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As originally conceived, supportive psychotherapy was indicated for patients with severe mental illness, as well as for other patients for whom expressive treatment was not indicated. The original indication for supportive psychotherapy was treatment at the extreme supportive end of the supportive-expressive psychotherapy continuum described in Chapter 1, “The Concept of Supportive Psychotherapy.” This form of supportive treatment was focused primarily on improving deficient ego functions, reducing anxiety, and preventing downward social drift due to loss of adaptive skills and increasing isolation. In addition to offering the patient an understanding, supportive relationship, this approach contained many of the following techniques: advice, reassurance, exhortation, praise, encouragement, lending ego, and environmental manipulation. Shoring up of defenses was the default mode, confrontation was rare, and interpretation did not occur.
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