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Supportive psychotherapy relies on direct measures. It is not assumed that improvement will develop as a by-product of insight. A major tenet of Freud’s early work in psychoanalysis was that the unconscious conflict that had produced the symptom would become conscious and be worked through, and then the symptom would disappear because it was no longer psychologically necessary. In contrast, supportive psychotherapy addresses conscious problems or conflicts, but not underlying unconscious conflicts and personality distortions (Dewald 1994). Greater self-awareness or insight about the origin of problems is not essential, although it may occur and be productive. Expressive psychotherapies are inherently supportive because of the interest and attention of the therapist, but support is an epiphenomenon in expressive therapy—one that may contribute significantly to the outcome.
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