Supportive Psychotherapy and Importance of Therapeutic Alliance

In a world rapidly evolving toward faster and increased information flow, patterns of communication between people have changed. Brief digital communication is now the norm for conversation, and phone screens are often the point of contact between people. There is no doubt that the way we interact with each other has changed. One is left to wonder: Are the psychological processes underlying human intimacy changing too? If so, what effect does this have on one of the most intimate professional endeavors—the psychotherapeutic process? In this essay I will argue that some psychotherapeutic techniques, such as developing the therapeutic alliance, are perhaps more pertinent now than ever.

For over a century the psychological disciplines have debated the question “What are the central or essential components for psychotherapy efficacy?” The science of psychotherapy was born with Sigmund Freud, and his position was that the relationship between patient and therapist was not only important, but essential for treatment. In psychoanalysis, working through the transference neurosis was in fact the curative process. It became apparent early on, however, that psychoanalysis was not an adequate treatment for a wide variety of psychiatric patients, especially those whose mental illness was more severe. Thus, supportive psychotherapy evolved with an emphasis on the therapist’s flexibility, accommodations in therapeutic structure, and—most importantly—attention to nurturing the therapeutic relationship. This nurturance also included active repair of the relationship by the therapist when it was disrupted or disturbed.

Fast forwarding through the different types of therapy that have evolved (psychodynamic, behavioral, cognitive, humanistic, gestalt, interpersonal, existential, holistic, and integrative, among others), standardized, manualized psychotherapies have become an industry standard. Fewer, more economical therapy sessions seem to be a trend, at least according to what insurance companies are willing to cover. With this focus on financial economy, will psychotherapy remain an effective treatment modality?

In regard to “what works” in psychotherapy, a few findings have been relatively consistent over the decades. First is that the therapeutic alliance accounts for a significant proportion of the therapeutic benefit, regardless of the type of psychotherapy conducted. Basically, patients want to feel a positive working relationship with their therapist, whether the treatment is cognitive-behavioral or supportive psychotherapy. A stronger therapeutic alliance is associated with completion of psychotherapy, which makes developing a positive alliance even more critical early on in therapy.

Second, in contrast to many of the other psychotherapies, a primary goal of supportive psychotherapy is the development and nurturance of a positive therapeutic alliance. The positive therapeutic alliance is seen as a correctional emotional experience in supportive psychotherapy, and many of the techniques used are expressly geared toward maintaining it. Supportive psychotherapy works for a wide range of clinical conditions and performs well when compared with other types of therapy. Supportive psychotherapy has been shown to be effective in treating patients with a variety of psychiatric and medical illnesses including schizophrenia, bipolar disorder, depression, anxiety disorders, personality disorders, substance use disorders, eating disorders, perinatal stress, breast cancer, ovarian cancer, diabetes, leukemia, heart disease, chronic bronchitis, emphysema, inflammatory bowel disease, and back pain and patients on hemodialysis.

Having taught supportive psychotherapy to nurses, social workers, psychologists, marriage therapists, psychiatrists, and trainees of all types over the past 30 years, I find now more than ever the tools of supportive psychotherapy are essential for clinicians. In a day and age where “results” are being squeezed out of doing less, it has become even more critical to have patients experience being heard and feeling cared for. Whether it be cognitive-behavioral therapy or medication monitoring, developing and maintaining a good therapeutic alliance remains tantamount to successful treatment. Supportive psychotherapy is a proven tool for building and repairing the therapeutic alliance. Supportive techniques are just the ticket for therapy success in treating patients in our modern, computerized, digital age. ■