons’ maturational crises with many psychological and somatic complaints. Short-term dynamic psychotherapy (McGill University—Davanloo) This technique encompasses nearly all varieties of brief psychotherapy and crisis intervention. This includes flexibility (therapists should adapt the technique to the patient’s needs), control, the patient’s regressive tendencies, active intervention

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