Intervention modes in psychoanalysis and in psychoanalytic psychotherapies: A revised classification.

Abstract

Psychoanalytic psychotherapy evolved here in America almost exactly a half-century ago, out of the psychoanalysis innovated by Freud a half-century earlier in Vienna. From the start, it was framed along two distinct lines that were called expressive (interpretive, insight-aiming, uncovering) and supportive (ego-maintaining, suppressive), both directions being solidly anchored in psychoanalytic understanding, but differing in techniques and in goals in relation to the differing clinical exigencies of patients across the entire psychopathologícal spectrum. Because of its greater closeness to the techniques and goals of psychoanalysis proper, expressive therapy has from the start been better articulated with greater (seeming) consensus on its modes of action and the mechanisms of the changes that it achieves. In this paper we trace out in detail the gradual elaboration of our understanding of the various techniques that can be specified in the originally more amorphous and ambiguous conceptions of supportive intervention modes. We offer in conclusion an amplified schema for categorizing both expressive and supportive intervention modes.

Psychotherapy for PTSD in the community: reported prototypical treatments

“…The psychodynamic-integrative prototype appears to be a truly integrative treatment, in that it correlated highly with both the Ablon and Jones (1998) psychodynamic and CBT prototypes, also correlating (but not as strongly) with an IPT prototype (Ablon & Jones, 2002). From a psychodynamic perspective, it contains elements of both the supportive and expressive treatments as described by Wallerstein and Dewitt (1997). For instance, supportive elements that were rated highly included the therapist giving explicit advice and guidance, discussing specific activities to do outside the session and acting to strengthen defenses.…”

“…The second psychodynamic factor corresponded roughly to what Wallerstein and Dewitt (1997) have termed 'supportive therapy'. In the psycho- dynamic tradition, 'supportive therapy' aims to decrease awareness of mental anguish and strengthen defenses in order to increase the adaptation of the ego in day-to-day life (Wallerstein & Dewitt, 1997).…”

“…The second psychodynamic factor corresponded roughly to what Wallerstein and Dewitt (1997) have termed 'supportive therapy'. In the psycho- dynamic tradition, 'supportive therapy' aims to decrease awareness of mental anguish and strengthen defenses in order to increase the adaptation of the ego in day-to-day life (Wallerstein & Dewitt, 1997). Supportive psychotherapy includes general strategies beginning with the patient's existing adaptive defenses and strengthening them, as well as helping the person develop higher-level, more adaptive defenses.…”

“…Nevertheless, the prototypes that emerged appear to have similarities with descriptions of various types of psychotherapy in the literature. The first psychodynamic factor consisted of items that described many elements of a common psychodynamic treatment that Wallerstein and Dewitt (1997) have classified as 'expressive therapy'. Expressive therapy aims to increase insight and knowledge of self, and uses the techniques of questioning, confrontation, clarification and interpretation (Wallerstein & Dewitt, 1997).…”

“…The first psychodynamic factor consisted of items that described many elements of a common psychodynamic treatment that Wallerstein and Dewitt (1997) have classified as 'expressive therapy'. Expressive therapy aims to increase insight and knowledge of self, and uses the techniques of questioning, confrontation, clarification and interpretation (Wallerstein & Dewitt, 1997). The therapist remains neutral and the therapeutic relationship is a mechanism for treatment, including interpretation of transference.…”