Developing Supportive Psychotherapy as Evidence-Based Treatment

To the Editor: In the April 2008 issue of the Journal, Carolyn J. Douglas, M.D. (1) discussed many issues involved in the surprisingly complex enterprise of teaching supportive psychotherapy. Dr. Douglas stated that “supportive therapy has not been sufficiently well defined in a manual or tested in controlled clinical trials to be considered evidence based” (1, p. 450). This assertion deserves exploration.

Supportive psychotherapy may be the most prevalent psychotherapy (2) . In the 1998 National Survey of Psychiatric Practice, 36% of patients treated by psychiatrists received supportive psychotherapy, a higher percentage than that for insight-oriented therapy (19%), cognitive behavioral therapy (CBT) (6%), or psychoanalysis (1%). The practice of supportive psychotherapy seems likely to increase since 1) residency training in the United States currently requires competency in the area of supportive psychotherapy; 2) several supportive psychotherapy texts have been recently published (3 – 5) ; and 3) supportive psychotherapy applies to a wide range of patients and clinical situations.

Psychotherapy research has usually examined supportive psychotherapy as a comparison treatment for more specific—putatively more “active”—approaches that may have received more rigorous therapist training, greater researcher allegiance (6), and even a larger allotment of therapeutic hours. Thus, existing data pertaining to supportive psychotherapy are often suspect. Nevertheless, increasing literature on supportive psychotherapy suggests that it is active, efficacious, and often achieves lasting, meaningful results (3 – 5, 7, 8) . In a recent borderline personality disorder study (9), supportive psychotherapy demonstrated generally comparable outcomes with those of dialectical behavioral therapy and transference-focused psychotherapy. In treating depression, supportive psychotherapy matched CBT despite fewer therapy sessions (10) .

Perhaps now is the time to complete the process of establishing supportive psychotherapy as an evidence-based treatment. As the most common psychotherapy, supportive psychotherapy should receive high research priority and be developed, applied, and evaluated as rigorously as CBT or interpersonal psychotherapy. It can then be taught to residents and other students as a treatment with demonstrated efficacy and refined through further research.